Home Birth Services

FAQ's About Home Birth with Kim

Midwives facilitate the collaborative process of informed decision-making and recognize clients as primary decision-makers about their care, including where they choose to give birth (e.g., at home, in birth centers, hospitals). Below is a discussion of some of the most frequently asked questions about home birth. The words/sentences that are underlined have links associated with them. 

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​Is Home Birth Even Legal? 

YES, home-birth is legal in Alabama - click here to see rules/regulations regarding midwives and out-of-hospital births provided by the Alabama State Board of Midwifery. 

Is Home Birth SAFE? 

According to the most recent and up-to-date research evidence, yes. In 2019, The Lancet published a large systematic review and meta-analysis that included data from around 500,000 intended home births. The authors found that, “The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital.” (Hutton et al,2019).​ But we should talk about what exactly makes it safe to plan an out-of-hospital birth:​

1. In countries with well-integrated midwifery, both maternal and infant outcomes for planned home and birth center births are not statistically different from planned hospital births (click these for reference 1, 2, 3). ​​

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2. In the United States, there are some states that do have midwifery services well-integrated into the the healthcare system/obstetrics (Example: Washington State, where I was practicing for the first 4 years my midwifery practice, others include AK, ID, OR, MT). In 2021, a large study was published in the American College of Obstetricians and Gynecologists' (ACOG) Green Journal: Obstetrics & Gynecology, describing outcomes for planned home and birth-center births in Washington State. The study population included 10,609 births: 40.9% planned home and 59.1% planned birth center births. transfers to hospital while in labor were more frequent among first-time pregnant birth givers, and the cesarean delivery rate was 11.4% in for first-time birthers and 0.87% for those who have had previous vaginal births. The perinatal mortality rate after the onset of labor (intrapartum and neonatal deaths through 7 days) was 0.57 per 1,000 births. Rates for other adverse outcomes were also low. Compared with planned birth center births, planned home births had similar risks in crude and adjusted analyses.​ 

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3. In 2020, Alabama had the third-highest Maternal Mortality Rate in the nation, at 36.4 maternal deaths per 100,000 live births, and the March of Dimes 2022 report card for Alabama reports the infant mortality rate is 7 per 1,000. In Alabama, midwifery care is not well-integrated into the obstetric healthcare system and obstetric care is mostly provided by physicians. For example, a query to the CDC Wonder Analysis of Public Health Data will show you that in 2021, there were just over 58,000 births in Alabama. Out of these 58,000 births, just over 1060 births were attended by Certified Nurse Midwives in the hospital, and even further, only about 310 births occurred at home with a midwife (National Vital Statistics Reports, 2021, CDC).

​ACOG identifies important elements for a safe planned home birth as: high degree of integration of midwives, education meeting International Confederation of Midwives standards, ready access to consultation and safe/timely transport to nearby hospitals, and appropriate selection of candidates. Midwife Kim is dedicated to establishing trusting/working relationships with local obstetricians and hospitals to improve community collaboration and help ensure/improve safety for people choosing home-births in the Prattville/Montgomery area in Alabama. She currently collaborates with Dr. Skanes at Oasis Women's Health in Birmingham, AL when needed.​Overall, home birth is a safe option for low-risk birthers.​

Who is Eligible for a Home Birth?

According to Alabama State Law, those who are eligible for home birth include low-risk pregnancies carrying a single baby (not twins) in a head-down position (not breech at the time of labor) with no preexisting or current complications or history of cesarean birth (so no TOLAC/VBAC eligibility in this state). ​Pregnancy is a normal physiologic process and most pregnant people can have a healthy pregnancy without complications, and many of the risks associated with pregnancy can be lowered or avoided by education about healthy lifestyle choices and good nutrition/hydration. Midwives perform a "risk assessment" at each prenatal appointment to ensure that the pregnancy remains appropriate to continue midwifery care, and consult with physicians as appropriate. Those who have any of the following conditions would not be good candidates for home-birth: insulin-dependent diabetes, severe preeclampsia, chronic high blood pressure, gestational diabetes that requires medication to control, and labor/birth happening before term/37 weeks.

​What Training Does a Midwife Have?

The education and training required of Certified Nurse Midwives (CNM), Licensed Midwives (LM), and Certified Professional Midwives (CPM) assures high quality, personalized care during pregnancy and birth for low-risk pregnant clients. Click on the following links to view articles and documents comparing educational/training requirements for CPM/CNM licensure here and here. Kim has been a nurse since 2013, certified RNC-OB in 2015, and a practicing CNM since 2018. She has midwifery experience within many birth settings that include high-volume hospital-based practice and birth-center/home-births.​ She carries active certification in Neonatal Resuscitation Program (NRP, 8th edition), Advanced Cardiac Life Support (ACLS), AWHONN intermediate and advanced Fetal Heart Monitoring training, and has training in both S.T.A.B.L.E and Emergencies in Clinical Obstetrics (ECO).

What does prenatal care with a midwife look like? 

The prenatal care schedule with a midwife looks very similar to what it looks like with your obstetrician. Some people call their midwife as soon as they find out they are pregnant! We can order labs for pregnancy verification, as well as early ultrasounds to determine your estimated due date and viability. You will see us as soon as possible for your first appointment and we will go over all of the lab work that is recommended for you and in each pregnancy - we can even offer genetic screening if you desire! We then will see you every 4-6 weeks until 20 weeks, when we will offer to order your complete anatomy ultrasound. You will then have appointments every 4 weeks until 28 weeks, when we discuss and offer the routine third-trimester lab work (such as screening for gestational diabetes, anemia, asymptomatic urinary tract infections, antibody testing if you have a Rh negative blood-type, discuss/offer rhogam administration, etc.). Your appointments will then move to every 2 weeks after 28 weeks until 37 weeks, when we will then see each other every week until you give birth! Around 36-37 weeks, we will have your appointment at your home to make sure everything is ready for birth (as well as offer to screen for Group-B strep). We encourage your entire birth team to be here for this visit (invite everyone you will have present for the birth, including spouse/partners, doulas, etc.). After you give birth, your midwife will come back to your home for several check-ins: 24-48hr postpartum, 5-7 days, and 2 weeks postpartum. Here we will monitor maternal and infant vital signs, perform any recommended heart and metabolic screenings (note: only physicians can order newborn screens in the state of Alabama, therefore, we will need to work with your pediatrician or family doctor to gather the supplies to perform the metabolic screen at home), ensure feeding is established and offer support and referrals when needed, and monitor your newborn's weight and jaundice levels. We will work closely with your pediatrician when able (I like to send records from each visit), and they will typically want to see your newborn within the first week of life. Your final 6-week postpartum visit will be back in the office.

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What do you bring to births? 

Take a look at a great example (Click here) of all of the things Midwives bring with them to births in the home! Midwives carry everything they need to ensure the safety of the birthing person and their newborn such as oxygen, fetal monitoring equipment, blood pressure monitoring, medications to manage emergencies, and equipment to resuscitate an infant if necessary. Your midwife will give you a list of things to gather and have ready for a home birth as well. You will need to gather towels, washcloths, swaddles, bowls, and equipment for waterbirths (such as a brand new hose and adaptor for the sink). ​

Do I Also Need To See an OB?

For low-risk women, a certified nurse-midwife can provide all the routine care you need across the span of a pregnancy, and beyond. You don’t need to see an OB physician as well, unless we refer you to one for evaluation of complications. You are welcome and encouraged to see an OB throughout your pregnancy if you wish, but it is optional. I encourage clients to establish care with a local physician who would be willing to be involved with a transfer to hospital-based care, should that become necessary

​Should I Hire a Doula?

YES! Doulas nurture and support the birthing person throughout the end of pregnancy, labor, and birth. Their essential role is to provide a continuous therapeutic presence and labor support to the mother as soon as she feels she needs it. Importantly, the doula’s role and agenda are tied solely to the birthing person’s agenda and their primary responsibility is to the birthing person—not to a hospital administrator, nurse, midwife, or doctor (Dekker, 2019). Click here for an article from Evidence Based Birth® on the evidence supporting the use of doulas for continuous labor support.​

What if Complications Arise During Labor?

- We will make a plan during pregnancy that prepares your family and birth team for the rare event of an emergent transfer to the hospital, and we will utilize local Emergency Medical Services. We typically discuss and make a plan for emergencies that can occur during or after birth, such as an unexpected breech presentation (we will transfer to the nearest hospital upon recognition of a breech presentation if birth is not imminent), shoulder dystocia (when birth of the fetal head occurs, but the shoulders are lodged inside of the pelvis), and postpartum hemorrhage (when the birth-giver loses too much blood after birth). 

- The majority of home to hospital transports during labor are not emergencies. Examples of non-emergent transfers to hospital care includes: labor that is not progressing after appropriate timing or if your water has been broken for too long before birth. If transfer to a hospital becomes necessary, I will go with you to the hospital, provide your records to the staff, and help with labor support throughout your birth when needed/allowed. I will try to stay with you until after baby is born and you have a successful nursing session, and we will resume your postpartum care when you return home.

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Does Insurance Cover Home Birth? ​

The short answer: Insurance does not typically fully cover out-of-hospital birth. 

- If you have Tricare Prime, I will need a referral approved prior to initiating care.

- There is some coverage with Blue Cross Blue Shield (limited coverage)

- Medicaid does not cover out-of-hospital births

Like many midwifery groups in the state of Alabama, Prattville Home Midwifery is considered “out-of-network” with most insurance providers. If it is possible to file for reimbursement with your insurance, then this can only be done at the completion of care, but we cannot guarantee any insurance payout. 

If you would like to verify if your insurance will help with the cost of home birth, please fill out the form HERE. There is a $20 fee to verify your benefits. 

For now, Prattville Home Midwifery accepts cash and check, as well as cash sending apps (e.g. Venmo, PayPal, Apple Pay, etc.) and most major credit cards (including HSA cards). If paying with card, a 3% fee will be applied to each payment (excluding HSA).
Our team is awaiting feedback after putting in applications to become an in-network provider with several other insurance companies and will announce if they obtain approval to be cleared for billing!