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  • Writer's pictureHannah Burba, CPM


Hiring a midwife is beginning a relationship. One that is dynamic, rooted in trust and facilitates safety, empowerment and shared decision making.

Desiring a home birth is often a yearning to be seen, to be heard, to be respected and to not have to fight for the choices parents are making for their families.

There are many different routes to planning a birth outside of the standard medical system- from birthing unassisted, to hiring a licensed midwife or hiring an unlicensed midwife.

In total, less than 2% of births in the US happen outside of the standard medical system- 1.4% in 2021 says the CDC- so a pretty small minority of pretty special people, in my opinion.

I do have a license to practice in the State of Maryland, which does mean that the state has already whittled down the number of people who can even legally qualify to begin a relationship of care with me (this is not ideal, and I hope an entirely other blog post to conjure up soon, many of the rules and regulations the state puts on midwives are not rooted in up-to-date evidence but in stigma and medical biases and patterns of inequity that do not serve many of the people for whom midwifery care could really help).

Some of the requirements pregnant people need to meet to begin working with a Licensed Certified Professional Midwife are:

  • No history of uterine surgery (VBACS)

  • a BMI over 18.5 and under 35

  • No Type 1 Diabetes or uncontrolled Gestational Diabetes

  • Hyperthyroidism treated with medication

  • Renal Disease

  • Heart Disease


And if any of these things occur during pregnancy, licensed CPMs need to transfer people to the hospital:

  • Fetal demise

  • Hypertension

  • Placenta Preia

  • Multiples (twins, triplets)

  • Preeclampsia

  • Severe anemia (hemoglobin under 10g/dL)

  • Breech presentation after 38 weeks

  • Severe infection

  • Daily tobacco use into the second trimester

  • Uncontrolled IBS

  • Going into labor naturally before 37 weeks and after 42 weeks

So…we are limited to a very specific set of low-risk pregnant people and babies.

That being said, each midwife has their own unique desires and people that they work well with, and I have been thinking a lot about what characteristics I really appreciate in clients coming into care.

A desire to learn and to grow throughout their pregnancy, birth and postpartum journey.

This isn’t a medical event. This is a life-changing, lineage-altering, humongous deal. Brining a life forward into a family is more than just a matter of clinical consideration. I believe the emotional, physical and spiritual aspects of this work parents are doing should be honored and held and mingled together throughout care.

Lots of questions

Nothing is more bland than showing up at a prenatal for someone who literally doesn’t have a single thing to share or ask about. It’s wonderful if things are feeling good in their body, baby is doing well, sleep is going well, bowels are moving well, family is going well, relationships are going well, preparation for the postpartum is going well, support in their community and home is building and feeling good, everything is perfectly aligned in the pelvis and throughout the emotional body as well…etc. But as you can see, we usually have a lot of things to discuss and I enjoy clients who are eager to share and be honest and grow together in this experience.

A commitment to nourishment

Food is a foundation of growing a new body for someone. Food is something that happens every day, multiple times a day (often in smaller, more frequent meals) and has the power to dramatically alter a pregnancy and a new human’s life once they are born. There is no one “right” way to eat during pregnancy, every single day is different. Every body is different, people have different values and relationships to food, different aversions, allergies, preferences…etc. I have worked with raw vegans, vegans, people who keep different stringencies of kosher, all-meat people, no-meat people, no-time-to-cook people, forget-to-eat-until-its-too-late people…my intention is to spend our prenatal visits creating and sourcing together ideas for adequate nourishment that clients can implement in their daily lives to set them and their babies up to thrive- So, if you don’t want to talk about vitamins A, D, E, K, protein, satiety, hydration, blood and stools…I’m probably not the right midwife for you!

A Valuing of my time and energy, and a willingness to invest in the caretaking of our mutual families

I never want money to get in the way of a home birth if it’s absolutely the right choice for a family.

Insurance companies are crazy and midwifery care is not well-integrated into the standard medical system (for many reasons).

I bring a tremendous amount of care, energy and attention to my clients. It goes beyond our prenatal appointments. The ability to text a care provider on a whim and expect a prompt reply, to be able to call with a concern and be seen pretty much immediately, to have close access to support, attention and care from a provider is a really unique, and hopefully valued thing. The worst feeling is agreeing to work for less than I am worth, asking those who work with me to work for less, and then feeling absolutely depleted because I wanted to help someone. This work is emotionally and physically demanding. Many midwives burn out because we don’t hold boundaries around tending to ourselves and over-extend ourselves for our clients. Ah! And holding a license means lots of money in lots of pockets and is an absolute financial commitment for a provider. Money IS a very uncomfortable thing to discuss, but I have learned I am much more excited to hop out of bed in the middle of the night if I feel valued, seen and heard as well. SO, a willingness to have honest conversations around where you are financially and how you intend to honor my boundaries and needs to support myself and my family is important for those choosing to work with me. Again, there is no one “right” way to pay for a birth, I have worked for free, sliding scales, extended payment plans…etc. Having honest conversations and respecting the needs of both families is what I want to attract in future clients.

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