Having up-to-date information on available options for birth care helps women and their families make decisions that suit them best. In this article, we aim to inform families, family support professionals, educators, and health policy makers on midwife-attended, out-of-hospital (OOH) birth care, because little reliable information is available to the public. In recent years, the numbers of OOH births have been increasing, and in 2012, about 1.4% of U.S. women planned OOH births, with more than twice that percentage in Washington State, at 3.4% (MacDorman et al. 2014). U.S.-based studies have shown that midwife-attended, OOH birth is safe and effective for low-risk women, and families appreciate receiving personalized care in a familiar setting. We discuss additional considerations, including costs, to help families and others as they make this important life decision.

Midwives and Out-of-Hospital Births

Midwives are women’s health care clinicians who provide holistic and comprehensive prenatal, birth, and postpartum care for women with healthy low-risk pregnancies. Some midwives practice in obstetric clinics and hospitals. Others practice independently, and they assist women in planned out-of-hospital (OOH) births exclusively. Although all midwives share the same general care philosophy, this publication focuses on those with OOH practices.

Care by midwives is holistic, focusing on physical, emotional, and spiritual health in the context of culture and family. Midwives offer all the same screenings, tests, and monitoring one would receive from a physician. Clients often have 24-7 direct access to their midwife via cell phone or pager when labor begins or if any concerns arise.

Generally, midwives aim to build trusting, respectful relationships with their clients, and value open communication. This begins with involving women in deciding on any screening, test, or intervention the midwife can offer. Through informed consent, midwives inform women of the known risks and benefits of any tests or treatments they may undergo. Clients are encouraged to consider how their beliefs, values, and preferences factor into the treatments they may accept.

The midwife supports the birthing woman throughout the process in making decisions for her and her baby’s health, and in listening to her body and instincts.

Midwives provide care throughout pregnancy, during birth, and in the early weeks postpartum. Prenatal visits with an OOH midwife often last 30 minutes to an hour. In those visits, clients receive routine prenatal and postpartum care, which may include any or all of the tests or procedures in Table 1.

Table 1: Screenings and Procedures Routinely Provided by Midwives

In labor and delivery, midwives aim to provide an optimal environment for normal physiologic (often called “natural”) birth. Supporting physiologic birth involves creating the conditions that allow women to access their own inborn capacities to give birth (Buckley 2015). This involves:

• Minimizing intrusions
• Providing continuous, one-on-one care and support
• Minimizing interventions
• Allowing women to move freely
• Allowing food and fluid intake as desired
• Allowing women to move in or out of water (showers, baths)
• Granting freedom to find effective birthing positions