Midwife does not always equal home birth supporter

Midwife = home birth supporter right?

Unfortunately, not always.

Let's dig deeper.

Let me preface this by saying:
I LOVE MIDWIVES.
No for real. I do. Like get me a "#1 midwife fan" tshirt and I will wear it every chance I can. I will never stop singing their praises and believe that midwives are the best choice for most birthing folks. The care they give is so special and important.

BUT - just because you have a midwife, doesn't mean that they are home birth supporters.

The Midwifery Scope and Model of Practice, states that midwives provide care in a variety of settings, including homes, hospitals and birth centres, where available. The birth setting is chosen by the client in consultation with the midwife.

The RM Standards of Practice regarding choice of birth place are further elaborated upon in Standard 7 and specifically state:

"The midwife shall respect the client’s right to make informed choices about the setting for birth and shall provide care in all appropriate settings."

Okay - so if it is in their standard of practice, surely that means they are home birth supportive right? Most definitely are, but not all.

Why would a midwife not be home birth supportive?
Well, honestly, I can't speak for them. I am sure it is very individual to each care provider and they each have their reasons.

Some of them that have been shared with me are:
1. Home births require more one on one support - midwives join birthing families in active labour and do not leave until a few hours after the baby is born. That can mean very long stretches of work with out the option to easily take breaks because the nurse can cover you.
2. Home births require two midwives during pushing, birth and immediate postpartum - one for the birthing person and one for the baby. This can be hard to juggle.
3. They do not have the option to be able to see multiple clients at once which means the clinic may need to set up one person on call for home births and one person on call for hospital births, plus one ready to be called as second attendant. When in a hospital, the one midwife can be supporting multiple births at the same time because they can leave the birthing person with a nurse while they go off to tend to the other people.
4. They want NO RISKS - which in birth, is just not possible.
5. They feel more comfortable having other people on hand to support them if needed.

Again, there may definitely be other reasons, I of course cannot speak for them, these are just some reasons that have been shared with me.

And all these points make sense from a care provider perspective. Attending home births requires more from the care provider and that can be hard to handle when you already feel overworked and unsupported by the health authority and government you work under.

BUT - this does not mean they get to take away that choice from the birthing person.

Here's some things you may want to ask your midwife to see how supportive they are of home birth:
1. How many home births did you attend last year?
2. How many of the planned home births happened at home and how many were transferred during labour, or plans changed in the final weeks of pregnancy on the recommendation from the midwife?
3. How would you support me if I chose not to transfer to the hospital upon your suggestion?
4. What are reasons you may no longer recommend home birth?
5. What are reasons you recommend transfer to the hospital?
6. What are the most common reasons people actually transfer to the hospital for?
7. What happens if you have another person in labour in the hospital while I am at home? Will you get back up or will you abandon care unless I go to the hospital with you?
8. What happens if I go beyond 41 weeks of pregnancy?
9. Flat out - what do you feel about home births?

These can feel like really difficult conversations to have with your midwife. I understand you don't want to upset them and these questions can feel super challenging. Remember, asking questions is not rude. Asking questions is pivotal to the health and safety of you and your baby. Asking questions are an essential part of having a birth you love. If they have issues with you asking these questions, well, that says all that you need to know about the care you are about to get.

When to ask these questions?
Honestly, as soon as possible. That way, if you discover your midwife is not actually a home birth fan, there is time to hopefully find a new midwife who will enthusiastically and fully support you in your birth.