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Is homebirth legal in North Carolina?
You may have your baby anywhere you wish, homebirth is NOT illegal in NC. At this point in time Certified Nurse Midwives can legally attend births at home in North Carolina. They must be licensed and have a doctor backup. Although many midwives (other than CNMs) have been through rigorous training and/or are certified, North Carolina does not recognize their certification and does not offer a way for these midwives to be licensed.

How much will a homebirth cost?
Probably a lot less than a hospital birth. You will most likely find that your midwife’s fee is nowhere adequate for the quality of care she gives you. The price of a homebirth midwife in North Carolina ranges from anywhere under $600 to around $3,500. However, your midwife may have a flat rate, offer a sliding scale, (her fee is based on your income), or may offer bartering for payment. Some midwives may accept payment by insurance companies, depending on your provider and policy.

Keep in mind that there may be additional costs associated with the birth other than the midwife’s fee. These might include the cost of: a birth kit, supplies for the birth, doctor visits, prenatal tests, postnatal injections (RhoGam, etc.), renting a birth pool, Doula services, and newborn tests (PKU test, blood work, etc).

That seems like a lot of money, I don't know if I can afford that.
People spend thousands of dollars and years of planning on a wedding, but typically they spend very little time or money planning for a birth. With the illusion of insurance handling all the fees for a birth in hospital it can seem like birth is “free” in the hospital. However, there ain’t no such thing as a free lunch.
For those having a regular birth in hospital, fees usually start at .....read more

What if something goes wrong?

Midwives are prepared for emergency situations. They carry with them all the essentials for routine births as well as items needed in emergency situations. These include, but are not limited to:

Doppler and a fetascope


Medication to control hemorrhage: Pitocin, Methergine (IM, oral)


Oxygen tank(s) and gauge(s) with adult and pediatric masks, and cannulas


Tubing suction devices, such as delee traps


Instruments: scissors, hemostats, needle holders, etc.


Blood pressure cuff/stethoscope for an adult


Ambu bags, adult and infant with a variety of sizes of infant masks


Amnihooks


Suturing equipment


Catheterization equipment


IV equipment


Baby scale, tape measure


Pulse oximeter


Newborn blood pressure cuff


Airways, infant and adult


ET tubes 2.0-4.0


Laryngoscopes: adult and infant


Medications such as Vitamin K, eye ointment, and lidocaine


Tubes for the laboratory examination of cord blood


Herbs for labor


Miscellaneous items, such as a mirror and flashlight


Extra birth supplies: sterile/non sterile gloves, Betadine, sterile and non-sterile gauze pads, K-Y jelly, bulb syringe, cord clamps, alcohol pads, perineal oil, and ammonia amps.

This information is copied with permission from Anne Sommers from her website, www.dear-midwife.com

What if the umbilical cord is wrapped around the baby’s neck?
One in three babies will be born with the cord wrapped around its neck. As the head approaches the midwife checks it for cord. If the cord is wrapped around the baby’s neck she will free it through one of a variety of maneuvers. If she is unable to free the cord she will clamp and cut it before the baby is fully born.

What if I hemorrhage?
Hemorrhage is very rare at homebirths. The reason for this is that midwives will screen out women who may be at risk for hemorrhage in the first place. Also midwives let you take your time delivering the placenta. Many doctors rush this period and do uterine compressions while pulling on the cord, which may cause the uterus to hemorrhage. Furthermore, midwives encourage the mother to breastfeed immediately after birth. Breastfeeding releases hormones, which cause the uterus to contract and stop the bleeding. Although it is rare, some mothers will hemorrhage at a homebirth. Midwives have many procedures to stop the hemorrhage. They may use medications, herbs or hand compressions, among other things.

What about birth with midwives at a hospital or birth center? What about in a hospital with an obstetrician and a doula?
The hospital or birth center makes the rules of protocol. The people who work in a hospital or birth center have to follow the rules, or they are out of a job. No one is foolish enough to risk their livelihood on one woman or one baby, and so occasionally.....read more

Will I have to sign any consent forms to have a homebirth?
Most midwives will require that you sign a form stating that you understand birth is a natural process and that you are taking full responsibilities for the outcome and you will not hold the midwife responsible for an ill outcome.

What supplies do I need for a homebirth?
You can purchase a birth kit from a variety of companies or get a list from your midwife and create your own. The kit includes the “medical” items for the birth like a cord clamp and surgical gloves. Your midwife may have her own special kit available through the kit company. You should also get a list of other supplies from your midwife with items such as towels, flashlight, batteries and garden hose (for birth pool), etc.

How messy is a home birth?
Birth is a messy process, but midwives do a great job of making sure that your home remains clean and free of stains. They will cover the bed or birthplace with plastic as well as the floor around the bed or birth area. They also use Chucks; absorbent plastic backed pads for other areas, like under the birth stool. These pads can easily be held beneath you if you have to move around and are disposable. If you have a birth pool, chances are it will have a disposable liner. After the birth, simply pump the water from the pool, throw away the liner, and disinfect the pool with a bleach solution. Your birth supply list will include a bucket or bowl, which is used to catch the placenta. Episiotomies are rarely performed at home births therefore reducing the amount of additional blood. Most midwives clean up after the birth including doing laundry. Check with your midwife to see what cleaning duties she offers.

What happens to the placenta after the birth?
After the birth the midwife will take a blood sample from the cord and examine the placenta to make sure that it is intact and has no anomalies. She should leave the disposal decision up to the family. The placenta is also known as the “internal grandmother,” “the baby’s cake,” and “the baby’s home.” And like its many names there are also many ways a family may dispose of the placenta. Most bury the placenta and plant a tree or other plants over it. Others burn it. And some families give the placenta to the midwife to use for educational purposes or dispose. Still some families take the disposable of the placenta very seriously, often with ritual. In some cultures the placenta is regarded as sacred with postpartum powers and the mother of the baby eats the placenta. This is known as placentophagia. Lotus birth is another placenta practice; the placenta stays attached to the baby via the cord until it dries up and falls off of the baby. Some cultures cut the placenta away and dry it separately to save for the baby until he or she comes of age or has children.

How do I get a birth certificate for my baby?
The state of North Carolina requires that any live birth regardless of gestation be filed with the registrar of the county the birth occurred in within 10 days after the baby is born.

Your midwife may provide for you a Birth Information Worksheet, which you will fill out and take with you along with the following 4 items to your County Health Department, Vital Statistics Office. If your midwife does not supply you a copy of the Birth Information Worksheet you may be given one to fill out at the Vital Statistics office or they may ask you the questions. Some counties are now sending the Birth Information Worksheet to the parents before they are scheduled for an appointment with the Vital Statistics office.

- Your ID

- Social Security Numbers (if you are a US citizen and have a SSN) - The Family Support Act of 1988 (Pub. L. 100-485) requires states to require parents to give their Social Security Numbers in order to get a birth certificate issued for a newborn. The law allows the requirement to be waived for "good cause", but there's no indication of what may qualify

- Proof of pregnancy - it is up to the county registrar to decide what to ask for within reason, but could be one of the following:

Notarized letter from anyone who knew you pregnant - letter states witness’s name and county and says that witness knew that X mother was pregnant and gave birth on X day.

Copy of a receipt from any doctor seen during pregnancy

Picture of mother pregnant

OR

- Proof of live birth- it is up to the county registrar to decide what to ask for within reason. It is not reasonable to ask for prenatal records from your midwife if she is practicing illegally. If you feel that you are being asked to supply unreasonable information, you should contact the Vital Statistics office in Raleigh.

Baby (bring baby with you)

Birth record from midwife (CNM)

- Proof of residence (this is a document that was sent to your address by a company, for example a telephone bill).

If the father and mother are not married the father’s name will not be on the certificate unless the father and mother complete an affidavit acknowledging paternity. The mother will have to sign the birth certificate; the dad can sign the certificate as the certifier if you do not want to list a midwife (example, your midwife is NOT a CNM). After the certificate is completed and signed by everyone the registrar will file it at the courthouse.

You will receive a “Mother’s Copy” in the mail a few days or weeks after you file the certificate. To obtain a certified copy, fill out an application form, make a check of $15.00 payable to NC Vital Records and mail (you can not fax or email) it to The North Carolina Vital Records Branch, Division of Health Services, 1903 Mail Service Center, Raleigh, NC 27699-3526. You should receive it in about 8 weeks.

According to the National Center for Health Statistics, in the United States, State laws require birth certificates to be completed for all births, and Federal law mandates national collection and publication of births and other vital statistics data. The National Vital Statistics System, the Federal compilation of this data, is the result of the cooperation between the National Center for Health Statistics (NCHS) and the States to provide access to statistical information from birth certificates.

Read the NC General Statutes Birth Registration

Read the NC Vital Records Field Services Procedures(html)or PDF

How a Birth Certificate Becomes Officially Filed:

1. Birth occurs
2. Preparation of birth certificate
3. Local Health Department reviews birth certificate
4. Copy for Register of Deeds and Local Health Department
5. Original forwarded to Vital Records
6. Certificate received by Vital Records
7. Certificate date stamped
8. Certificate manually reviewed
9. Questionable information queried
10. Certificates sorted
11. State file number stamped
12. Medical information coded
13. Demographic information coded
14. Coded info keyed
15. Now, the record becomes officially filed!

How do I get a Social Security number for my baby?
When you fill out the birth certificate form there’s an area that you check saying that you want a Social Security Number for your child. It can take a long time to get the Social Security Number and you may not get it at all, even though you checked that you want it!

If you do not receive the number in the mail, you will need to call the Social Security Administration at 1-800-772-1213 and check to see if the information has been filed. If the information has not been filed, you will need to visit your local Social Security Administration office and fill out an application. You will also need to bring a certified copy of your baby's birth certificate, proof of identity of your baby (vaccination records, blood type record, doctor's record, midwife's record, etc). All documents must be either originals or copies certified by the issuing agency. They will not accept photocopies or notarized copies of documents. You must also show evidence of your identity and citizenship. You will need to bring either a driver's license, US passport, employee ID card, marriage or divorice record, health insurance card (not Medicare), military ID, or life insurance policy. And you will need both parents Social Security Numbers.

You can call the office the next day to obtain the number and the card will be mailed to you within 2 weeks. You will need your baby's SSN to file your taxes, as well as for other things. For more information, visit the Social Security Administration's website at http://www.ssa.gov/ssnumber/

Are there any prenatal tests that are required by law?
No, according to the American College of Obstetricians and Gynecologist’s Pregnant Patient’s Bill of Rights, a woman has the right:

• To be informed of the effects and risks of drugs and procedures on her and her baby.
  
• To be told of all possible alternatives and options in treatment and procedures
  
• To choose for herself, without pressure from any health care provider, whether or not she and her baby will accept drugs, treatments, and procedures
  

Your midwife may however ask you to sign an informed consent form or waiver if you decline some prenatal tests.

What prenatal tests are available, if I want to take advantage of them?
This is just a basic list, and there are probably many more including genetic tests. Also, it’s just a brief description of each test. If you would like a midwife’s perspective on these tests, read "Ina May’s Guide to Childbirth.”

Basic tests (which your midwife might require) include:

• Blood test that results in finding Blood count (CBC), Syphilis, Blood type and Rh factor, German measles (rubella) immunity, and HIV.
  
• Pap smear to screen for cervical cancer.
  
• Urinalysis to confirm the pregnancy and check for signs of infection.
  
  

Other tests available are:

• Toxoplasmosis screening – eating undercooked meats and being in contact with cat feces is the most common cause of toxoplasmosis exposure.
  
• Hepatitis B test – doctors routinely test pregnant women for antibodies to hepatitis B, an infection transmitted through a blood transfusion, shared needles, or bodily fluids. It attacks and damages the liver and can be passed to a woman’s unborn baby.
  
• Sexually transmitted disease screening – vaginal swab to detect gonorrhea and chlamydia in the mother, which can cause eye and lung infections in newborns.
  
• Sugar/protein level test – a urine test that you will most likely do at each midwife or doctor’s visit. Sugar in the urine can be a sign that you have gestational diabetes and protein in the urine could mean that you have toxemia or preeclampsia.
  
• Glucose screening – performed during 24th and 28th weeks of pregnancy. You drink a sweet liquid called glucola and then your blood is drawn and tested for glucose level an hour later.
  
• Alpha-fetoprotein (AFP) – performed between the 16th and 18th weeks of pregnancy. An excessive amount of AFP in your blood could indicate that the baby has a neural tube defect such as spinal bifida.
  
• Chorionic Villus Sampling (CVS) – performed between the 10th and 12th weeks of pregnancy.
  
• Ultrasound – doctors usually perform this between the 17th and 19th weeks of pregnancy for evaluating fetal development.
  
• Fetal Fibronectin test – checks for a protein that leaks from the womb indicating the chance for preterm labor.
  
• Non-stress test – given when the pregnancy is considered “high risk” or past the due date. It allows the doctor to evaluate the baby’s well being by measuring changes in the baby’s heart rate.
  
• Group B Strep test - performed during the 35th to 37th weeks of pregnancy. It’s a vaginal and rectal swab to detect Group B Strep. Group B Strep can cause a baby to develop pneumonia, sepsis and/or meningitis.
  

Are there any infant tests required by law?
Yes. The Infant Screening Tests (also called PKU tests) test is required in all 50 states and in North Carolina by state law G.S.130A-125 (below). You will note on 5b that the screening does not have to be done if parents object.

130A‑125. Screening of newborns for metabolic and other hereditary and congenital disorders.

(a) The Department shall establish and administer a Newborn Screening Program. The program shall include, but shall not be limited to:

(1) Development and distribution of educational materials regarding the availability and benefits of newborn screening.

(2) Provision of laboratory testing.

(3) Development of follow‑up protocols to assure early treatment for identified children, and the provision of genetic counseling and support services for the families of identified children.

(4) Provision of necessary dietary treatment products or medications for identified children as medically indicated and when not otherwise available.

(5) For each newborn, provision of physiological screening in each ear for the presence of permanent hearing loss.

(b) The Commission shall adopt rules necessary to implement the Newborn Screening Program. The rules shall include, but shall not be limited to, the conditions for which screening shall be required, provided that screening shall not be required when the parents or the guardian of the infant object to such screening. If the parents or guardian object to the screening, the objection shall be presented in writing to the physician or other person responsible for administering the test, who shall place the written objection in the infant's medical record.

(b1) The Commission for Health Services shall adopt temporary and permanent rules to include newborn hearing screening in the Newborn Screening Program established under this section.

(c) A fee of fourteen dollars ($14.00) applies to a laboratory test performed by the State Public Health Laboratory performed pursuant to this section. Fees collected shall remain in the Department to be used to offset the cost of the Newborn Screening Program. (1991, c. 661, s. 1; 1991 (Reg. Sess., 1992), c. 1039, s. 6; 1998‑131, s. 13; 2000‑67, s. 11.31(a); 2005‑276, s. 41.1(a).)

Tell me about the PKU test

Phenylketonuria (PKU) causes severe mental retardation, which can be prevented if the condition is detected before symptoms develop and the child is treated with a special diet. The PKU test is also called Newborn Screening Tests it includes tests for PKU as well as diseases and disorders. NC Public Health Law, 130A-125, requires the newborn screening test. The Newborn Screening test in North Carolina (since 1987) includes Phenylketonuria (PKU), Galactosemia, Sickle Cell Disease, Congenital Adrenal Hyperplasia (CAH) and Hypothyroidism. In addition, since August 1997, North Carolina has used the tandem mass spectrometry methodology to screen for more than 20 inborn errors of metabolism including amino acid disorders, organic acidemias, and fatty acid oxidation disorders. We were the first state to use this type of expanded screening statewide. In hospitals the test is administered when the infant is between 24 and 48 hours of age and again at two weeks of age. Your midwife may wait until your baby’s a few weeks old; this insures that the baby is well hydrated. To do the test your midwife will warm the heel of your baby with a special “heater” pack or a warm wet cloth. Then, she pricks the heel and makes it bleed and drops the blood on filter paper. She sends the blood sample to a lab to be tested. You will need the Federal Tax ID from your baby’s pediatrician. Your midwife will put this number; the name of your pediatrician and her own information on the filter paper and the results will be mailed to your pediatrician and midwife. If the results are abnormal it is the responsibility of your pediatrician or midwife to notify you and obtain a repeat sample. If you do not get a repeat sample within 14 days a certified letter will be mailed to the baby’s mother. Your midwife will probably ask that you reimburse her for the price of this test ($14.00).

Can I refuse the PKU test?

Yes. If you were to have a hospital birth you would have to sign a form saying that you do not want the test done and it’s reported to the state. Your midwife may also ask you to sign a form; she is required to submit the information to the state.

Tell me about the newborn hearing test

Two hearing tests are used to screen babies. All that’s required of the newborn is to lay still. This test is usually done while the baby’s asleep. OEA or Otoacoustic emissions tests show whether parts of the ear respond properly to sound. To do this test the technician places a sponge earphone in the baby’s ear canal. The ear is stimulated with sound, and the “echo” is measured. The echo is found in everyone with normal hearing. No echo may mean that there is hearing loss. The other test is called ABR or Auditory brain response. This test checks how the brain and brain stem respond to sound. To do this test the baby wears earphones and electrodes are placed on his head and ears. The baby may be given a mild sedative to calm him. Sound is sent through the headphones and the electrical activity in the baby’s brain is measured. If your child doesn't respond consistently to the sounds presented during either of these tests, the technician may suggest a follow up hearing screening and a referral to an audiologist for a more comprehensive hearing evaluation. The General Assembly passed legislation establishing the North Carolina Universal Newborn Hearing Screening (UNHS) Program. This legislation, [SL2000, Ch. 67, S. 11.31, (a) (5)], requires that "the Department of Health and Human Services shall establish and administer a Newborn Screening Program. The program shall include, but shall not be limited to: For each newborn, provision of physiological screening in each ear for the presence of permanent hearing loss." The Commission for Health Services adopted temporary and permanent rules for program implementation. These rules require that every infant born in North Carolina be screened for hearing loss, and that the Department of Health and Human Services (DHHS) establish a reporting system for the collection of hearing screening outcomes.

Can I refuse the Hearing Test?

Yes. According to the Department of Health and Human Services Division of Public Health GUIDELINES FOR UNIVERSAL NEWBORN HEARING SCREENING “Parents may object to the hearing screening (i.e., decline the screening) in accordance with G.S. 130A-125(b),” which states: “The rules shall include, but shall not be limited to, the conditions for which screening shall be required, provided that screening shall not be required when the parents or the guardian of the infant object to such screening. If the parents or guardian object to the screening, the objection shall be presented in writing to the physician or other person responsible for administering the test, who shall place the written objection in the infant's medical record.” [Source: CHAPTER 130A.]). Check with your midwife to see what she requires of you if you do not want the newborn hearing screening.

What about newborn eye drops and Vitamin K?
Newborn eye drops are made from either erythromycin or silver nitrate. They are administered to infants to prevent an infection of the tissue surrounding the eye. The infection can cause blindness and is caused by normal bacteria or bacteria associated with a sexually transmitted disease such as gonorrhea or chlamydia. Often the infant’s eyes will be irritated for a few hours or days after the application. According to the National Eye Institute’s publication “Clinical Trial of Eye Prophylaxis in the Newborn”:

The results suggest that prenatal choice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care who are screened for sexually transmitted diseases during pregnancy.

The findings concerning the species of bacteria most often associated with conjunctivitis as well as the finding that method of delivery is unimportant suggest that bacteria were transmitted to the infants’ eyes after birth and not from the birth canal.

Vitamin K is administered to infants to help their blood-clotting ability. There are some rare diseases called Vitamin K deficiency bleeding which 1 baby in ten thousand will have. Most of these babies are breastfed (formula contains Vitamin K). Babies who are most at risk for this disease are babies who’s mother’s took certain medications during pregnancy, who had a difficult delivery, who were born premature, or babies who have liver disorders.

Vitamin K can be administered through an injection or administered orally. There is some evidence that Vitamin K is linked to childhood cancer, including leukemia.

According to Rule 10A of the NC Administrative Code 41A .0204 - Control Measures - Sexually Transmitted Diseases, "All newborn infants shall be treated prophylactically against gonococcal ophthalmia neonatorum in accordance with the STD Treatment Guidelines published by the U.S. Public Health Service. The recommendations contained in the STD Treatment Guidelines shall be the required prophylactic treatment against gonococcal ophthalmia neonatorum."

Since this procedure is part of the standard procedures in US hospitals, your midwife may offer it and if you do not want it, ask you to sign an informed consent form.

Can I refuse newborn eye drops or Vitamin K?
Sure. Just let your midwife know that you do not want these, she may ask you to sign an informed consent form. If you have to be transferred to the hospital you will have to sign a consent form there as well.

Do I need a Pediatrician for my baby?
Although your midwife will check your baby’s weight, temperature, and heart rate for several days postnatal, she may require that you have your baby visit a doctor or pediatrician a few days after the birth for a physical. It will be your choice if you decide to take your baby for regular well baby check ups or only when your baby’s sick.