Home birth questions, answered

For a healthy woman with a low-risk, single-baby pregnancy, planned home birth attended by a trained, licensed midwife is a reasonable and well-studied choice. The research on outcomes describes births planned at home and attended by a qualified midwife with a working plan for transfer if high risk, which is very different from an unplanned birth outside a hospital.

Midwifery in Florida is a licensed, regulated profession. Licensed midwives (L.M.) complete an accredited midwifery program, pass a national examination, and practice under the Florida Department of Health. Licensure sets standards for who is an appropriate candidate for home birth, what equipment and medications a midwife carries, and when consultation or transfer to a physician is required.

In practice, safety comes from three things working together: careful screening throughout pregnancy so that risk factors are caught early, skilled attendance during labor with continuous monitoring of you and your baby, and a clear, rehearsed plan for transferring to the hospital if anything falls outside normal. We carry oxygen, neonatal resuscitation equipment, IV fluids, and anti-hemorrhagic medications to every birth, and we’re certified in adult and neonatal resuscitation.

Vaginal birth after cesarean (VBAC) is a real and reasonable goal for many people, and we understand how much it can matter after a birth that did not go the way you hoped.

Whether a VBAC at home is appropriate depends on the specifics of your history: the type of uterine incision used in your cesarean, why the cesarean happened, how many you have had, how much time has passed, and how this pregnancy is progressing. Florida’s practice standards for licensed midwives also set requirements around VBAC care, including physician consultation in certain circumstances.

Because every story is different, we can’t answer this in general terms. It starts with a conversation and a look at your operative records from your previous birth. We’ll share honestly what we see and what your options are, and if home isn’t the right setting for your VBAC, we’ll help you find a supportive provider who can offer one in a hospital.

Bring your records to a free consultation and we’ll go through them together.

Planning for a possible transfer is simply part of planning a home birth; it doesn’t mean anything has gone wrong. Together we make a transfer plan with you long before labor begins.

Transfers don’t happen often, but occasionally we do need the hospital, perhaps because a pregnancy becomes high risk or a labor needs tools or care we don’t have at home. True emergencies are rare, and usually there’s time to gather your things and drive. We go with you to the hospital and stay for your birth, resuming postpartum care as normal once you’re discharged and back settled in your home.

Midwifery care is self-pay, and you choose a payment plan that spreads the cost across your pregnancy, with the total paid in full by your 36-week home visit. If you have insurance, it can then be billed as one global fee at the end of your care, in the hope that you’ll receive some money back as a reimbursement. This single fee covers the full course of care:

• All prenatal visits, from your first appointment through the end of pregnancy
• 24-hour availability for questions and concerns throughout your care
• Attendance at your labor and birth, including a birth assistant
• Postpartum and newborn visits through six weeks after birth
• Breastfeeding support

Laboratory work, ultrasounds, and any specialist referrals are billed separately, by the lab or provider performing them, directly to you or your insurance. We only order the labs that are clinically indicated for your individual situation, and if you’re self-pay you can purchase labs as needed.

Home birth usually costs considerably less than a hospital birth, and the difference is larger if you’re paying out of pocket. Payment plans spread across pregnancy are standard, and we’ll happily work one out with you.

Because fees change, we share the current cost of care at your free consultation rather than publishing a figure that might go out of date. Call (904) 540-7994 and we’ll gladly walk you through the numbers, with no obligation.

Often, yes, though the details vary a lot from plan to plan, so it’s worth checking yours.

Private insurance. Many plans reimburse licensed midwifery care, frequently as an out-of-network benefit. What you ultimately pay (after receiving a reimbursement at the end of your care) depends on your out-of-network deductible, your coinsurance rate, and whether your plan will issue a gap exception. We’re happy to help with the paperwork you need to submit a claim, and we’ll help you ask your insurer the right questions.

Florida Medicaid. We do not accept Medicaid.

A good first step is to call your plan and ask whether licensed midwife services and a planned home birth are covered, and at what rate. Bring what you learn to your free consultation and we’ll help you make sense of it together.

Most women begin care with us in the first trimester, around nine to twelve weeks. Starting early gives us the fullest picture of your pregnancy and the most time to build a relationship before labor.

And if you’re further along, it’s not too late. We regularly accept transfers of care from women who started with an obstetric practice and decided partway through that they wanted a home birth instead. For example, a client whose testimonial appears on this site switched at five months. What matters is whether your pregnancy remains a good candidate for home birth and whether we have capacity for your due date.

That being said, we take a limited number of clients each month so that we have time for every family. If you know you’d like a home birth, we’d love to hear from you sooner rather than later.

We attend home births throughout Northeast Florida, including:

• St. Augustine and greater St. Johns County
• Nocatee and Ponte Vedra
• Palatka and Putnam County
• Jacksonville and the surrounding Duval County communities
• Palm Coast
• Flagler Beach

Prenatal visits are mainly in the office, with some at home. If you’re in the heart of St. Augustine, we’re happy to do most of your visits at home if you prefer.

If you’re outside these areas but within a reasonable drive, please still call. We’ll let you know whether we can come to you, and if we can’t, we’ll do our best to connect you with a midwife who can.