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It is very very rare. And even rarer, my insurance paid for the whole thing!
I had to search for a midwife who does homebirths. She came to my house for all my appointments. Brought her equipment with her. She was able to take blood and send it away for testing. She had a doppler machine for listening to the heartbeat (at the visits and during labor to make sure the baby was ok). For the 20week anatomical check ultrasound, she had to send me to the hospital.
I had to order a $50 birth kit with some basic medical supplies in it, and it also had chux pads, and some baby first-aid items. I was also responsible to provide a container for the placenta (I got a tupperware thing at the grocery store.) I also got a waterproof mattress pad for the bed, and put some taped-together chux pads on the couch, but I would have done that anyway out of fear of my water breaking and ruining furniture.
Compared to going to an OB, I got a lot more time to talk to the midwife. She made a lot of notes about my preferences. She talked to me about nutrition a lot. I got much more customized treatment than if I had to comply with hospital policies.
I had the option of providing my own support person to keep me comfortable, or hiring a professional doula. I just chose to have my mother there. So she took care of holding my hand, putting a cool wet cloth on my head, fetching me water, etc.
While I was laboring, they decided to take turns napping, in case it went on for a looooong time. I was on the couch, and the midwife went to nap in my bed, so she would be fresh for the important parts. Then after a while I felt an urge to push, and my mother woke up the midwife. She checked me at that point, and found I was ready. (I wouldn't let her check earlier, because I was afraid to be told that I had barely dilated at all. And then I would have felt discouraged.)
The whole 2 hours I was pushing, the midwife worked her ass off trying to stretch me to minimize tearing. She was hanging over the arm of the couch, massaging olive oil into me and slowly stretching me. Nobody with an MD after their name would have done that. A doc would have just done an episiotomy. I ended up with a few tiny tears, and she was able to stitch them from the inside, so I didn't feel any pain when urinating.
Of course after the birth she examined the baby. Then she waited for the placenta and checked it to make sure nothing was left inside. She asked me what I wanted to do with it. Some women eat it because it is so full of nutrients and can fend off post partum depression. Others plant it in their garden under a tree with a nice ceremony. I said I didn't care what she did with it. She threw it away.
Then it is the midwife's job to do all the cleaning up. She took all the sheets and blankets and towels and put them in the wash. Midwives are responsible for cooking, too, but my mother had made a lasagna. While the midwife was cleaning, my mother helped me and the baby into the bath, and then into the bed that had already been made with clean sheets, and we just cuddled and slept.
It was all very peaceful and relaxed and with no fear. I think homebirth is a good choice if you have a reasonable amount of faith in your body that you don't think complications are likely, and if you have enough trust in your midwife that she would be able to identify a problem early enough to keep it from being a dangerous emergency. We had talked about plan B in case I needed to transfer to the hospital. We were prepared for contingencies. (I've also heard of women choosing homebirth if they had a history of sexual abuse, and couldn't handle the idea of having doctors looking at their vaginas and sticking their fingers in. A homebirth feels much more private and intimate.)
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