Frequently Asked Questions

Frequently Asked Questions

If you are considering a home birth, perhaps the following are questions you have wondered about. Don’t hesitate to contact me with any specific questions…I’d love to help you in any way I can! Please note, these questions and answers pertain specifically to my practice here at Gentle Delivery Childbirth Services, and may not apply to other midwives and practices.

Q. At what point in my pregnancy should I contact you?
A. You are welcome to contact me at any time-with preconception questions or as soon as you find out your pregnant. A free no-obligation consultation where you can ask questions and see my office can occur at any point, but I typically schedule your first actual appointment once you are between 10-12 weeks along, as that allows the baby to be mature enough to hear the heartbeat. The earlier you are in touch, the greater chance I will have an opening over the time you are due, though it’s never too late to talk with me about your options, either…we can begin care late in the pregnancy when necessary, too!

Q. What does a normal prenatal look like, and where does it take place?
A. Prenatal appointments normally take place in my home office, usually on Tuesday and Thursday afternoons, although other times are possible. I generally expect to take anywhere from 30 min. to an hour, with the goal being able to spend enough time to answer any questions or concerns a couple might have, as well as including education regarding exercise, nutrition, positioning, childbirth, etc. At each visit a urine sample is checked, weight is recorded, BP is taken, and baby is listened to, measured, and palpated to see his or her position. Other testing and/or procedures will be performed as needed. The normal schedule for visits is every month until 28 weeks, followed by bi-weekly appointments until 36 weeks, and weekly visits thereafter. A home visit is performed at 36 weeks, in order to give myself and any other birth attendants a chance to see your location in normal daylight hours! 

Q. Do I need to see a doctor besides seeing you for prenatal care?
A. That honestly depends upon your personal preferences. The prenatal care I give would be similar to what you would receive from a doctor, including labs and referrals for things like sonograms. Most of my clients do not see a doctor while receiving care from me, as it keeps costs down and keeps them from multiple prenatal care visits. If your OB office is open to co-care, it can provide you with a seamless transition in case of transport, especially if it is covered by your insurance provider. If care with an OB is covered in full by your insurance provider, you may benefit from continuing care with them in order to have the costs for your labwork and other testing covered completely.

Q. Will my insurance cover your services, or how can I afford it?
A. Sadly, many insurance companies do not cover home midwifery care, though it is always worth checking into thoroughly. I would be happy to provide you with some information on how to best discuss this with your insurance company, and I am also willing to give you a written statement complete with insurance codes to submit to your insurance company. In order to keep my own costs down, I do not file insurance, but I do try to make care accessible to all families by charging a sliding scale fee based upon your family’s income. Keep in mind, too, that when using insurance, you will have a co-pay, and for some people the cost of my services are either similar or lower than the co-pay amount you would be paying with a hospital delivery.

Q. I notice you have a student working with you. How does that influence my care?
A. When a student is interning for midwifery training, their level of involvement varies according to where they are at in their studies. A student midwife begins by observing all aspects of midwifery care, and applying the academic knowledge she has already received to practical, hands-on situations. As her experience expands, so do her opportunities-she assumes more responsibility depending upon her level of experience and skill. Students are always grateful for any opportunity afforded them to learn, and would love to be as involved with your care as you feel comfortable with. I always strive to make sure the client feels completely comfortable with any care provided by a student, whether that is allowing the student to feel for baby’s position and fundal measurement, or whether it is as extensive as allowing the student to participate in a high level of care during delivery. Whether you prefer lots of involvement or minimal involvement, a student generally acts as my birth assistant during the actual labor and delivery, helping to provide labor support, take notes, and in general act as my second set of hands. 

Q. Who will attend my birth? Is is okay to invite others to be present in addition to the birth team?
A. Normally I attend births with one or two qualified assistants. These ladies are usually either skilled students or birth attendants, and enable me to know you are getting the best care possible, allowing both baby and mom to be cared for in case of emergency. Besides this, whomever else you choose to have present at your birth is up to you. I’ve been at births where it was the bare minimum of people, and I’ve been to births where there was a crowd! The main issue is that you feel totally and completely at ease and comfortable with whomever is present, as that can majorly impact your experience.

Q. Are children welcome to attend the birth?
A. It’s your birth, so you get to decide if you want your children present or not! If you are planning on having your children attending, I strongly recommend you having an extra person handy whose sole responsibility is caring for your child(ren) so that you can focus on the delivery.

Q. Do you do waterbirths?
A. Yes! Laboring and delivering in the water are both options. For many people, their home tub is comfortable enough, but if you’re wanting to use an actual “birth pool”, I can put you in touch with rental possibilities.

Q. I had a cesarean with my previous delivery, does that rule out a home birth?
A. I am happy to help women VBAC whenever possible. For most women, a VBAC at home is statistically safer than a repeat c-section. Make sure you get a copy of your previous medical records, and we can discuss your particular situation in person in more detail.

Q. What birth positions are options at home?
A. There are about as many options as there are women!  One benefit to delivering at home is the flexibility to figure out what works the best for you…whether that is squatting, laying in bed, standing in the shower, or wherever you are the most comfortable. I have a traditional “birth stool” that I bring along to births which gives you the option of a low squat, but most women instinctively find a position that works the best for them.

Q. Are you prepared for possible emergencies?
A. Yes. I maintain current certification in both neonatal resuscitation and CPR, bringing along emergency equipment in case of a baby with breathing difficulties. I also carry equipment to assist with stabilizing a mom in the rare case of hemorrhage. It’s my goal to make your home birth experience as safe as possible, which includes careful monitoring of both baby and mom during and after labor, so as to catch any concern that is out of the scope of “normal”. Consistent prenatal care combined with healthy, low risk moms lowers the chance of emergency procedures drastically, but your birth team stays alert for any signs of possible surprises. We can discuss this question in more detail during your consultation if you wish.

Q. So, laboring at home sounds nice, but what about the mess that comes along with birth?
A. Most people are surprised at how little mess is involved. I have families purchase disposable underpads (available at most drugstores) and a cheap shower curtain, which we use to protect surfaces such as the bed and carpet for the actual birth. These things get thrown away afterwards, and myself or my assistant will start laundry before we leave your home. We also make sure to tidy things up so that you aren’t left with clean up!

Q. How do I go about getting documentation for my child?
A. I will file all needed paperwork with the state, which includes the official birth certificate and request for a social security number. I also perform the newborn screening test on your baby during the home visit which occurs 24-48 hours after birth.

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Sweet baby feet as baby is being weighed during the newborn exam!

 

February Travels…and what the CPM Title Actually Means

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Beautiful palms and lots of green-we soaked it up while we could, and then returned to 12 in. of snow still on the ground at home!

Happy March to each of you! I am really ready for winter to be over, especially since this one seems to be stretching on and on. This past month has been busy, and I even enjoyed a 6 day reprieve from cold when I took my 15 mo. old to Costa Rica in order to attend a dear friend’s wedding. It was a great trip, though not without excitement (like when I realized I left my wallet behind when I arrived at the airport and was ready to depart…or when flights were cancelled due to weather…and other such things….so grateful for how the Lord took care of every detail!). The chance to reconnect with old friends was very special, and it was fun to introduce them to my little fellow, though it would have been even better if my husband and 2 yr. old could have joined us. They seemed to manage quite well on their own, but we were all ready to be back as a little family once again!

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The way to travel with a toddler…

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Matthias LOVED playing in the water-this same day it was -10 in PA!

I was trying to come up with a good idea to write about this month, and then I thought that perhaps I could blog about one of the items on my list of things that I want to add to my prospective client handout folder. One question, or series of questions, that comes up frequently during the initial interview has to do with my certification, and what exactly it means. There are so many different names and titles out there that it can be confusing at times! When you go to figure out what care provider is right for you, it is helpful to have an idea of what his/her qualifications are, and what all is entailed with those. So, here’s a brief look at what the Certified Professional Midwife title means…

The North American Registry of Midwives (NARM) was founded in 1987 by the Midwives Alliance of North America, and they oversee the certification standards of the CPM credential. In order to become certified, one must first show that she can provide competent, safe, and qualified care to mothers and babies throughout the birth and postpartum process, both by completing academic studies and by demonstrating care in a clinical setting. This requires that a prospective midwife both study through a NARM-approved academic institution, as well as complete an internship under the supervision of other certified midwives. Proving that one has the mastered the skills necessary to provide knowledgeable care takes time, and there is an extensive set of qualifications that must be met before one can sit for the final exams that cover questions relating to each phase of maternal and infant periods. Once the exams are passed, re-certification must take place every 3 years, which requires ongoing continuing education and re-certification of CPR and NRP.

When I first looked into obtaining midwifery education, I decided to pursue getting certification, even though the state I was working in did not recognize the credential. It was important to me that I do my best to provide the best care possible, and submitting to the qualifications necessary to become a CPM helped prospective clients to know that I took my job seriously and that I had demonstrated the ability to pass the national standard for midwifery care. In areas where licensure is not offered for homebirth midwives, this certification also gives clients the assurance that a certain level of training has been taken, instead of not having any idea of what a midwife’s qualifications may or may not include. Interestingly, many of the states that offer licenses to midwives are using the CPM as the basis for their training requirements. While many midwives who do not have the CPM title are competent and experienced, I feel like having a standard of competency for certification helps to ensure safety and high standards of care for each mother who desires to birth out of the hospital.

Finally, I like the way this quote sums it up, taken from http://www.nacpm.org/what-is-cpm.html
“A Certified Professional Midwife (CPM) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM). CPM is the only international credential that requires knowledge about and experience in out-of-hospital birth.”

If you’re interested in looking into this topic further, I’d suggest you check out these links:
http://narm.org/advocacy/narm-brochure-text/  gives a good overview of the Midwifery Model of Care and how CPM’s help to promote this, and http://midwifeinternational.org/how-to-become-midwife/certified-professional-midwife-vs-certified-nurse-midwife-whats-difference/  details the differences between the CPM and CNM titles.

Feel free to let me know if you have questions, or if you’d like to add a comment regarding this…thanks!

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Little M ready for his newborn exam…a March baby who will be having a birthday soon!

Link to article of interest…

I know I’ve not done well at keeping this blog up the past while…it’s been a busy summer! I had a baby of my own in June, which I will have to post about sometime soon. Being a mom has been a blessing and a challenge! But I came across this article, and wanted to share it:

http://erinmidwife.com/2011/03/31/if-i-were-at-home-i-would-have-died/

Enjoy!

Vaginal Birth After Cesarean (VBAC) Information

Recently I’ve been contacted by several people interested in finding out more about having a VBAC homebirth, checking out their VBAC options in this area, and in general seeking more information. I thought some of you may be interested in the following links to articles on the Midwifery Today site.

Along those same lines, a midwife friend of mine just sent me this quote from a prominent midwifery textbook, which sheds some light on the commonly recognized risk in attempting a vagina birth after cesarean:

“Rupture of a low transverse uterine incision, if it occurs, is not generally catastrophic or life threatening to either the mother or the baby. Such a rupture is usually no more than a dehiscence of the old scar and an incidental finding during uterine exploration following a vaginal birth or during an elected repeat cesarean section. To be life threatening, rupture of a uterine scar either extends into the rich blood supply found in the uterine corpus and fundus or disrupts the placenta, which is normally located in the uterine fundus. Because of these possibilities, VBAC is not recommended for women with classical upper uterine segment vertical scars.”   (from Varney’s Midwifery, Helen Varney)

If any of you would have VBAC stories to share, I would love to hear them! It is always encouraging for those facing a new situation to hear from those who have successfully done it before.

Homebirth after Cesarean: The Myth and the Reality – by Amy V. Haas

http://www.midwiferytoday.com/articles/homebirthaftercesarean.asp

VBAC and Choice: Many Questions and a Few Answers – by Nancy Wainer

http://www.midwiferytoday.com/articles/vbacchoice.asp

“Birth is not an Illness!”

While compiling helpful articles and information for the childbirth class handbooks last month, I came across this one and thought it would be a good one to share. It is interesting to get this perspective!

Birth is Not an Illness!

15 Recommendations from the World Health Organization compiled from Care in Normal Birth: report of a technical working group 1997 – WHO/FRH/MSM/96.24

These 15 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive in the understanding and implementation of proper prenatal care.

1. The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

2. The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy and birth and following birth should be the duty of this profession.

3. Information about birth practices in hospitals (rates of cesarean sections, etc.) should be given to the public served by the hospitals. There is no justification in any specific geographic region to have more than 10-15% cesarean section births (the current US c-section rate is estimated to be about 23%).

4. There is no evidence that a cesarean section is required after a previous transverse low segment cesarean section birth. Vaginal deliveries after a cesarean should normally be encouraged wherever emergency surgical capacity is available.

5. There is no evidence that routine electronic fetal monitoring during labor has a positive effect on the outcome of pregnancy.

6. There is no indication for pubic shaving or a pre-delivery enema.

7. Pregnant women should not be put in a lithotomy (flat on the back) position during labor or delivery. They should be encouraged to walk during labor and each woman must freely decide which position to adopt during delivery.

8. The systematic use of episiotomy (incision to enlarge the vaginal opening) is not justified.

9. Birth should not be induced (started artificially) for convenience and the induction of labor should be reserved for specific medical indications. No geographic region should have rates of induced labor over 10%.

10. During delivery, the routine administration of analgesic or anesthetic drugs, that are not specifically required to correct or prevent a complication in delivery, should be avoided.

11. Artificial early rupture of the membranes, as a routine process, is not scientifically justified.

12. The healthy newborn must remain with the mother whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.

13. The immediate beginning of breastfeeding should be promoted, even before the mother leaves the delivery room.

14. Obstetric care services that have critical attitudes towards technology and that have adopted an attitude of respect for the emotional, psychological and social aspects of birth should be identified. Such services should be encouraged and the processes that have led them to their position must be studied so that they can be used as models to foster similar attitudes in other centers and to influence obstetrical views nationwide.

15. Governments should consider developing regulations to permit the use of new birth technology only after adequate evaluation.