Midwifery Care

FREQUENTLY ASKED QUESTIONS

Is home birth safe?

Home birth, for healthy low-risk women with comprehensive prenatal care, is as safe as, if not safer than hospital birth.  There are multiple studies* that show that 85-90% of home births occur without any complications.  There are fewer interventions, much lower cesarean rates, and much higher satisfaction with the birth process.

Here is a great handout from Citizens for Midwifery to read and share.

http://www.bmj.com/content/330/7505/1416.full

http://www.cmaj.ca/content/181/6-7/377.full.pdf

 

What is your philosophy about birth?

While I am hired for my expertise in the birthing process, I do not take over your experience.  I am the guardian for a safe normal birth. I am both visible and invisible in supporting/guiding you on your journey into motherhood. I assist you rather than imposing my ideas, and encourage you when needed, and –most importantly– I do not take credit for your birth.

 

How many births have you attended as a midwife?

I have attended approximately 1500 births.

 

How many midwives/assistants are on your birthing team? What role do they play?

In addition to myself, I usually have one to two assistants and/or students.  They occasionally attend prenatal, postpartum, and well-woman appointments.  At the birth we work as a team, monitoring heart tones, setting up the birth space, providing labor support, cleaning up afterward, and attending to clients postpartum.

 

How many births do you generally do a month?

After many years of doing 4-6 births per month, I have recently reduced my birth load down to 2-3 per month.

 

Do you offer water birth?

Absolutely!  I offer a large, portable tub for rental.  A deep tub for labor can be very therapeutic and welcoming.  Some women choose to stay in for the birth, while some find that they push more efficiently on the birth stool or other positions.  It’s your birth  – we work with your preferences!

 

At what point in pregnancy do you begin care?

Usually clients begin care with me between 8 and 12 weeks.  Studies show that women who receive early prenatal care tend to have fewer complications and better outcomes.

 

How often would I see you for prenatal care?

My clinic days are on Tuesday and our visits will last for an hour.  I will see you every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, and weekly thereafter until you give birth.  Our visits will consist of discussion, education, preparation for your upcoming birth, concerns and questions, and checking on the well being of you and your baby.

 

If I’m receiving care from you, do I also need to see an obstetrician or family doctor?

No. I am considered a primary care provider, and provide all of your prenatal and postpartum care.  If there is a complication that arises during your prenatal or postpartum care, I will refer you to an OB or specialist. I do full scope midwifery, which includes well-woman care.

 

What testing do you offer?

I follow the community standard of care, which includes routine lab work, genetic/prenatal screenings if desired, and ultrasound when necessary.

 

Do you visit our home for any of the prenatal exams?

No. I typically do not do home visits but may do so, depending on specific circumstances.  Specifics for your birth, including set-up & supplies are discussed during prenatal visits and my childbirth preparation classes.

 

What medical/non-medical equipment do you bring for the birth?

We bring oxygen and resuscitation equipment (my team is trained in neonatal resuscitation), IV equipment, medicines for treating hemorrhage, usual medical equipment (doptone for listening to heart tones, blood pressure cuff, stethoscope, thermometer, etc), birth stool, and various herbs and homeopathy remedies for labor, birth and postpartum.  We also carry sterile instruments, suture material, and local anesthesia for repairing tears, when needed.

 

What about having our other children at the birth?

I love and encourage children at births, provided that the parents are comfortable with it.  When children are well prepared and have an adult present to care for them, they enjoy being part of the process.  Often it is quite helpful to them in welcoming their new sibling.  I also encourage having them attend prenatal visits and have an extensive lending library with books and DVDs to help them prepare for this new experience.

 

What about the mess?

Most home births are not messy.  We take care to protect the furniture and carpeting and everything will be cleaned up, including placing laundry in to soak, before we leave.  Sometimes your house is left cleaner than it was before we arrived!

 

What does your postpartum care include?

After the birth, we do several comprehensive home visits in the first week for mom and baby, extensive breastfeeding support, and office visits at weeks two and six.  The final six-week postpartum visit includes family planning and well-woman care (physical exam and pap).

 

What is your cesarean rate?  VBAC rate?

My cesarean rate is very low, about 5%, and VBAC rate is about 90%.  Most birth centers have cesarean rates less than 12% and the national hospital average is 33%.  At some local hospitals it is as high as 45%.

What is your transfer rate?

The majority of transfers is for lack of progress and are not emergencies.  My transfer rate is about 8-10%.  True emergency transfers are extremely rare – less than 0.5%.

 

Why are your outcomes so good?

I offer holistic, individualized care for healthy, low-risk women – from the first visit onward.  We work together as a team, focusing to make your pregnancy, birth, and postpartum period the best that it can be and keeping your risk factors low.  Also, I do not offer services that will increase your risk such as medical induction, narcotic type pain meds, etc.

 

What hospital do you transfer to?

My preferred hospital for transfers is San Jose Valley Medical Center, which is quite homebirth-friendly.  If you are a Kaiser patient, then we would transfer to Kaiser Santa Clara.

 

What is your role at the hospital if we have to transfer care?

Your birth team will not abandon you!  I will help to facilitate a smooth transfer of care to the hospital, if that is needed.  My role continues to be very hands-on, but more as an advocate and for emotional support.  I do not have hospital privileges; therefore, I may not be able to “catch” the baby, depending upon the doctor/hospital. We will stay with you until your baby is born, breastfeeding is established, and you are doing well.  Depending upon the circumstances, I encourage early departure, if that is desired, as we do home visits within 24 hours of the birth.

 

Do you offer a complimentary interview?

Yes, I do a one-hour complementary consult/interview.

 

What are your payment requirements?

I require an initial deposit at the first prenatal visit and final payment by 36 weeks.  My fee does not include lab work, classes, birth kit, birth tub rental, visits with other care providers, doulas, additional herbal supplements, etc.

 

What about medical insurance?

PPO’s are required to pay for Nurse-Midwifery services but payments depend upon your specific insurance—and whether you have maternity coverage.  Most HMO’s do not cover homebirth.  I work with a homebirth-oriented billing service to maximize your reimbursement.