Switching from Hospital to Home Birth during KY’s COVID-19 Outbreak

This question is so popular that we dedicated an entire post to it!

Click here to visit our post, “Finding a Home Birth Midwife in Kentucky”.

The post above will take you to our map of licensed Kentucky providers. Beyond the map, the #1 way to locate a midwife is by word of mouth.  Seek out other home birth families in your area. Talk to local doulas and childbirth educators.  They often will be connected to other birth professionals in the area, including midwives. 

The short answer is no, it is not illegal to have a home birth in Kentucky. There are no laws stating where a you can or can not give birth.

In Kentucky, a physician, Certified Nurse Midwife, or Licensed Certified Professional Midwife can legally attend births. Anyone otherwise providing services as a “skilled birth attendant” (not to be confused with a doula) is technically practicing illegally unless they are serving friends or family, or serving their religious or cultural community where home birth is a part of their religious or cultural tradition. We’ve dedicated an entire post to this question because of how often it is asked, and the length of the answer. Click here to visit “Is Home Birth Legal in Kentucky?” to read up on our current situation surrounding the legality of home birth midwifery, and the current laws in place.

Nope! It really isn’t. You will have a birth kit that your midwife has designed for her and your specific needs. The birth kit contains personal supplies such as disposable underpads (often called chux pads) and gloves. Common household items like bowls, trash bags, towels, and plastic coverings (think cheap plastic shower curtain) help to keep surfaces clean from any bodily fluids. Your midwife will instruct you on how to best set up your birth space to keep the area as clean as possible. After the birth, the midwife (and her team) will also clean up the area and dispose of any trash or debris while you rest with your new babe!

A midwife and doula have very different roles when it comes to birth.

A midwife is the medical professional of the birth team. She is caring for your health and the health of your baby. She will attend your prenatal visits, keep medical records, give medical advice, oversee the birth, asses when a hospital transfer is necessary, and perform postpartum care for mother and baby.

A doula is a trained birth professional that offers physical and emotional support before, during, and after labor. A doula does NOT provide any sort of medical care or medical advice. A doula is NOT trained to deliver babies. A doula may help you understand what to expect during birth, offer measures to increase your comfort during labor, and be the communication line between you and your chosen birth team.

A home birth in Kentucky can range anywhere from $2,000 to $7,000 depending on the midwife you choose, what area she is located in, and her experience. Most often, this fee is paid out of pocket. Typically, insurance companies will NOT cover a birth attended by a CPM, as they are not yet licensed in our state. We are hoping the licensing process will be finalized during the summer of 2020.

Some individuals have luck submitting a claim with their insurance company after the birth and receiving a partial reimbursement afterwards. Insurance may fully cover birth with a CNM, depending on if she is in-network.

*You may be able to use HSA/FSA funds to pay your midwife, but YOU SHOULD BE PREPARED TO PAY THE FULL FEE OUT OF POCKET.

A midwife’s fee includes all prenatal care, the birth, and postpartum/newborn care. the supplies for prenatal care, the birth and supplies needed for it, and postpartum/newborn care and supplies. It includes the time she is on call for you for 24/7 for weeks at time, the gas it takes to visit you, the charting and paperwork, the extremely detailed and personalized care for you as an individual and her expertise and knowledge. There may be other costs involved, such as birth supply kits or pool/pumps (for water births, if your midwife does not supply a pool). Outside tests and ultrasounds are NOT included in the initial fee.

**COVID-19 INFORMATION**
DO NOT expect the midwife to charge only part of her fee just because you are coming into care late in your pregnancy.** A midwife’s fee is not just for the one day you give birth. It includes all prenatal, postpartum, and newborn care, including catching up on information if you transfer to her late. Some midwives may offer sliding scale payments based off your income. Ask your midwife if she offers payment plans.

Certified Nurse Midwives (CNM) are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Their education and practices are mostly hospital based, but they are able to provide care for births in hospital, home, and birth center settings.

Certified Professional Midwives (CPM) are professional independent midwifery practitioners who have met the certification requirements of the  North American Registry of Midwives (NARM). Applicants can qualify to take the NARM exam by either apprenticing with a qualified midwife and completing an Entry-Level Portfolio Evaluation Process or graduating from a midwifery program or school. If the program or school isn’t accredited by the Midwifery Education Accreditation Council, applicants must complete the Entry-Level Portfolio Evaluation Program. The CPM is the only NCCA-accredited midwifery credential that includes a requirement for out-of-hospital experience. Click here to read our post dedicated to the education and training requirements set forth for CPMs.

Traditional Midwives, sometimes referred to as lay midwives or community midwives, are uncertified or unlicensed midwives who often have informal education, such as apprenticeships or self-study, rather than a formal education from accredited institutions.

Planned home birth with a midwife is a safe option for low risk mothers. Many people mistakenly view home birth as “less safe” than hospital birth. However, countries who have midwives as the leaders of maternity care and where home birth is considered among the norm experience better birth outcomes than countries where birth is facilitated in hospital settings with obstetricians. Families and individuals who choose home birth must be comfortable with taking responsibility for their health and personal choices. Each family must decide what risks they are comfortable with taking.

A high quality, peer reviewed study of almost 17,000 home births was published in Journal of Midwifery & Women’s Health in 2014. CPMs were the care providers for most of these births. The study found the following:

• The average cesarean rate was 5.2%, compared to the national average of 32%
• About 1 in 10 women were transferred to a hospital, mostly for stalled labor or the need for an epidural
• Home birth mothers experience lower rates of intervention
• 97% of babies were carried to full term
• Only 1% of babies needed to be transferred to a hospital after birth, most for non-urgent reasons
• 86% of newborns were exclusively breastfeeding at 6 weeks of age

The study concluded that, “Low-risk women… experienced high rates of normal physiologic birth and very low rates of operative birth and interventions, with no concomitant increase in adverse events.”

Follow this link to view the full study.

We’ve found that the most effective way to get someone on board with your plans to birth at home is to set up an interview with a midwife, even if your partner insists there is no way a home birth is happening. Usually their fears are motivated by 1) love and concern for you and the baby, and 2) not realizing home birth midwives are highly skilled birth professionals who are trained specifically for attending birth in the home setting. The interview will allow them to ask the questions that will put their fears to rest. Pinterest is a great resource for finding interview questions. The midwife interview has turned many skeptics into believers!

This is one of our most common questions, so we’ve dedicated an entire post to it. Click here to read the post.

Prior to July 15, 2020, paperwork was processed through county health departments. Now, everything is processed directly through the Office of Vital Statistics in Frankfort. If you are working with a Certified Nurse Midwife or Licensed Certified Professional Midwife, they will be able to take care of most of this for you using the state’s online system.

The Kentucky Vital Statistic website with information for home birth is here: https://chfs.ky.gov/agencies/dph/dehp/vsb/Pages/homebirths.aspx

By law, each live birth is to be registered within 5 days of the birth.

Your midwife will perform prenatal visits (either in home, or her own office) where she will check typical things like blood pressure, baby’s heart rate, and screen your urine. She will attend your birth, help clean up after the birth, provide postpartum care, and perform newborn tests and the newborn metabolic screening. Your midwife will have all the necessary knowledge and equipment to stitch tears, stop bleeding, resuscitate a newborn, etc.

The midwife will visit you several times in the weeks following the birth to continue postpartum care and provide newborn care (usually up to 6 weeks). If you’d like your newborn to receive a hearing test, you will have to schedule that with the health department after the birth. You may choose to take your newborn to the pediatrician a week or two after birth. You can discuss with your midwife if this is a good option for your family or not.

Once you have contacted a midwife, she will tell you exactly what you need on hand. A midwife may have her own birth kit that she has already prepared for you, or she will ask you to order a birth kit from an online supply store. Either way, your specific midwife will have a clearly defined list of the supplies you need and where you can get them. Typical supplies are things like gloves, chux pads, cord clamps, suction bulb, peri bottle, sterile syringes etc. Please do not buy anything on your own before you have discussed with your midwife what she requires for a birth.

Home birth is essentially unmedicated child birth, and can be a mental and physical challenge. Midwives may require that you take a childbirth education class or hire a doula for your birth. Your midwife will not have an epidural or pain medication for contractions. You should prepare yourself with comfort measures (examples: breathing techniques, Hypnobabies, aroma therapy, birth pool/hydro therapy, music, meditations..) and coping techniques ahead of time. Many people have found the following things helpful when researching home birth options or trying to get a picture of what home birth may look like:

BOOKS

Ina May’s Guide Guide to Childbirth

Spiritual Midwifery

The Thinking Woman’s Guide to a Better Birth

BLOGS/WEBSITES

Midwife Thinking

https://midwifethinking.com/

Feminist Midwife

https://www.feministmidwife.com/

Evidence Based Birth

https://evidencebasedbirth.com/

VIDEOS/DOCUMENTARIES

YouTube has tons of different videos of actual home births. Watching a few may give you an idea of how broad the scope is when it comes to coping with pain, midwifery styles, setting up a birth space, what to expect immediately after birth, etc.

If your first plan is to birth in the hospital or a birth center, but the changing policies on visitors or support persons makes you nervous, you should research all of your options to find what will work best for you and your family. It is highly unlikely that a midwife will allow you to occupy a space on her calendar if home birth is not your first priority. There are many people genuinely seeking to give birth at home as their first or only option, and our midwives want to honor those clients. It would be unfair to the midwife and the other pregnant people she may have to turn away to devote her time and supplies to someone who is not genuinely committed to giving birth at home. It is not a good idea to consider home birth a “backup plan” just in case your hospital suddenly changes policies. It is best to make a choice and stick with it.

At any other time in Kentucky’s history, your midwife would likely not have asked you to limit the amount of support people at your birth. However, with the current social distancing practices employed to reduce the spread of COVID-19, it is very likely that your midwife may ask you to reduce the amount of people at your birth to only those who are absolutely necessary. This may mean having only your partner (if you have one) and your hired doula at your birth. Usually your other children, birth photographers, or immediate family members are welcomed and encouraged to attend if it is your wish, but during the outbreak it’s necessary to limit your and the midwife’s exposure to possible carriers of infection. Please take this into consideration if you are planning to give birth at home during this time.

Home birth is not just about the location in which you will give birth. Care with a home birth midwife looks much different than care with a hospital based provider. Clients who choose home birth are choosing autonomous care. Patients who choose hospital birth are usually subjected to the standard tests and procedures no matter their personal health or beliefs.

With a home birth midwife, your prenatal visits should last anywhere from 45 minutes to an hour. Your midwife will get to know you personally, and this relationship will help her customize your care to your individual needs. You will still receive standard health care: blood pressure checks, urine tests, lab work (maybe outsourced), fundal height checks, checking fetal heart tones, etc. You may choose to opt out of certain tests or procedures like cervical checks, use of fetal doppler, or the gestational diabetes test, or may you choose an alternative method for the procedure: jelly beans for diabetes testing or fetoscope for checking fetal heart tones.

Most midwives also take a holistic approach to maternal care. Your midwife will make sure you are doing well emotionally and physically. Another difference is instead of prescribing pharmaceutical drugs, she may recommend herbs, teas, tinctures, or other holistic approaches that pair well with pregnancy and birth. A midwife still carries standard medication for emergencies in birth.

Your midwife will expect that you take on the responsibility to understand common tests and procedures performed and whether or not you want them for you and your baby, whereas an obstetrician may assume that you will want all tests/procedures and perform them automatically. Your home birth care really is personalized in so many ways!

You will see the same midwife throughout your pregnancy and she will be the midwife at your birth, pending extenuating circumstances (although this is not common). This one-on-one approach for every prenatal helps to build the relationship of trust between you and your midwife and your midwife learns what is normal for you as an individual. With an obstetrician, you may see the same doctor for prenatals but end up with a different doctor when you arrive in labor.

Understand that there is no epidural option for home birth. There are many coping techniques to deal with the pain of childbirth, but it will be up to you to research, learn about them, and pick the technique that is right for you.

Finally, home birth is a mindset. You are choosing autonomy. When you choose to give birth at home, you are choosing to take personal responsibility for a healthy pregnancy, labor, and birth. Your midwife can help guide you through the process, but you are choosing to commit to learn how to best take care of yourself, how to cope with natural labor and birth, and which test and procedures are right for you and your baby. Your midwife is there to answer your questions and monitor your health, not to make your choices for you.

In short, no. Continuous prenatal care with the same midwife is a large part of what makes home birth safe. Through your many prenatal visits, your midwife will learn what is normal for you and your body. This helps her determine when things may be “off” during your labor or postpartum period. Without this very specific knowledge of what is normal for you, there is the potential for increased risk for you and your baby. It is an issue of safety for everyone involved.