What’s included in Earthen Vessels Nurse-Midwifery maternity care?
The following services are included in the fee for Self Pay clients:
- Prenatal visits beginning at 12 weeks (every 4 weeks from 12-32 weeks, every 2 weeks from 32-36 weeks, every week from 37-41 weeks, twice a week after 41 weeks)
- On-call availability 24 hours a day for labor beginning at 37 weeks gestation
- Labor, birth, and immediate postpartum care
- Baby care following the birth
- Two postpartum home visits for mother and baby, the first at 1-2 days postpartum and another at 3-5 days postpartum
- An office visit for the mother and baby at about 2 weeks and 6 weeks after the birth
- Breastfeeding assistance
The homebirth and birth center fee for Self Pay clients does NOT include:
- RN birth assistant (paid directly to RN at birth)
- Distance fee if applicable
- Lab work Payment collected when lab is collected or billed to insurance
- Items on the homebirth supply list or additional supplies listed on financial agreement, like medications, nitrous oxide, suturing
- More than one unscheduled urgent or off-hours visits
- Special procedures or other screening or diagnostic testing
- Non-stress test (NST)
- Recommended or prescribed medications or supplements
- Newborn metabolic screen paid directly to state
- Any referred services (e.g., ultrasound, consultation visits with other providers, etc. are paid directly to other provider or office)
- Birth tub rental if desired
- Facility fees for New Eden Care Center use, this is paid directly to the Birth Center
- Nitrous oxide for labor pain relief
Insurance billing is done on a limited basis and creates complex payment arrangements that can be discussed at a consultation. Tricare, HSA and flex plans, and Samaritan, Christian Medishare and similar programs welcome! Out of network billing on case-by-case basis for non-HMO insurance if homebirth services are covered.
Why have a home birth?
Every family has a right to experience childbirth in an environment where human dignity, self-determination, and the family’s cultural context are respected. While the majority of women in the United States give birth in the hospital setting, some families prefer to plan a home birth or birth in an out-of-hospital birth center. In the context of midwifery care, women are encouraged and supported to make informed choices regarding the type of maternity care experience that will best meet their individual needs, including location for the birth.
Families choose homebirth for many reasons. Common reasons include avoidance of interventions including cesarean section, personalized care, freedom and control in labor and birth, cost savings, previous negative hospital birth experiences, and a more family-centered experience. A variety of reasons people choose homebirth were highlighted in the Birthplace study which found that, compared to women planning a hospital birth, those planning a homebirth have a lower risk of having a cesarean section, a lower risk of an assisted delivery (forceps or vacuum), and less risk of hemorrhage. The study found that women planning a homebirth were more likely than women planning for birth in other settings to have a normal birth. In this context, normal birth is defined as labor that starts spontaneously without induction, progresses without the use of an epidural, and the baby is born without assistance from forceps or vacuum nor the need for an unplanned cesarean. Birthplace results show 88% of planned homebirths were normal births compared to fewer than 60% of planned obstetric unit births.
The families in the video explain their personal reasons for choosing homebirth:
Choosing your place of birth is a big decision and one that only the expectant mother, along with her husband or partner, can make after careful research and discussion with their healthcare provider. Earthen Vessels Nurse-Midwifery is happy to discuss your maternity care needs to help you decide if homebirth might be right for you.
Is homebirth safe?
Several factors are important when planning a homebirth from a safety standpoint: 1) Hiring a trained, educated qualified midwife able to practice legally in your state; 2) appropriate risk screening by the midwife to ensure only low risk mothers birth out of the hospital; 3) timely, coordinated transfer of care when needed for mother or baby prenatally, in labor, or after birth; 4) a collaborative arrangement with a physician who can assist the midwife with questions; 5) a professional, trained assistant at births; 6) adequate emergency equipment and supplies for mother and baby at the birth, and 7) a birth team trained in emergency procedures. Any interview of a potential midwife should include discussion of these topics.
What does research have to say?
There are numerous studies on the safety of home birth and all families should do their own research and come to their own conclusions about what is best in their situation, Here are a few studies and a link to a large study in full text for your consideration:
Outcomes for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
Olsen O, Clausen, J. Planned hospital birth versus planned home birth. Cochrane Database of Systematic Reviews. September 12, 2012. An updated systematic review of randomized controlled trials (RCTs) comparing planned home births to planned hospital births among women with uncomplicated pregnancies. Authors also conclude that evidence from increasingly well-designed observational studies suggests that low-risk women who plan a home birth experience significantly fewer interventions and complications than low-risk women who deliver in hospital.
Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home births with registered midwife versus planned hospital birth with midwife or physician. CMAJ 2009;181(6-7):377-83. A prospective, five-year long cohort study compared outcomes for low-risk women in a midwife-attended planned home birth group (n=2889), planned hospital births attended by the same midwives (n=4752), and a matched cohort of physician-attended hospital births (n=5331). In this intention to-treat analysis, women in the planned home birth group had significantly fewer intrapartum interventions, including narcotic or epidural analgesia, augmentation or induction of labou, and assisted vaginal delivery or caesarean delivery; and significantly fewer adverse outcomes (e.g. postpartum hemorrhage, fever, and 3rd or 4th degree tears). There were no significant differences between the home birth group and either comparison group with respect to a 5-minute Apgar score of less than 7, a diagnosis of asphyxia at birth, seizures, or the need for assisted ventilation beyond the first 24 hr of life.
Nove A, Berrington A, Matthews Z. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK. BMC Pregnancy & Childbirth. 2012, 12 (1),1-11. This observational cohort study used data from 15 hospitals. The authors compared the rates of postpartum hemorrhage between women who planned a home birth and those who planned a hospital birth. Postpartum hemorrhage (PPH) was defined as a loss of > 1000mL of blood. Excluded were high-risk pregnancies, unplanned home births, pre-term births, elective Caesareans, medical inductions, miscarriages, and terminations. A total of 273,872 pregnancies were included: 5,998 planned home births and 267,874 planned hospital births. The odds of postpartum hemorrhage (PPH) were significantly higher (250%) among planned hospital births than for planned home births.
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What does homebirth look like with Earthen Vessels?