For Parents

How do I find a Midwife?

You can find Midwives by using a search engine, Facebook, Instagram or Yelp. Most Midwives will have some online presence. You can also contact an association like the Iowa Midwives Association to be forwarded to Midwives in your area. In true Iowa fashion, word of mouth and direct referrals from happy families is how most midwives get new clients. You can also search through local Facebook groups to see if certain practices tend to be recommended, but just remember like anything else, everyone has their own opinions and experiences that may not be the same as your own. We recommend meeting with at least a few Midwives (if possible) to make sure your personal goals for health and their midwifery philosophy align.

How do I know if she's licensed?

You can find out if your Midwife is licensed in the state of Iowa by visiting:

Iowa Board of Nursing: Certified Professional Midwives
Iowa Board of Nursing: Certified Nurse Midwives

Who should consider a homebirth?

Having your baby at home is safest for those with no chronic health conditions such as hypertension or diabetes and have an uncomplicated gynecological history. The best candidates are those who have had a vaginal birth before without complications. However, homebirth is an option for first time parents or other special circumstances depending on your health and previous birth history. The best way to find out if you are a good candidate for a homebirth is to have a consultation with a homebirth midwife to go over your history.

How much does a homebirth cost?

Midwifery services in Iowa have a wide range of prices depending on location, specialty, travel necessary and access to resources. On average you are looking to spend $4500-$7000 to hire a Midwife for maternity care. This cost covers all of the care provided by the Midwife, but does not cover any services performed by a third party, such as labwork or ultrasounds. Fortunately, most routine labwork and ultrasounds can be billed to your insurance or provided at a steep self-pay discount. Some Midwives include in their price a box of homebirth supplies called a birth kit, while others will either give you a list of supplies to purchase yourself or provide a place where you can buy your own birth kit. Birth kits are not usually expensive, typically under $50. The same goes for birth tubs, some Midwives will include it in their total fee and others may rent them for around $150-$200 or you can invest in buying your own tub.

Are Midwives covered by my insurance?

At the creation of this website (2024) there is only one homebirth practice in Iowa that is in network with insurance. There are significant boundaries to Homebirth Midwives taking insurance, the biggest is of course reimbursement rates. Most major insurance companies are confused on how to reimburse for homebirth, or if it's covered at all. The answers can unfortunately change depending on who you ask. Insurance companies ask providers to bundle their services to reduce cost, unfortunately for a small practice, these bundles tend to be reimbursed at a rate less that what a Midwife usually charges. Hospital practices can take on a much larger client load than a homebirth midwife because they use a facility to give birth in. That facility hires staff (like nurses) to take care of you during the majority of your labor until it's time to have a baby. That facility collects their own fee from the insurance. A homebirth provider is doing more jobs themselves without the benefit of being able to bill a facility fee. Which also means their client load must stay low enough that it is manageable. With smaller client loads and more work, homebirth providers must charge appropriately and unfortunately, insurance just isn't designed well to support this type of service.

How is a birth certificate filed for home births?

Licensed Midwives have the ability to register with the state to file birth certificates. Typically during your pregnancy, the Midwife sends a registration of an intended homebirth to Vital Records and they in turn mail a birth certificate packet to either the client or the Midwife. After you give birth, your Midwife will help you fill it out, get it notarized, attach payment ($35) and mail it back to Vital Records. Once accepted the state mails you your baby's birth certificate and social security card within a few weeks.

What are the different types of Midwives?

There are many types of Midwives, but for simplicity sake we will narrow it down to those that practice homebirth in Iowa. There are generally three kinds of homebirth midwives you may encounter in Iowa, Certified Nurse-Midwives (CNM), Certified Professional Midwives (CPM) and Traditional/Amish Midwives (DEM). In order to obtain a license to practice you must be a CNM or CPM. A more traditional-type midwife (DEM) must be part of a cultural or religious group (like Amish) providing traditional midwifery care, or cannot receive a fee in order to practice legally. Visit here for a list of exceptions.

A Certified Nurse-Midwife (CNM) must have a masters degree in nursing, must be trained in a hospital, but may receive additional apprenticeship with a homebirth midwife. CNMs may practice in a hospital, birth center or homebirth setting. CNM's may also provide primary care to women throughout their lifespan and can prescribe medications.

A Certified Professional Midwife (CPM) must finish an apprenticeship with another homebirth midwife, complete an accredited midwifery program and pass a midwifery exam. They are only trained in homebirth or birth center birth and may practice in a birth center or home setting, but not in a hospital. They can provide well woman exams and routine testing (like paps) or preconception counseling but generally don't do primary care. CPMs do not prescribe medication, but do have access to emergency medications and equipment and tend to be well versed in natural therapies.

Traditional/Amish Midwives (DEM) will generally finish an apprenticeship with another homebirth midwife and may or may not complete a non-accredited midwifery program. These Midwives may or may not have access to emergency medications or routine testing, but tend to have much knowledge of natural therapies and traditional midwifery practices.

Each homebirth Midwife type has its strengths and weaknesses and it can be hard to generalize how they might practice. Some Midwives may have a more natural or traditional type of practice or lean more towards the medical model regardless of their credential. It is always a good idea to ask the Midwife you are interviewing what kind of training and experience they have and what their philosophy of care looks like. This might help you decide which kind of Midwife is the best for you.

Interview Questions

To help you make an informed decision about hiring a particular homebirth midwife, we have compiled a list of interview questions that may be useful. There are no wrong answers, but there may be wrong answers for you. Chose the Midwife that best aligns with the kind of care you are looking for.

- What kind of Midwife are you and are you licensed?
- How long have you been practicing?
- Do you see your clients for visits in their home or an office?
- Do you work with another Midwife or are you a solo practice?
- How many clients do you usually have give birth per month?
- Do you have an assistant that comes with you to births or do you attend them alone?
- What is included in your service price? What things aren't included?
- Do you include a birth tub or birth kit? Or do I purchase those myself?
- Can you describe a typical homebirth experience to me?
- When do you usually come to a birth?
- How long do you stay after the baby is born and when do I see you next?
- Are you neonatal resuscitation certified? What kind of resuscitation equipment do you bring?
- Do you have access to emergency medications such as Pitocin or IV fluids?
- Do you weigh my baby, check for jaundice or tongue ties? Or do you recommend I see a pediatrician right away for those things?
- What is the most common reason for transfer to the hospital during labor, in your practice?
- What kinds of things would risk someone out of care before having a homebirth?
- Do you have knowledge of herbs, supplements, nutrition or any other natural therapies for pregnancy?
- Do you have the ability to prescribe medications for things like a urinary tract infection or birth control?
- Do you provide any well woman care such as STI testing or Pap smears?
- What do you think is important for families to know about planning a homebirth?
- Are you able to make referrals for labwork and ultrasounds?
- Do you do any labwork or ultrasounds in your office?
- Do you have any requirements for care, such as a required anatomy scan or labwork?

What is the community standard of care for vbac, breech and twins?

Community Standard

Iowa homebirth midwives have a strong community standard of care to provide services for those wanting a midwife to help facilitate a physiological birth after a prior cesarean (vbac), breech or twins at home. Most hospitals in the state of Iowa do not offer services for these special circumstances. If this changes, our community standard may also change. Most of the homebirth Midwives in Iowa have extensive training and experience in these areas. You can also expect that homebirth midwives will regularly employ other midwives to assist them at these special circumstance births. This may increase the cost of services or it may not depending on your Midwife's arrangements.

A community standard of care refers to the expected practices of a profession based on their scope of practice and similar circumstances, resources and training available in a given area. This can be different from the community standard of care in a hospital based practice, that has protocols and limited access to experiences based on liability perceived by the hospital they work at. Community standards can be more helpful when trying to understand out of hospital practices where informed decisions may be deviate from mainstream medical practices. The community standard requires that the patient be told what other physicians and midwives in the same community would tell a patient in the same or similar circumstances. “Community” refers both to the geographic community and to the specialty (intellectual community). A community standard can be made by combining common practices of homebirth midwives within a state, and global midwifery practices. Midwives in one state may have ample vaginal breech birth training and experience opportunities while other states may have no access to training or resources at all. Since the International Confederation of Midwifery clearly states "Undertake appropriate manoeuvers and use maternal position to facilitate vertex, face, or breech birth" to be part of an essential midwifery competency, breech birth is a reasonable community standard where adequate training and experience can be obtained.