Can You Still Have a Home Birth with an Incompetent Cervix?
An incompetent cervix is one of the more common complications of pregnancy, and it simply means that the cervix starts dilating too early in the pregnancy, increasing the risk of preterm labor and a baby being delivered before the lungs and other organs have fully developed. A cerclage — a stitch that keeps the cervix closed — is the most common treatment for an incompetent cervix and is 85 to 90 percent effective in preventing preterm labor, according to the American Pregnancy Association.
Finding out that you have an incompetent cervix can be scary if you were hoping for a home birth, but it doesn't have to change your birth plan dramatically. It is possible to have a home birth after you've had a cerclage, but it's going to come with unique challenges. The first is that, depending on your state, your midwife may not be able to put in or remove the cerclage. Laws vary by state, but it's not uncommon for states to exclude midwives from being able to actually practice medicine. For example, in Ohio, there are no legal protections for home birth midwives, which means they can face criminal charges for doing things like administering Pitocin — even in an emergency — or doing any stitches post-birth.
This means that you're probably going to need to see a traditional OBGYN alongside your midwife, and many OBGYNs are less than accommodating about this. If you have a history of incompetent cervix or preterm labor, you may want to ask around and interview potential doctors about their comfort level with working in tandem with a midwife. Some will be OK with doing the cerclage, ultrasounds, etc and monitoring you during the pregnancy knowing that once the cerclage is out, you will be planning a home birth, but others may refuse. If you already have a midwife in mind, she may be able to make a recommendation as midwives usually have the inside scoop on which doctors are friendly with or staunchly against home birth.
As with any birth, it will be important to communicate honestly and openly with both your OBGYN and your midwife so that everyone has a true picture of the risks, challenges, and plans going into the birth. A history of an incompetent cervix doesn't have to exclude you from a home birth, provided you have no other complications and are able to get the cerclage put in and taken out, but it is definitely something that should be taken seriously when considering a home birth.