Questions families actually ask

For carefully selected low-risk pregnancies within an integrated system — strict candidacy, a skilled attending provider, and a rehearsed hospital transfer plan — large international studies show perinatal outcomes comparable to hospital birth, with fewer interventions. Outside those conditions, studies show a small but real increase in risk, on the order of one to two additional perinatal deaths per 1,000 planned home births in American data. Our practice exists to provide the conditions the good outcomes depend on, and to tell you honestly when your pregnancy isn't a fit.

In most plans we coordinate, a certified nurse-midwife from our vetted directory — the clinician category that attends home births in the world's best-performing systems. A small number of physicians attend home births regionally; where one is available and appropriate, we'll connect you. Dr. Gomez directs the consultation, candidacy, and plan, and does not attend deliveries.

You'll already know, because it's written in your transfer plan by 28 weeks: the named receiving hospital, the specific triggers for transfer during labor, who calls, how you travel, and the records that come with you. Your attending provider accompanies you. Most transfers are unhurried — long labors, requests for pain relief — not emergencies. And your own request to go is always, by itself, enough.

No — this is one of our firm criteria. Labor after cesarean carries a small risk of uterine rupture, which is precisely the situation where hospital minutes matter most. We're glad to help you plan a hospital birth aimed at the labor experience you want; many of the preparation elements are exactly the same.

Both are outside home birth candidacy in our practice, consistent with every well-performing system. A breech baby found before labor may be turned (a procedure called ECV); if it succeeds and everything else holds, candidacy can be restored.

Laboring in water has good evidence for comfort and we support it readily. Birth in water is a more nuanced conversation that depends on your attending provider and your circumstances — we walk through the evidence in consultation, and we maintain a complete physician-written review at waterOB, our companion resource.

GBS-positive status receives individualized review rather than automatic exclusion: candidacy is usually retained with an agreed plan for antibiotics in labor, or a documented informed decision if you decline them. The logistics get settled well before labor.

Candidacy has a ceiling — plans hold through roughly 41 to 42 weeks with increased monitoring at the end, and convert to hospital planning past the ceiling. The exact protocol is in your signed criteria, agreed at intake, so a post-dates plan change is expected rather than sprung on you.

We are a self-pay consultation practice and don't bill insurance; we provide documentation for out-of-network reimbursement where applicable. Attending providers, doulas, and other team members set their own fees; some are reimbursable depending on your plan.

A history of substance use disorder in stable, documented recovery receives individualized review — not reflexive exclusion. We look at recovery duration, support structure, and the pregnancy itself. We built this practice to be recovery-literate, and that word is chosen carefully.

You can — many families do. What homeOB adds is the layer American home birth is missing: independent physician assessment of whether home birth fits your pregnancy at all, published criteria instead of private judgment, vetting of the attending provider's record and equipment, and a physician who already knows you if the plan has to change at 36 weeks. We have no delivery fee riding on your choice, which is exactly why our counsel is worth having.

Yes. Plainly, early, and with the reasons in writing — and then we'll help you plan the hospital birth that protects as much of what you wanted as possible. A practice that can't say no isn't giving you advice; it's giving you marketing.