What Does Prenatal Care Look Like With a Home Birth Midwife?

By Jill Snelson, CPM

People sometimes assume that choosing home birth means opting out of traditional prenatal care.

It doesn't.

In fact, prenatal care is one of the most important parts of planning a safe home birth because pregnancy gives us months to learn about the health of both mother and baby and to continually determine whether home remains an appropriate place to give birth. It gives us time to get to know one another and establish the foundational trust that is imperative to home birth. At Charis Birth & Wellness, prenatal care is comprehensive, clinical, and relationship-centered.

We still do the prenatal-care things.

At your appointments, I am assessing many of the same things you would expect to have evaluated during routine prenatal care.

We monitor maternal blood pressure and other vital signs, fetal heart tones, baby's growth, position, and development, and other indicators of maternal and fetal well-being. Routine prenatal labs and evidence-based screening options are discussed and offered throughout pregnancy.

As pregnancy progresses, we continue reassessing risk.

Being a good candidate for home birth at twelve weeks does not automatically mean someone will still be a good candidate at thirty-eight weeks. Pregnancy is dynamic. New information can pop up, and part of my responsibility is recognizing when consultation, additional testing, co-management, or transfer of care is appropriate.

That ongoing assessment is an important part of home birth—not something separate from it.

But appointments feel different.

One of the biggest differences families often notice is time. I don't want you to feel like you need to choose your most important question before I walk out the door.

We sit and talk. Usually with our feet up!

We discuss nutrition, symptoms, sleep, previous birth experiences, emotional well-being, labs, supplements, upcoming decisions, preparation for labor, newborn care, breastfeeding, postpartum recovery, what is currently stressing you, what is making you excited, and whatever else is relevant to you that day.

Sometimes we are discussing something highly clinical. Sometimes we are talking about whether you actually need the dress you saw at Target on the clearance rack.

Both conversations have a place. Midwifery care works best when there is a relationship underneath the clinical care. Pregnancy gives us time to build that relationship.

You are involved in your own care.

Informed decision-making is very important to me.

That means I don't want you agreeing to something merely because “the midwife said so.” When there are decisions to make, I want you to understand what is being offered, why it is being recommended, what information we have, what alternatives exist, and what the potential benefits and risks are. If I can’t answer your “why?”, then I shouldn’t be recommending it in the first place.

You are the one living in your body and raising your baby.

My role is to bring clinical knowledge and experience to the conversation so that you can make informed decisions—and to be clear when something affects whether I can safely continue providing out-of-hospital care.

Autonomy and responsible clinical practice can coexist.

At 36 weeks, I come to you.

Around 36 weeks, we have a prenatal visit in your home.

This isn't because I need your house to look a certain way. I promise I am not coming to inspect your baseboards. (You should come see my house!)

The home visit gives us the opportunity to make sure I know exactly where you live while it’s still daylight out, talk through where you are imagining labor and birth happening, review your supplies and setup, discuss access to the home, and make a practical plan for labor.

We also talk through when to call, who will be present, how your birth team works, and what would happen if plans need to change.

By the end of pregnancy, very little about the logistics of your birth should feel mysterious.

By the time labor comes, we know each other.

That may be my favorite thing about this model of care. When you call me in labor, I'm not meeting you for the first time. I know what this pregnancy has looked like. I know your baseline. I know what matters to you. I know the things you're afraid of and the things you're excited about. I know your history and your preferences, and you know how I practice.

That relationship doesn't replace clinical skill. It makes the clinical care more personal.

And when I think about what good midwifery care should look like, I believe women deserve both.