Good morning, Asheville. Brook here. A few months ago, we asked y’all about midwifery + home birth resources in the area, and given that tomorrow is not only my daughter’s birthday, but also International Day of the Midwife, it’s an apt time to explore this topic. It’s particularly timely, too, because as the pandemic has spread, more expectant parents — both in WNC and throughout the country — are looking into alternatives to hospital births. As someone who had a pretty rad home birth herself, I’m excited to discuss it with y’all.
When I was pregnant, I suspected I would choose a home birth. For one, I didn’t have health insurance and knew birthing in a hospital would be cost prohibitive. As someone with wild anxiety, I knew the most calming thing I could do would be to be with my dogs, which obviously wouldn’t fly in a hospital.
Then, I watched the documentary The Business of Being Born, which explores the history of American obstetrics + the shift of birth from home to hospital, and I knew I wanted to give birth at home, like my grandmothers had done before me. Also, if you’re interested in watching the doc, it’s streaming free due to the pandemic). Because I was in good health with a low risk pregnancy (ie, with no conditions like diabetes or high blood pressure, which could increase the risk of complications) I knew home birth was the right choice for me.
Editor Brook greeting her daughter during her home birth
Home births are exactly what they sound like: pregnant folks labor + deliver their babies in their own homes, rather than in hospitals or birth centers. Labor and delivery occur naturally, meaning without medical intervention such as epidurals, pitocin, or the like. They are attended by midwives, trained health professionals who help women during labor, delivery, and after the birth of their babies. While the majority of midwives in the United States practice in hospital settings, others practice in birthing centers and private practices and provide in-home birth services.
Midwives are the OGs of labor + delivery. Birth has historically been a female-centric event where laboring women are supported by other women and attended to by a midwife. Protip: check out Appalachia’s granny midwives for some especially cool history.
There are four types of midwives.
- Certified Professional Midwife (CPM) — Certified professional midwives work exclusively in settings outside of hospitals, like homes + birth centers. These midwives have completed coursework, an apprenticeship, and a national certifying exam. Their licensure is only accepted in 33 states, though many work in states where they’re not recognized.
- Certified Nurse Midwife (CNM) — Certified nurse midwives have completed both nursing school + an additional graduate degree in midwifery. They’re qualified to work in all birth settings and can work and write prescriptions in all 50 states. They can also provide other primary and family/reproductive healthcare.
- Certified Midwife — Certified midwives have the same graduate-level education + training as certified nurse midwives, except they have a background in a health field other than nursing. They take the same exam as nurse midwives through the American College of Nurse Midwives.
- Self-Taught or Traditional Midwife — These midwives lack formal certification or licensure. They often serve specific communities, including indigenous or religious populations.
DYK Google searches in the country for “home birth” were at their highest level in five years at the end of March? This is especially interesting considering that in 1900, 95 percent of births in the United States took place at home. Today the number is roughly one percent.
Expectant mothers are understandably worried about being exposed to COVID-19 in a hospital setting. Others are concerned about laboring without their partners or chosen support team. While it’s common for hospitals + birthing centers to limit the number of people allowed in a birthing woman’s room, the pandemic has seen these restrictions tightened even further. Some are not allowing spouses or partners. Mission Hospital is currently allowing expectant mothers only one guest. WNC Birth Center is allowing two.
I chatted with Certified Nurse Midwife (CNM) Sharon Wallis of Bella Luna Midwifery, a home birth midwife, who confirmed she’s fielded more inquiries about her services + more requests for late pregnancy transfers from women whose birth plans have changed as a result of the pandemic in the last few months. Sharon pointed out that there’s a significant secondary impact from the pandemic that is also a likely factor for increased interest in alternative birth methods — many folks have lost their sources of income or insurance. It is common for home birth mIdwifery practices like Bella Luna to offer payment plans.
Her clients are also appreciative of the fact that she doesn’t have the same stringent guidelines on guests that hospitals must have. Sharon doesn’t put limitations on the number of guests or visitors laboring moms can have in their home at their birth, though she does help clients think through social distancing guidelines, how many people their guests have been around, etc.
Certified Professional Midwife (CPM) Nancy Koerber of WNC Birth Center says the number of folks looking into their services has increased dramatically since the pandemic. She, too, has seen a lot of inquiries into late pregnancy transfers. And, like everyone else, she’s had to amend her services to include more telehealth appointments. Because of the pandemic, the folks at the birth center have had to limit the number of visitors into the center, so partners and kids stay home during moms’ exams, but they are included on Facetime meetings. Both Sharon + Nancy are also wearing PPE during labor and educating clients on current health guidelines during prenatal visits, as well as performing more frequent and intensive clearing of the physical spaces clients attend.
In times of such uncertainty + fear, Sharon and Nancy see the increased attention on + re-evaluation of alternative birth methods — like home birth and birthing in birthing centers — as a positive effect of the pandemic. Both show women researching and broadening their options and having more control and autonomy over their health.