A home birth midwife provides all your prenatal care (usually 10-12 visits), attends your labor and birth at home, monitors you and your baby for complications, and provides postpartum care for 6 weeks. Most midwives stay for 2-4 hours after the birth to make sure you're both stable.
If you're considering home birth, you probably know midwives do more than catch babies. But the scope of what they actually do, from the first prenatal visit through the weeks after birth, isn't always clear. Here's what you're paying for when you hire a home birth midwife, broken down by what happens at each stage.
You'll typically have 10-12 prenatal appointments, each lasting 45-60 minutes. That's longer than the 10-15 minute appointments most OBs offer. Your midwife checks your blood pressure, measures your belly, listens to the baby's heartbeat, and orders routine labs and ultrasounds.
She also talks through your birth plan, answers your questions, and discusses what to expect during labor. Many midwives spend time on nutrition, positioning, comfort measures, and what situations would require hospital transfer. You're not just getting checked, you're getting educated.
Most midwives schedule visits monthly until 28 weeks, then every two weeks until 36 weeks, then weekly until you give birth. Some include home visits in the last month to check your birth space and make sure you have the supplies you need.
Your midwife arrives with medical equipment in a large bag or two. This typically includes oxygen (for you and baby), IV supplies and fluids, medications to stop hemorrhage, suturing supplies, a doppler or fetoscope for monitoring the baby's heart rate, and a blood pressure cuff.
She also brings resuscitation equipment for the baby, including an infant bag and mask for breathing support. Most midwives carry the same emergency medications you'd find in a hospital delivery room: Pitocin, methergine, or misoprostol for bleeding, and lidocaine for stitching.
Some midwives travel with a birth assistant or second midwife, especially if you're having your first baby or live far from a hospital. Others come alone and call a backup if needed.
Your midwife monitors the baby's heart rate regularly (usually every 15-30 minutes in active labor, every 5-15 minutes during pushing). She checks your blood pressure and temperature periodically. She doesn't do continuous monitoring like you'd have in a hospital, but intermittent monitoring is the standard of care for low-risk labor.
She helps you change positions, get in and out of the tub if you're using water, and offers hands-on support like counterpressure or hip squeezes. She watches for signs that labor is progressing normally and watches for red flags that would mean you need to transfer.
She doesn't do routine cervical exams unless you want them or she's concerned about progress. Many midwives check you once or twice, or not at all if everything seems to be moving along.
Your midwife puts the baby on your chest immediately if the baby is breathing well. She monitors the baby's color, breathing, and tone while the baby is skin-to-skin with you. If the baby needs help, she suctions the airway, rubs the baby's back, or provides oxygen or breathing support.
She waits for the placenta to deliver (usually 10-30 minutes), checks it to make sure it's complete, and monitors your bleeding. If you tear or need stitches, she numbs the area and repairs it. She helps you start breastfeeding, usually within the first hour.
She checks your blood pressure, pulse, and bleeding regularly during the first two hours. She watches for signs of hemorrhage, which is the most serious immediate risk after birth. Most midwives stay for 2-4 hours after the birth before cleaning up and leaving you to rest.
Your midwife does a full newborn exam within the first hour or two after birth. She checks the baby's heart rate, breathing, muscle tone, reflexes, and looks for any abnormalities. She weighs and measures the baby.
She offers (but doesn't require) vitamin K, antibiotic eye ointment, and heel stick screening for metabolic disorders. You can decline any of these. Most midwives draw the newborn screening blood themselves and send it to the state lab, though timing varies by state (some require it within 24 hours, others within a few days).
She checks the baby again at each postpartum visit, watching weight gain, jaundice, feeding, and elimination. If the baby isn't gaining well or shows any concerning signs, she refers you to a pediatrician.
Most midwives include three postpartum visits in their fee: one within 24-48 hours, one at 1-2 weeks, and one at 4-6 weeks. Some do more. These visits happen at your home.
At each visit, your midwife checks your bleeding, your uterus (to make sure it's shrinking), your blood pressure, and any tears or stitches. She checks how breastfeeding is going, watches for signs of postpartum depression or anxiety, and answers questions. She weighs the baby and makes sure feeding and diaper output look normal.
You can also call or text your midwife between visits if you have concerns. Most midwives offer phone support for at least six weeks postpartum, and many stay available by text much longer.
The average home birth midwife fee ranges from $3,000 to $6,500 depending on your area. This is a global fee that covers everything: all prenatal visits, the birth, immediate postpartum care, and follow-up visits. You don't pay extra if you have a long labor or if your midwife stays for 12 hours.
This fee doesn't usually include lab work, ultrasounds, or genetic testing, which you'll pay for separately. It also doesn't include supplies you need to buy for the birth (usually $50-$150 in items like underpads, receiving blankets, and basic first aid supplies).
Some insurance plans cover home birth with a licensed midwife. As of 2024, 11 states require Medicaid to cover home birth, and some private insurers reimburse part or all of the fee. Your midwife can tell you if she bills insurance or if you need to file for reimbursement yourself.
With insurance coverage, after deductibles and copays
Source: Health Care Cost Institute 2023, MANA Stats 2023
Your midwife transfers you if you develop a condition that's outside the scope of home birth. Common reasons include labor that stops progressing after many hours, meconium in the amniotic fluid (baby's first bowel movement, which can signal distress), a baby whose heart rate shows concerning patterns, or bleeding that doesn't stop.
Some conditions require immediate transfer by ambulance: severe hemorrhage, a baby who doesn't breathe despite resuscitation, a prolapsed umbilical cord, or seizures. These are rare. Most transfers happen during labor and aren't emergencies, you go by car with your midwife or partner.
Transfer rates vary by study but typically range from 10-30% for first-time mothers and 4-9% for mothers who've given birth before. Your midwife stays with you at the hospital in most cases, though she hands over medical care to the hospital staff.
A home birth midwife provides full-spectrum maternity care, not just labor support. When you interview midwives, ask how many prenatal visits they include, whether they bring a second attendant, what their postpartum schedule looks like, and what's included in the fee versus what you pay separately. If you want to know if a midwife is a good fit for you specifically, ask what her transfer rate is and what situations she's transferred for in the past year.