After a home birth, your midwife stays with you for several hours to monitor both you and your baby, deliver the placenta, perform newborn checks, and handle essential medical tasks like vitamin K administration. The immediate postpartum period at home looks different from a hospital discharge, but the clinical steps are largely the same. Here’s what to expect in the hours, days, and weeks that follow.
The First Hours After Delivery
Your midwife will check your vaginal bleeding, heart rate, temperature, and the firmness and height of your uterus starting within the first hour and continuing regularly over the next several hours. Blood pressure is measured shortly after birth, with a second reading within six hours if the first is normal. You’ll also be asked to urinate within six hours of delivery, which your midwife will document. These checks help catch early signs of excessive bleeding or infection.
Most midwives stay for at least two to four hours after delivery, sometimes longer. During this time, they’ll also help you get comfortable, support your first breastfeeding attempts, and watch for any signs that you or the baby need further care.
Delivering the Placenta
The placenta still needs to come out after the baby is born, and how this happens at home often differs from hospital practice. Many home birth midwives use a hands-off approach called physiological management: no medication is given to speed up contractions, the umbilical cord isn’t clamped until it stops pulsing (or until the placenta is out), and the placenta is delivered through gravity and your own pushing, sometimes with nipple stimulation to encourage contractions.
The alternative, active management, involves giving a contraction-stimulating medication right around the time of birth, clamping the cord early, and gently pulling on it to guide the placenta out. Your midwife may use active management if there’s concern about heavier bleeding or if it was part of your birth plan. A placenta that doesn’t deliver within a reasonable time frame, or blood loss that becomes excessive, can be reasons for a hospital transfer.
Newborn Assessment
Your baby’s first medical evaluation happens almost immediately. At one minute and five minutes after birth, the midwife assigns an Apgar score, rating five things: heart rate, breathing effort, muscle tone, reflexes, and skin color. Each gets a score from zero to two, for a total out of ten. If the score is below seven at five minutes, the midwife continues checking every five minutes up to twenty minutes.
Beyond the Apgar, your midwife performs a physical exam that includes checking your baby’s general appearance, verifying that nasal passages are clear, confirming open passages for urine and stool, and assessing the movement and development of the arms and legs. Weight, length, and head circumference are measured. This exam is essentially the same one a hospital nursery would perform.
Vitamin K and Eye Ointment
Newborns are born with very low levels of the clotting factor vitamin K, which puts them at risk for a rare but serious bleeding condition. The standard recommendation is a single injection given within six hours of birth. To allow uninterrupted skin-to-skin contact and a first breastfeeding session, many midwives wait a bit before giving the shot, but it’s typically done before they leave. Oral vitamin K is sometimes requested by parents, but it is less effective than the injection and is not approved for use in newborns by the FDA.
Antibiotic eye ointment is also applied within the first hour of birth to prevent a type of eye infection the baby can pick up during delivery. Your midwife carries both of these supplies and administers them at home just as they would be given in a hospital.
Newborn Screening
Every baby in the United States is offered a blood spot screening that checks for a panel of rare but treatable conditions, including metabolic, endocrine, and immune disorders. This involves a small heel prick and a few drops of blood on a special card. In a hospital, it’s done around 36 hours after birth, close to discharge. For home births, midwives are qualified to collect the sample and carry the same test cards.
The timing can vary slightly. Your midwife may return the next day to collect the sample, or arrange for it during a scheduled follow-up visit. A hearing screening is also recommended for all newborns. Since the equipment is typically found in hospitals or audiology offices, your midwife will let you know where and when to schedule this, usually within the first few weeks.
When a Hospital Transfer Happens
Most home births don’t require a transfer, but your midwife is trained to recognize when one is necessary. In the postpartum period, the most common reasons for an emergency transfer include heavy bleeding (generally defined as more than 1,000 milliliters of blood loss), a placenta that won’t deliver, or signs of distress in the baby such as persistent low Apgar scores, breathing difficulties, or meconium aspiration. Retained placenta and the need for stitching a significant tear are also common transfer reasons.
Your midwife will have discussed a transfer plan with you before labor, including which hospital you’d go to and how you’d get there. If a transfer does happen, the midwife typically accompanies you and communicates your medical details to the receiving team.
Follow-Up Visits in the First Weeks
Unlike a hospital birth where you’re discharged after a day or two and may not see a provider for weeks, home birth midwifery care typically includes multiple follow-up visits. A common schedule involves a visit within the first 24 hours after birth, another around day three, and a third before the end of the first week. Some midwives add a visit around two weeks and another at six weeks postpartum.
During these visits, your midwife checks your bleeding, uterine recovery, blood pressure, and emotional well-being. For the baby, they assess weight gain, feeding, jaundice (yellowing of the skin), umbilical cord healing, and general development. The six-week visit typically marks the end of midwifery postpartum care and serves as a broader check on your physical recovery and adjustment.
Filing the Birth Certificate
One thing that’s handled automatically in a hospital falls to you (with your midwife’s help) after a home birth: registering the birth. The process varies by state, but it generally involves completing a birth registration form, having the birth attendant sign it (the birthing parent cannot serve as both the parent and the attendant on the form), and submitting supporting documents.
In Washington State, for example, the paperwork includes the birth filing form, a supporting affidavit signed in front of a notary public, copies of government-issued ID for both parents and the attendant, and proof of the birthing parent’s residence within 30 days of the birth. If the parents aren’t married, a separate parentage acknowledgment form is needed to add the second parent to the certificate. Forms must be submitted before the child’s first birthday, though most families complete this well before then. If your midwife has attended home births in your state before, they’ll typically walk you through the specific requirements and may handle much of the filing themselves.
Practical Recovery at Home
One of the differences families notice most is that after a home birth, there’s no transition from hospital to home. You’re already in your own bed, with your own food, your own bathroom. But this also means there’s no nursing staff down the hall. Your midwife will talk through warning signs to watch for between visits: soaking through a pad in an hour or less, fever, foul-smelling discharge, severe headache or vision changes, or a baby who isn’t feeding or seems unusually lethargic or yellow.
Having a support person available for the first several days makes a meaningful difference. Someone to bring you food, keep water nearby, help with older children, and let you rest while keeping an eye on how you and the baby are doing fills the gap that hospital staff would otherwise cover. Your midwife is also typically reachable by phone between scheduled visits for questions or concerns that come up.