What medical equipment and supplies do I bring to a home birth?
I carry 2 bags and a basket. One bag is doppler (for checking fetal heart tones in labor) and respiratory equipment, including oxygen. The other bag includes medications for bleeding (all the same anti-hemorrhagics that the hospital has) as well as homeopathy, herbs and essential oils. This bag also has IV supplies, suture instruments/supplies, and supplies for cutting the umbilical cord. My basket holds supplies for mom and baby assessment, including baby scale and measuring tape, BP cuff and thermometer, fetoscope, and blood draw supplies.
Is there a difference between a direct entry midwife and a nurse midwife?
There are differences and similarities between direct entry midwives (DEM’s)
and nurse midwives (CNM’s). The primary difference is in the educational pathway. DEM’s may have completed a formal educational program or have what is considered substantially equivalent education, which likely involves an apprenticeship with another midwife. After this they must pass the North American Registry of Midwives (NARM) written exam which is similar to the exam that CNM’s must pass for their certification. Direct entry midwives may have titles such as CPM (Certified Professional Midwife) which is an additional certification they have completed; and/or LDEM (Licensed direct entry midwife) or RM (Registered midwife) depending on whether their state’s process is licensure or registration. DEM’s are legal in many states but not all.
A CNM is usually a registered nurse first. She has also completed a master’s degree program in a medical university that specializes in midwifery. She must then pass an exam and be certified by the American Midwifery Certification Board. This grants them the title “CNM” for certified nurse midwife. They must recertify every 5 years. CNM’s practice legally in all 50 states and have prescriptive privileges. CNM’s provide pregnancy care and many provide primary care and gyn care as well. They are independent health care providers in Colorado. This means they consult appropriately with other health care providers when indicated but do not require any type of supervision or collaborative practice agreement.
DEM’s work almost exclusively in homes and occasionally in birth centers. CNM’s most often work in hospitals but can work in birth centers and in homes also. There are around 200 CNM’s doing home birth in the US.
The bottom line is that CNM’s and DEM’s are all midwives. Unlike physicians, all midwives have extensive education and training in normal female life processes such as the menstrual cycle, pregnancy, birth and beyond. We can treat some of the abnormal or will refer appropriately if a concern is beyond our scope, but we specialize in keeping women and families healthy and enjoying life.
Why does home birth cost so much?
Let’s compare the cost of hospital birth to the cost of home birth.
If you have your baby in a hospital you pay:
- The midwife or doctor who provides your pregnancy, birth, and postpartum care. This is calle a “global ob fee” and is typically somewhere in the $2500 or so range.
- Hospital charges for the place you have your baby, nurses to care for you and your baby, and supplies and equipment for them all to use. Usually $8,000-$10,000, or more if you have a C-section or complications.
- A doctor to see your baby while he/she is in the hospital and for follow up care after going home. Usually $600-1200.
If you have your baby at home you pay your midwife a set cash fee ($4000), or we file claims to your insurance . This covers:
- Your “global ob care” as described above provided by your primary midwife
- Any assistant(s) who will help her with care for you and your baby during labor, birth and immediately after birth.
- Supplies or facility fee. We are the facility, rather we carry the facility with us in regard to equipment and supplies.
- Care for baby, both at birth as well as follow up for 6 weeks.