"The home-birth was an experience that I would recommend to anyone who is interested in natural childbirth. ...The satisfaction with how the delivery went has made a big difference for me mentally, emotionally, AND physically..."

Frequently Asked Questions

Is homebirth legal in Iowa?
What’s a nurse-midwife, and how is it different from other types of midwives or an obstetrician?

Is homebirth safe?
What about birth centers?
What about planned hospital birth?
Do you attend waterbirths?
Do you take insurance?
What does a homebirth cost? What does that cover?
What is not covered?

Is homebirth legal in Iowa?

Yes, it’s legal! However, as of this writing, a certified nurse-midwife (CNM) is the only kind of midwife who can legally attend homebirth in Iowa. (Physicians could legally attend homebirths as well, but very few choose to, and I am not currently aware of any who are doing so.) For more information on different types of midwifery, see "What's a nurse midwife...?" below.

What’s a nurse-midwife, and how is it different from other types of midwives or an obstetrician?

A certified nurse-midwife is a nurse who holds a master’s degree in midwifery—essentially, a type of nurse practitioner who is licensed and qualified to manage the care of healthy women and newborns. Unlike obstetricians, who are surgeons specializing in pathology and abnormality, our major specialty is normal. Our scope of practice includes minor illnesses and GYN concerns, contraception, care during pregnancy and birth, and postpartum care. We can also care for the well newborn up to six weeks of age. There are other capable, competent types of midwives, such as Certified Professional Midwives (CPMs), as well as many who choose not to seek any type of licensure, but at this time, CNMs are the only midwives legal under Iowa law. This does not mean that you will face prosecution for having a homebirth with a non-nurse midwife, but your midwife may, and it can also have implications for her ability to order tests and communicate with other healthcare providers (such as pediatricians). The type of midwife you choose to attend your birth is a personal choice, with no right or wrong answer. Please let me know if you have other questions.

Is homebirth safe?

Yes. Well-designed studies have repeatedly demonstrated the safety of planned homebirth for healthy women. In countries where midwives routinely care for low-risk women during labor and birth (as opposed to the United States, where they are cared for by high-risk surgical specialists known as obstetricians), fewer women and babies die, far fewer Cesareans occur, breastfeeding rates are higher, and childbirth is generally safer. In 2009, a study published in BJOG: An International Journal of Obstetrics and Gynaecology followed over a half million women under midwifery care, 60% of whom planned a homebirth, 30% of whom planned a hospital birth, and 8.5% for whom their intended place of birth was unknown. Analysis over a period of seven years and including intrapartum death, neonatal death, death within 7 days, and neonatal admission to the intensive care unit were analyzed and “no significant differences were found between planned home and planned hospital birth” in the given parameters (de Jonge et al., 2009).


So what about the recently published American College of Obstetricians and Gynecologists (ACOG) statement which claims that “published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births”?

In short, two factors help explain why the conclusions of the Wax homebirth study differ so radically from other studies that have gone before it. First, the quality of the evidence: it’s well-accepted in statistics that the larger your sample size, the more accurate your data is likely to be. The sample size in the de Jonge study was 321,307. That’s 33x the size of the Wax sample size (9,811). Another major factor affecting the quality of the conclusions drawn by the Wax analysis was that it included unintended homebirths in the reporting of the neonatal death rate. This doesn’t make much sense when you’re trying to decide whether to plan a homebirth for yourself—because by definition, nobody plans an unplanned homebirth! Births that occur unexpectedly at home are obviously going to be less safe than those which are planned for and have a trained attendant present.

The other factor, which helps explain why ACOG would not only accept but widely publicize the results of a study that a Canadian doctor, researcher, and professor calls “Garbage in, garbage out,” is that it is first and foremost a trade organization—one which exists to protect and promote the financial interests of its members. Hence the release of the above “opinion”—not “news bulletin,” or “summary of scientific fact,” but “opinion.” As Upton Sinclair is reported to have said, “"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" Since very few doctors are attending homebirths, and the satisfaction rating for midwives and homebirth is through the roof compared with that of doctors and hospitals, I’d say that an obstetrician’s salary just might depend on "his not understanding” the safety of planned homebirth.

For more information on criticisms of the Wax meta-analysis, author and journalist Jennifer Block has an excellent summary here, and CNM, researcher, and former Yale faculty Amy Romano takes an in-depth look here.

de Jonge, A., et al. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG, 116(9):1177-84.

Wax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta analysis. American Journal of Obstetrics and Gynecology, 203(3):243.e1-8.

What about birth centers?

Birth centers are a wonderful option for women desiring a supportive environment for a natural birth. Unfortunately, at this time there are no freestanding birth centers in eastern Iowa. (However, we are excited to witness the "birth" of the Healing Passages Birth & Wellness Center in Des Moines!) Many hospitals bill their maternity wards as “birth centers,” but these are in fact standard labor and delivery units housed on the grounds of the hospital, with typical rates of intervention and restrictions on the freedoms of laboring women—which can include prohibiting eating and drinking, routine separation of mom and baby, and frequent supplementation with infant formula.

Many families ask about a birth center birth because of the perception that it is safer than homebirth—“the best of both worlds,” with the comfort of home but the safety of the hospital. In fact, a homebirth midwife carries the same equipment with her (oxygen, anti-hemorrhage medications, resuscitation equipment) that is standard at any birth center, making homebirth at least as safe as a birth center--with the added benefit that the mother is generally even more comfortable and relaxed on her own turf. The main exception to this would be if you live quite far from the nearest hospital (birth centers are typically located within a certain proximity to a medical center) and needed to transfer emergently. However, most homebirth transfers are non-urgent in nature, and multiple studies have shown that for low-risk women, the safest option may be avoiding the interventions standard in the hospital altogether, and giving birth out-of-hospital with a trained midwife in attendance.

What about planned hospital birth?

We only attend births in the home. However, if you desire natural birth but know that hospital birth is right for you, we would be happy to suggest questions to ask potential hospital providers, as well as recommending local natural-birth-friendly practitioners, in order to help you choose one that is a fit for you.

Do you attend waterbirths?

Absolutely! Many practitioners and institutions are comfortable with women laboring in the water, but will ask you to shift your focus and get out of the tub precisely as you're about to give birth! We're very strong supporters of waterbirth--the  majority of births we have attended have been waterbirths, and both of my children and several of Dara's were born in the water as well. In addition to providing superb relaxation and pain control, we also like the fact that it carves out a private space in which the mother can labor and birth, and we think it offers impressive benefits in reducing lacerations (tears) and increasing mobility for position changes as well.

Do you take insurance?

We do. we work with a billing company who is able to submit claims to your insurance for your care. This gives clients the opportunity to utilize the benefits they are paying for, while it allows us to focus on what we do best--midwifery, not insurance claims! That being said, as a small, intimate practice where your providers will know you well and you can have confidence that we will be the ones to attend your birth, we do request payment in full by 34 weeks, regardless of your insurance status. This way, the last weeks of your pregnancy don't include worries about money, and we are able to keep the practice financially viable for the benefit of all women and families desiring homebirth with us. After the birth, the billing company will then work with your insurance to maximize the reimbursement received.  

Due to the nature of the insurance agency, neither Eastern Iowa Midwifery nor the billing agency can guarantee reimbursement of any claims. While we realize the initial outlay is high for many families, people with very low incomes have paid for their dream births in a variety of creative ways, including careful budgeting, loans from family members, gifts from baby shower attendees, proceeds from a bake sale or yard sale, selling on eBay or Etsy, etc. Some people think of it this way: it almost definitely costs less than a wedding, and has a much larger implication for your family's future! 

Note to Medicaid recipients: Unfortunately, at this time we are unable to accept Medicaid, as their reimbursement is too low to cover the costs incurred by the care we provide. However, many of our clients who are eligible for Medicaid opt for our cash-pay discount and are then pleased to find that at least their labs, ultrasounds, and any consulting medical care (if needed) are usually covered by the plan.

What does a homebirth cost? What does that cover?

Please contact me for an up-to-date listing of fees and costs; I'll be happy to get one to you right away. Our overall cost includes all prenatal care, the birth, and postpartum checks up to and including 6 weeks for mom and baby. We typically provide prenatal care in clients' homes or, for those living outside the Cedar Rapids/Iowa City area, in my home office (located in northwest Cedar Rapids). During late pregnancy (around a month before the due date), we will usually do a longer visit in the clients' home to get familiar with the surroundings and meet any support people they anticipate inviting to their birth. We make sure supplies are on hand and ready to go. If a waterbirth is planned, we talk in detail about how to make sure things are ready for that, and we can provide an inflatable birth pool if desired. We then typically see clients once or twice a week until the baby is born. Dara and I are on call for and attend the birth together. We remain with you until the baby is born, you are stable, the baby is nursing, and everyone is comfortable and happy. One or both of us will then usually return for postpartum visits sometime in the first week and as needed, and a visit is typically scheduled for around two weeks and six weeks as well. These involve checking weight and vital signs on the baby, assessing how the mother is healing, supporting breastfeeding, and being a listening ear for any concerns that arise. This can also include assistance with birth control if desired. 

What is not covered?

Lab services, such as the neonatal metabolic screening (PKU test), and the prenatal panel of labs are an additional charge, although if you have insurance, it will likely cover many of these costs. If you do not have insurance, these costs range from $65 for a typical prenatal panel of labs, to $112, which is the fee set by the State Hygienic Laboratory for processing the newborn heelstick blood test.  Another additional cost is the birth kit; this can be ordered from www.preciousarrows.com (under "Birth Kits," look under "E" and "Eastern Iowa Midwifery") and includes many of the one-time-use supplies that will be needed during and after your birth. The cost for this is approximately $50and ships for free.

Dara and I attend all births together unless some rare exception occurs, but if you would like the additional services of a professionally trained doula of your choice, it would be your responsibility to contract separately for these.

Please let me know if you have any other questions! We look forward to talking with you.

Is homebirth legal in Iowa?
Currently, there is no prohibition against homebirth in Iowa—so yes, it’s legal! Confusion sometimes sets in regarding the type of midwife who can legally attend a homebirth. As of 2011, a certified nurse-midwife (CNM), a nurse who holds a master’s degree in the study of midwifery, is the only kind of midwife legal in Iowa. (Physicians could legally attend homebirths as well, but very few choose to, and I am not currently aware of any physicians who are openly attending homebirths in Iowa at this time.) There are other types of midwives who give safe, legitimate care, such as Certified Professional Midwives (CPMs), who obtain their training through apprenticeship and take a national licensure exam—but they are not currently legal in Iowa. They are legal in other states, including neighboring Wisconsin, and there is an ongoing grassroots movement to legalize CPMs in Iowa (see Friends of Iowa Midwives for more information), but this has not yet taken place.

Is homebirth safe?
Despite what you may have heard recently in the news, well-designed studies have repeatedly demonstrated the safety of planned homebirth. In countries where midwives routinely care for low-risk women during labor and birth (as opposed to the United States, where they are cared for by high-risk surgical specialists known as obstetricians), fewer women and babies die, far fewer Cesareans occur, breastfeeding rates are higher, and childbirth is generally safer. In 2009, a study published in BJOG: An International Journal of Obstetrics and Gynaecology followed over a half million women under midwifery care, 60% of whom planned a homebirth, 30% of whom planned a hospital birth, and 8.5% for whom their intended place of birth was unknown. Analysis over a period of seven years and including intrapartum death, neonatal death, death within 7 days, and neonatal admission to the intensive care unit were analyzed and “no significant differences were found between planned home and planned hospital birth” in the given parameters (de Jonge et al., 2009).
So what about the recently published American College of Obstetricians and Gynecologists (ACOG) statement which claims that “published medical evidence shows it does carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births”?
In short, two factors help explain why the conclusions of the Wax homebirth study differ so radically from other studies that have gone before it. First, the quality of the evidence: it’s well-accepted in statistics that the larger your sample size, the more accurate your data is likely to be. The sample size in the de Jonge study was 321,307. That’s 33x the size of the Wax sample size (9,811). Another major factor affecting the quality of the conclusions drawn by the Wax analysis was that it included unintended homebirths in the reporting of the neonatal death rate. This doesn’t make much sense when you’re trying to decide whether to plan a homebirth for yourself—because by definition, nobody plans an unplanned homebirth! Births that occur unexpectedly at home are obviously going to be less safe than those which are planned for and have a trained attendant present.
The other factor, which helps explain why ACOG would not only accept but widely publicize the results of a study that a Canadian doctor, researcher, and professor calls “Garbage in, garbage out,” is that it is first and foremost a trade organization—one which exists to protect and promote the financial interests of its members. Hence the release of the above “opinion”—not “news bulletin,” or “summary of scientific fact,” but “opinion.” As Upton Sinclair is reported to have said, “"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" Since very few doctors are attending homebirths, and the satisfaction rating for midwives and homebirth is through the roof compared with that of doctors and hospitals, I’d say that an obstetrician’s salary just might depend on his “not understanding” the safety of planned homebirth.
For more information on criticisms of the Wax meta-analysis, author and journalist Jennifer Block has an excellent summary here, and CNM, researcher, and former Yale faculty Amy Romano takes an in-depth look here.

de Jonge, A., et al. (2009). Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births. BJOG, 116(9):1177-84.

Wax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta analysis. American Journal of Obstetrics and Gynecology, 203(3):243.e1-8.