Myth Busting Homebirth Midwives: Separating Fact from Fiction

As a certified nurse midwife with a passion for home births, I often encounter numerous misconceptions and myths surrounding the practice of midwifery care in the home setting. These misconceptions occurred in my own home when my partner and I were discussing the type of care we wanted during my second pregnancy. It was clear to me what I wanted and knew was the safest and best place for me, but he needed some education and myth busting.

These myths can create unnecessary fear and uncertainty, which may deter some from considering the incredible option of home birth with a midwife. This blog post is here to help debunk common myths specifically related to home birth midwives and provide a clearer picture of the truth. Hopefully this will help spark a conversation between you and your support people and open up a topic that is still unnecessarily controversial.

Myth #1: Homebirth Midwives Lack Proper Training

One prevalent myth is that home birth midwives are less qualified than their hospital counterparts. In reality, certified nurse-midwives (CNMs) who attend home births undergo the same comprehensive training, including both didactic education and hands-on clinical experience as CNMs who practice in a birth center or hospital setting. They are well-equipped to handle a wide range of situations safely. Midwives undergo extensive training to understand the physiologic process of pregnancy, labor, birth and postpartum. Midwives are also trained to recognize when a situation deviates from normal. They are trained to recognize what interventions can be offered and discussed and when a situation needs to involve care by a physician.
In January of 2021, SB 1237 came into effect in CA, stating that CNMs are officially an independent provider that can offer without having a written agreement with a physician and do not need to be supervised by a physician in order to practice. Yes, there are certain restrictions that came with this bill, but it just goes to show that CNMs are trained and qualified providers for birthing people seeking midwifery care.

Myth #2: Homebirth Midwives are Unprepared for Emergencies

Some believe that home birth midwives are not prepared for emergencies. However, home birth midwives come prepared with emergency equipment, medications, and protocols designed to address any unexpected situations. They are trained to recognize signs of complications and have backup plans in place to transfer care to a hospital if necessary. Midwives continue their education and maintain certification for resuscitation skills, both adult and neonatal, so that they are able to care for the parent or baby in case of an emergency. In addition to that, midwives gather together and hold drills sessions to practice and keep their knowledge fresh to be able to act quickly if the situation necessitates it.

Myth #3: Homebirth Midwives Don't Use Medical Interventions

While home birth midwives emphasize a low-intervention approach, they are trained to use medical interventions when needed. They carry equipment for monitoring vital signs, administering medication, and handling complications. The focus is on providing individualized care in the comfort of your home while maintaining the safety of both parent and baby. The most important thing is to keep the birthing parent and the baby safe. That can be accomplished without compromising their autonomy, their well being, their preferences. It’s all about informed consent.
***Food for thought: The misconception is that if you’re in a hospital setting, even if you're completely low risk, it’s better to be there just in case something happens. BUT, being in that setting puts you at risk of receiving interventions that are almost always unnecessary. You’re in a setting that has policies in place that don’t always place YOU as a priority. These policies are there to maintain the stability of the labor and delivery unit and the team caring for everybody there who’s birthing their baby. It’s very hard to receive individualized care in this setting, although it can be done if you're aware and are able to advocate for yourself.

Myth #4: Homebirth Midwives Only Accept Low-Risk Pregnancies

While this is not completely a myth, I wanted to mention it so I can stress the fact that homebirth midwives assess each pregnancy individually and can provide care for women with various risk factors or medical conditions. They work closely with clients to ensure that the home birth plan aligns with their specific needs and circumstances. Midwives work closely with physicians when a consultation for a certain issue is necessary or collaboration of care can occur, when the client’s pregnancy falls out of the scope of midwifery practice alone. There are certain guidelines that midwives need to follow when caring independently for their families. You can find out more about these requirements in the blog post Homebirth: A Gentle Option for Low-Risk Pregnancies.

Myth #5: Homebirth Midwives Don't Provide Prenatal and Postpartum Care

Homebirth midwives offer comprehensive care that includes prenatal visits, postpartum care, and newborn assessments. They monitor your health throughout pregnancy, provide support during labor and birth, and continue to care for both mother and baby in the postpartum period. Midwives are the ones that provide that initial physical assessment of the baby. Usually occurring hours after birth, permitting, and very close to the parents. The parents can participate in this process and the pace is dictated by the baby. The prenatal visits are long, allowing time for all clinical aspects for the visit to be accomplished but also time to answer questions, acknowledge fears, promote health and well being. Same schedule of visits usually occurs as it would in a doctor’s office, but will include more as needed and requested by the family in their care. Same goes for the postpartum visits. The norm is one or two postpartum visits at most, but homebirth midwives usually provide more postpartum visits and follow up. There is a range of offerings, it just depends on the midwife you end up hiring.

Myth #6: Homebirth Midwives Don't Offer Pain Relief Options

Home birth midwives offer a variety of pain relief options, including relaxation techniques, water birth, and natural pain management methods, sometimes even certain medications. They also discuss pain relief preferences with clients and can make arrangements for medical pain relief, i.e epidural, if requested. This is done on a case by case basis, depending on how the labor and birth are unfolding. Sometimes needing a transfer for pain relief with an epidural to achieve rest and relaxation is what’s necessary to progress to a healthy vaginal birth. Again, as long as these options are discussed and informed consent is achieved, midwives will support their clients and their decisions.

Myths about homebirth midwives often misrepresent the reality of their qualifications, capabilities, and the safety precautions they take. Midwives who attend home births are dedicated professionals committed to providing safe, personalized, and empowering birth experiences. They build strong relationships with their clients, offering emotional support, guidance, and reassurance throughout the entire birth experience. By, hopefully, dispelling some of the myths out there, you can start making informed decisions about the care you choose for your pregnancy, birth and beyond. And should you choose to hire a midwife for a homebirth, know that you are embarking on a beautiful birthing journey.
Check out the post about Homebirth Midwife Interview that includes a downloadable version of a questionnaire that can help you interview a prospective midwife. Hopefully, it can help you gather all the information you need and assist you in finding the right midwife for you.

Further reading and references:
SB-1237 Nurse-midwives: scope of practice
CNMA - What is a nurse midwife
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
Planned home birth: benefits, risks, and opportunities
The safety of home birth: Is the evidence good enough?