FAQs | Desert Rain Midwifery

FREQUENTLY ASKED QUESTIONS

This question is critical for clients, partners, and support people to ask themselves in order to find the model of care that works best for you. While there are many layers to answering this question that are unique to each individual, I invite you to seriously consider the following.

There is a difference between actively desiring a homebirth and wanting to avoid the hospital. Actively wanting something sits differently in our bodies than does seeking to avoid something. Motivation arising from truly desiring homebirth tends to call forth qualities - opening, courage, questioning, resilience - that support engagement in midwifery care and embracing the realities of birthing at home. Motivation arising from trying to get away from something (such as the hospital or intervention) tends to call forth closing and a pervasive sense of fear and anxiety. These emotions often show up most strongly in vulnerable moments, such as late pregnancy or labor.

That said, homebirth with Desert Rain Midwifery will likely be a good fit if the following are true for you:

You view birth as primarily a natural life experience

You have a desire to experience the full spectrum and intensity of labor sensations

You would like to share responsibility for your care and birth outcomes with your midwife in an evidence-based context

You embrace hard work

You accept facing the unknown (with support!)

Relationship with your care provider is important to you

If, however, the statements below are more true for you, then homebirth is likely not a good fit, nor are you likely to be pleased with the Desert Rain Midwifery model of care should you choose it:

You don’t like hospitals or want to avoid something (such as cesarean birth, continuous electronic fetal monitoring, intervention, or trauma)

You believe birth is first and foremost a risky medical event

You prefer to relinquish responsibility for your care and birth outcomes to a care provider

During my nearly two decades of birthwork, I have found these to be the most important (and the most often overlooked) considerations to honestly sit with prior to entering care. I am happy to talk with you about this.
In a nutshell, yes, homebirth is safe for low risk women/birthing people and their babies in the context of appropriate preparation and professional support, or we would not offer this service.

Any discussion of safety requires a precise definition of homebirth. When Desert Rain Midwifery refers to homebirth, we mean a planned birth at home attended by a trained and licensed midwife. This midwife brings the necessary education, skills, experience, safety equipment, and medications to attend to emergencies that may arise. This midwife appropriately discerns who is low risk and thus eligible for homebirth. Regular prenatal care has preceded this birth.

Homebirth DOES NOT mean an accidental birth at home in the bathtub by yourself before you could get to the hospital (this is an unplanned birth at home). Homebirth DOES NOT mean having the baby in the car with your partner while you drive to the hospital (this is an unplanned car birth). Homebirth DOES NOT mean planning to birth your baby at home WITHOUT a trained medical provider present (this is a freebirth, see FAQ about freebirth).

Some research lumps together all people who have their babies outside of a hospital or birth center under the umbrella term homebirth. Unfortunately, such research does not distinguish whether or not this was a planned event, whether or not a midwife or other medical provider was present, whether or not the birthing person received adequate prenatal care, and whether or not the birthing person was screened appropriately for low risk status. Outcomes are very different depending upon these factors, so the definition of homebirth matters.

High-quality research associates homebirth – planned with a midwife for low risk women – with the following:

Decreased rates of obstetric intervention when compared to hospital birth

Less cesarean births (also known as c-sections)

Less forceps-assisted births

Less vacuum-assisted births

Less perineal tearing

Less postpartum hemorrhage

Risk of fetal or newborn death comparable to hospital

Of note, 2 studies found an increased risk of early neonatal death when compared to hospital birth for women having their first baby or for women attempting VBAC with no prior history of a vaginal birth. The overall risk for early neonatal death in these populations is low (less than one half of 1%).

Safety for mother/birthing person and baby comparable to planned birth center birth

Moderate-quality research associates homebirth – planned with a midwife for low risk women – with the following (these findings can also be considered elements of safety):

More maternal satisfaction with the birth experience when compared to hospital birth

More maternal autonomy when compared to hospital birth

Less provider mistreatment compared to hospital birth

Homebirth safety is enhanced when there is effective coordination with higher levels of care, including well-established transfer-to-hospital protocols. This is why Desert Rain Midwifery requires that clients live within 30 minutes of a hospital. We maintain excellent collaborative relationships with local hospital-based providers and perinatal specialists. We consult regularly with these colleagues and are very grateful for them! Our collaborative relationships are part of what makes Desert Rain Midwifery strong and what helps keep you safe.

If you would like the below articles used as the research for this explanation, please ask! We are happy to share them with you.

References

Bovbjerg, M. L., Cheyney, M., Hoehn-Velasco, L., Jolles, D., Brown, J., Stapleton, J., Everson, C., & Stapleton, S. (2024). Planned homebirths in the United States have outcomes comparable to planned birth center births for low-risk birthing individuals. Medical Care, 62(12), 820-829. https://doi.org/10.1097/MLR.0000000000002074

Palmer, M., Gordon, V., Bronkema, J., Christianson, A., & Hall, P. (2026). Midwifery provision of homebirth services. Journal of Midwifery & Women’s Health, 0(0), 1-12. https://doi.org/10.1111/jmwh.70081
What is a CNM? A word on different types of midwives…

CNM = Certified Nurse Midwife

A certified nurse midwife is a master or doctorate level trained nurse who is an independent health care provider. A CNM is one of four types of Advanced Practice Registered Nurses, equivalent to a nurse practitioner. CNMs specialize in care for women and pregnant/birthing people and their babies during the childbearing year. They also provide gynecological care and basic primary and mental health care. CNMs at Desert Rain Midwifery provide prenatal, labor, birth, postpartum, and newborn services; well-woman/person exams; paps; birth control; screening and treatment for vaginal infections and sexually transmitted infections; and first line treatment for anxiety and depression. CNMs do not provide cesarean birth, forceps-assisted birth, or vacuum-assisted birth. In addition to the CNM credential, all CNMs are also registered nurses (RN).

CNMs can legally practice in all 50 states and work in homes, birth centers, and hospitals. Most CNMs work in hospitals, as this is where the bulk of their training occurs. A CNM in New Mexico is an independent practitioner, meaning they work under their own authority, not under another provider such as a medical doctor. CNMs have full prescriptive privileges, which means they can prescribe medications. Most carry malpractice insurance.

Desert Rain’s midwives are CNMs. We respect and have collegial relationships with many midwives whose credentials differ from ours. We want there to be a midwife to fit every client who desires one! If we are not a good fit for you, we may know someone who is.

CPM = Certified Professional Midwife

Certified Professional Midwives are independent practitioners specializing in community birth. They provide care for low-risk women/birthing people and babies in the childbearing year including prenatal, labor, birth, postpartum, and newborn services. Many also provide some gynecology care such as paps and well-woman/person care.

CPMs are trained in one of two ways: 1) by completing an educational program accredited by the Midwifery Education Accreditation Council or 2) by completing a, usually multi-year, apprenticeship-based model with a qualified preceptor. All of their clinical training occurs in the community birth setting. CPMs are not required to become nurses first, nor are there degree requirements as there are with CNMs though some CPMs choose to pursue these credentials.

CPMs work in homes and freestanding birth centers; they cannot work in hospitals unless it is under a different credential. In New Mexico, CPMs can carry and administer birth-related medications stated on their licensure formulary (anti-hemorrhage medication, antibiotics for GBS positive status, oxygen, newborn medications). They cannot prescribe medications and they usually do not carry malpractice insurance. CPMs can legally practice in 30+ states and New Mexico is one of them!

LM = Licensed Midwife

In New Mexico, CPMs are licensed by the Department of Health and receive the LM credential through this process. They can choose to become CPMs first and then seek LM licensure, or obtain LM licensure first and then seek CPM credentialing if desired. This is why you may see some midwives with both CPM and LM behind their name.
In the United States, community birth means birth occurring at home or in a freestanding birth center – in other words, not in the hospital. Community births are planned – they’re not accidents on the way to the hospital! – and they are attended by trained medical professionals, usually midwives.
What is evidence-based care?

Evidence-based care is a way of deciding what to do and not do when providing healthcare. It is made up of three pieces:

Evidence from research – clinical trials, studies, interviews, surveys, and more

Clinician expertise – at Desert Rain Midwifery, the clinician is your midwife

Client values and preferences – in other words, what matters to you!

Desert Rain Midwifery provides evidence-based care. This means that we depend on all three pieces – research, clinician expertise, and client values/preferences – to make decisions and determine the course of care. This is a collaborative process between client and midwife. (See shared responsibility for more on this collaboration.)

We seek to find the highest quality research that is most relevant to each clinical scenario and share with you what this research says and why it matters. Often we encounter areas of care for which there isn’t research, or only poorly done research. Rarely is there a one-size-fits-all answer, and research is only one piece of the puzzle. The other two pieces - the midwife’s expertise (which comes from her education, skills, and experience in community birth) and, very importantly, what matters to YOU – are critical in navigating a way forward.

Evidence-based care is NOT doing something because that’s the way it has always been done. Evidence-based care is NOT blind allegiance to a study or trial or article. Evidence-based care is thoughtful, discerning, and nuanced. Evidence-based care is open to change, with reason, but does not support change for the sake of change.

For a great client-friendly resource that dives into evidence-based care as it relates to birth, we recommend Evidence-Based Birth.
Homebirth safety requires, in part, that the birthing person be low risk. A critical part of the midwife’s role is appropriately identifying who is low risk and eligible for homebirth care. For those who are higher risk, a hospital birth is recommended.

In order to make this determination, the midwife will thoroughly review your health history to determine your status prior to accepting you into care. She will reassess risk status throughout care as health conditions change and/or complications arise. The information below is meant to give you an idea of what the midwife considers. This information is NOT all-inclusive. If you have any questions regarding your status, please schedule a consult with Desert Rain Midwifery.

In general, low risk means that the following are true for you:

Age 15-44 at the time of birth

Able to move your body freely in day to day life and in pregnancy (no physical limitation that would limit walking or getting in and out of bed, a bathtub, an exam table, or a car on your own)

Expecting one baby (not twins or triplets!)

Received prenatal care in this pregnancy consistently since at least 28 weeks

Current pregnancy is without complication(s)

Make an effort to eat as nutritiously as you can given your life circumstances and budget

Have a physically and emotionally safe home environment

May have some health conditions – hypothyroid, depression, anxiety, mild asthma, and others – that are effectively managed and under the care of a medical professional

Without intoxicating substance use including nicotine/tobacco, THC, alcohol, prescription and illegal drugs

Without previous serious lower back or pelvic injury

No history of major medical condition(s) – this includes medication-controlled diabetes and high blood pressure

If you have given birth before, you:

May have had ONE (not more than one) cesarean birth (c-section)

May have had one (not more than one) pregnancy with pre-eclampsia that did NOT require blood pressure medication. If your pre-eclampsia incidences were in the postpartum period ONLY then this does not affect your eligibility for care.

May have had diet-controlled gestational diabetes in previous pregnancies, NOT insulin-controlled

Have NOT had two postpartum hemorrhages in a row of 1500 ml or more

Things that don’t necessarily risk you out of care on their own but may play a role if other risk factors are present:

Significantly under or overweight at start of pregnancy

Required fertility services to conceive this pregnancy including IVF
This is a necessary question to ask when planning a homebirth because birth is such an unknown. This is part of birth’s beauty and part of its challenge. We cannot predict what kind of labor you will get. Doing all the “right” things does not guarantee you will birth in the place you desire – if only! That said, what you can count on is that the midwife will always let you know what she recommends and why, discuss options, and help you navigate next steps with thoughtfulness and compassion.

With that as context, transfer may occur during any point in your care based on changing health conditions. Transfer will ALWAYS occur in conversation with you, so that you understand the reasons why a higher level of care is recommended, what to expect, and what next steps look like. Once transfer is decided upon, the midwife consults a collaborative hospital provider, sends records, and accompanies you to the hospital if the transfer occurs during active labor or in the immediate postpartum period. If you have a doula, the doula remains with you through your hospital experience.

The vast majority of transfers that happen in prenatal, labor, birth, and the immediate postpartum period are NOT emergencies and can occur by private vehicle. Rather, they are because things are starting to veer from the broad range of normal; the midwife recognizes this and transfers TO KEEP things as normal as possible with the interventions the hospital offers. When an emergency does occur, transfer is facilitated by ambulance as quickly as possible while the midwife uses her expertise to stabilize things until arrival in hospital.

Once you and baby are discharged from the hospital, the midwife resumes postpartum and newborn care (as long as you and baby remain eligible) at Desert Rain Midwifery the same way as if you had birthed at home. An important element of care is helping you process the reasons for transfer and your birth in hospital.

Any care provided outside of Desert Rain Midwifery, such as ambulance or hospital services, is billed directly to client’s insurance.
Laboring at home means experiencing the full spectrum and intensity of labor sensations. Pain coping options that Desert Rain Midwifery offers do not take away the pain. They are meant to help you get through what you’re experiencing by decreasing the pain somewhat, helping you to feel safe, and minimizing suffering. This is very different from pain relief (such as an epidural, available only in hospital), which attempts to remove pain as much as possible. Pain relief is NOT available at home; pain coping options are. For more information on the difference between these two, click here.

The following pain-coping options are available to you at home:

Water – tub and/or shower

Movement and positioning

Heat packs

Massage / physical touch

Consistent, reassuring presence

Sterile water papules

For repair of perineal tears after birth, we offer (and recommend!) lidocaine to numb the area.

We also recommend that you consider obtaining the following to help with pain-coping:

A doula

TENS unit (many doulas offer a TENS unit as part of their services)

Taking childbirth preparation classes that focus on pain coping, such as Birthing from Within or Hypnobirthing

See our Resources page for information on local doulas and childbirth classes.
Yes, waterbirth is an option with Desert Rain Midwifery! If you have an oversized clean bathtub, that will likely work. A regular-sized bathtub is not big enough. The midwife will confirm bathtub capacity and safety at the 36-week home visit. If your home does not have a bathtub or a big-enough bathtub, we recommend that you purchase a birth pool. Even if you don’t think you’d like a waterbirth, you might consider laboring in warm water (called water immersion) as this can be very helpful for pain coping.

For low-risk women and birthing people, waterbirth is safe. For more information on what the evidence says, click here.
If you have had one previous cesarean birth, you are eligible for a homebirth with Desert Rain Midwifery. Your surgery needs to have been an uncomplicated low transverse cesarean section. Desert Rain Midwifery requires your operative report from the cesarean birth, and we will need to make sure that your current pregnancy’s placenta has not implanted over your previous cesarean scar. In labor, we will place an IV port in your hand or arm as an extra precaution.

The likelihood of delivering vaginally after a previous cesarean birth is influenced by many factors. Research has identified some of these factors. We are happy to have a conversation with you based on your unique health history and how this relates to what we know about VBAC success.

For information around safety, benefits, and risks of vaginal birth after cesarean (VBAC), please click here.

There is debate among expert bodies around whether or not someone who has had a previous cesarean birth can be considered low risk and thus eligible for homebirth care. One study of Certified-Professional-Midwife-attended homebirth VBACs found a high likelihood of successful VBAC at home (87%), but an increased risk of transfer, maternal blood loss, postpartum infection, uterine rupture, NICU admission, and neonatal death (less than one half of 1%) compared to women/birthing people without a history of cesarean birth. Because Desert Rain Midwifery believes in a woman’s right to choose place of birth and the evidence around VBAC at home is not conclusive, we support homebirth VBAC care for those who desire it with precautions in place. That said, it is important that you understand that attempting a VBAC at home means a longer time to emergency services (should this become needed) due to transport time to the hospital. This delay could negatively affect outcomes. Attempting a VBAC with a hospital-based provider allows for more immediate access to emergency services should they be needed.

If you have had two or more previous cesarean births you are NOT eligible for homebirth care and we strongly recommend that you birth in hospital.
A doula is someone trained in providing social-emotional support during labor and birth. A doula serves as a reassuring presence throughout your experience. They can assist with positions and natural pain-coping methods, share information and suggestions, and help advocate for you. Doulas do not provide medical care. Research shows that doulas “improve birth outcomes and increase satisfaction with the birth experience” (ACNM Birth Doula Position Statement, 2022). For an evidence-based overview on the benefits of doulas, click here. In our experience, people who have a doula cope with labor more effectively and feel better about their experience regardless of where they birth.

We recommend doulas for all of our clients who desire one! If this is your first baby or your first time giving birth without an epidural, a doula is required. See First Unmedicated Birth Requirements for more information.
In order to have a homebirth with Desert Rain Midwifery, we ask that your home:

Be physically and emotionally safe for you

Within 30 minutes of a hospital

Have electricity, adequate heating and cooling, running water, and internet service

Maintain a basic level of cleanliness (NOT spotless or clutter-free!) – no active bug or rodent infestation, no visible grime in the kitchen or bathtub, safe to walk on floors, clean bedding and towels, etc.

Have a space where you can have privacy without family members and/or animals if desired

Beyond that, we DO NOT CARE if you live in an apartment, a house, a mobile home, an RV, a yurt, or if your home is big and fancy or simple and small. We are not there to judge, just to provide you with the best possible care we can. ☺
It’s OK! One of the beauties of midwifery care is that you are supported. This includes changing your mind about whatever, whenever. The midwife’s job is to listen when you are asking for more or different support and take action as needed. This support might take the form of information, reassurance, or a different coping technique at home. Or it could mean a more significant change in plans such as transferring to the hospital. Whichever it may be, the midwife will help you obtain the help you need, as much as she is able.

What do women/birthing people tend to change their mind about? Anything and everything! They may have thought they wanted a bunch of people as additional labor support, but when the time comes they only want their partner. Or maybe they spent months visualizing a waterbirth, but in the moment they feel more effective pushing on land. Or as the due date comes and goes, they discover they actually would feel safer birthing in a hospital. Or when the intensity of labor comes, they decide they want an epidural. All of this is OK and not a failure! It’s part of being human, learning about yourself, and responding to what you need in the moment. It can be courageous, actually, to allow yourself to change your mind.

Desert Rain Midwifery does not provide refunds for transfers due to a client’s change of mind. For details, please see Desert Rain Midwifery’s financial policy, which will be reviewed with you at your initial consult.
Freebirth means planning to birth at home unassisted – that is, without a trained midwife or medical provider present. This isn’t an accident; this is the plan. There has been a recent rise in freebirth visibility through social media influencers. The (in our opinion, false) belief portrayed via social media seems to be that if you are natural enough, cool enough, healthy enough, or believing enough, freebirth is a safe option for you. We strongly disagree. We also understand that some people live in areas where midwifery care, community birth care, or what they feel is safe or desired hospital birth options are not available to them, so they consider freebirth.

Desert Rain Midwifery does NOT recommend that anyone have a freebirth. While we believe that birth for low risk women/birthing people is primarily a natural life event, we also know that birth can veer from normal quickly and seriously. Without the expertise of a trained medical professional to both determine low risk status and to act in emergency situations, freebirthers are putting themselves and their babies at serious risk. A hallmark of homebirth safety is the presence of a trained and licensed medical professional at the birth; an approach that eliminates this crucial component is not one we support.

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