Is Homebirth Safe?
It is just as safe to have a baby at home as it is in the hospital if you have an appropriate healthcare provider. Midwives are experts in normal! Most people having a baby are healthy and go on to have normal healthy pregnancies and birth. During your consultation we will evaluate if you have any health history that may make a home birth an unsafe option. We will also monitor you for any issues that may come up during your pregnancy. Certified Nurse Midwives are educated similarly as nurse practitioners so we can assess, treat, and if needed consult if problems arise. Multiple studies on planned homebirth have found that there is a significant decrease in interventions, better outcomes for babies, very low rates of cesarean section, and a high vaginal birth after cesarean rate (VBAC).
How often are prenatal appointments?
Your choice of 30 or 60 minute in office visits at our Malta location every 4 weeks from the beginning of pregnancy through 28 weeks, then every 2 weeks until 36 weeks. We do one in home 90 minute birth planning visit at 36 weeks. At the end of your pregnancy we see you in the office weekly until you have your baby. Additional visits for other concerns are scheduled as needed. If this is your first pregnancy we recommend hour long appointment times as this allows adequate time to answer all of your questions and provide the education for a healthy pregnancy and birth.
What are your office hours?
Both midwives are in the office two days per week. We see clients Monday, Tuesday, Thursday, and Friday for regularly scheduled appointments. We are closed on Wednesday. Appointments go from 10 am to 3:30 pm. Most home visits and postpartum visits occur at the end of our clinic day.
What happens during prenatal visits?
Our practice is based on the value of informed consent. Our goal during pregnancy is to provide the time and education for you and your family to make the most informed decisions that are right for you. Education is an integral part of the midwifery model of care. Your first appointment is typically 1 hour so we can review your health history, pregnancy history, and answer any questions you may have. Most other prenatal visits we discuss your concerns, provide education appropriate to how many weeks pregnant you are, monitor the health of your pregnancy, and of course listen to your baby.
What happens at the 36 week birth planning meeting?
It is really important to us that you are able to make informed decisions about your birth in your home. This visit is when you tell us how we can make your birth unique to you and your family. We help you envision how your home will be your birth place. We also learn how to drive to your house, where to park, where your birth supplies are located in your home, and what door to enter when you are in labor. We will also make a personalized comprehensive hospital transfer plan just in case.
What about lab work and testing?
We discuss all standard/routine prenatal testing and include the risks/benefits as well as pros/cons of every recommendation. We encourage families to learn as much as possible to make informed choices specific to their family. The recommended labwork is constantly changing so we will discuss all current recommendations with you. We do not have a lab in our office, so bloodwork is typically done at the many area LabCorp locations. Billing of labwork is done directly through LabCorp. We perform pap smears, and cervical/vaginal cultures when needed in the office. Ultrasounds are typically done in your community if you choose to have them. Where they are done depends on insurance, if you want to use insurance, and where you live. We do not require “routine” ultrasounds, however there are reasons we may request that you have one. We partner with Mobile Mama Ultrasound which provides ultrasounds in our office for a reasonable cash pay. Typically this cash pay option is much lower than many deductibles from insurance.
What does 24/7 availability mean?
Many of our clients really appreciate the personalization of their care with us. We are dedicated to establishing a trusting relationship with you. This includes having your questions answered, being available for any illness or emergency that may occur, and we are on call for you during your due month. Sometimes it is just nice to hear reassurance from your midwife. Many clients utilize the chat feature of our electronic medical record. It is like being able to text your midwife!
What do you bring to births?
In addition to our knowledge, education, and experience, we bring many things that assist us in monitoring you and your baby’s health during the labor. This includes equipment for you and your baby such as a waterproof fetal heart rate doppler, blood pressure cuff and stethoscope, thermometer, and infant stethoscope. We bring supplies to perform the initial newborn exam and any newborn procedures that you choose to have. We also prepare for any emergencies that may occur. We have standard medications for excessive postpartum bleeding, nausea, antibiotics, IV kits and fluid if needed, sterile instruments for cord cutting, and supplies to repair a laceration if it occurs. The CNM’s and RN’s are certified in Neonatal Resuscitation which requires oxygen, suction, and resuscitation equipment for the baby and birth parent. We also bring a birth stool to use for birth or to sit on in the shower.
What about a birthing tub?
We love pools for labor and birth. Water is a wonderful tool for labor, both for comfort and supporting good labor progress. There are many options for you. You may buy or rent your own tub. We sell personal use pools for $75 in our office. We will also lend you an air pump to blow up the pool, and a sump pump to empty the water out after use. You will need a new hose and an adapter for your hot-cold water source. We will give your clear instructions and you are responsible for setting up the tub for labor and birth. We strongly recommend having your tub and supplies ready by the 37th week of pregnancy.
Will I need a doula?
Doulas (professional labor companions) can be wonderful resources prenatally and during the many hours of a long labor. They may provide comfort, physical support, and reassurance. If you plan to have a doula at your homebirth, s/he must be comfortable with homebirth and midwifery care. The doula is a member of the team, not a go-between. Ideally, your doula will attend a prenatal visit with you so they can meet the midwives and address any questions or concerns about the doula’s role at a homebirth. Postpartum doulas offer tremendous support for families in the first weeks after birth.
Can my older children attend the birth?
Most children handle birth very well, often surprising their parents! Children do best when they are prepared, have an adult with them that they know and feel comfortable with, and have the option to leave. The designated grown up is in the home for the children and their needs and is not necessarily there when the baby is born.
I have pets. Is this a concern?
Pets are great. Cats will labor sit with you. Dogs should be given great respect during the birth of the baby and the placenta. Having a place they like to be during this time is a good thing. You have to factor in the temperament of your particular dog. After your birth, the baby and dog should be introduced to each other. Letting the dog smell the first hat or blanket the baby wore will introduce the baby’s smell first. This can help ease the transition for sensitive dogs.
How messy is it?
We clean up as we go and try to minimize and control any mess. You will have a bag of garbage to put outside in the can at the end of the birth and one load of laundry.
How long do you stay after the birth?
Normally we stay until all are well, fed, clean, and ready to be alone as a family. Three hours is the norm, sometimes it can go beyond this though. During that time, we clean up, perform a thorough newborn exam, facilitate the initiation of breastfeeding, discuss what to look out for, and when to call us. We also leave written postpartum instructions.
How often do you see mothers and babies after the birth?
The postpartum home visits are very important in our practice. Typically the RN comes to your home 24-48 hours after birth to help with breastfeeding, answer questions, perform a cardiac evaluation of baby, and do a physical exam of you and baby. One of the midwives return between days 3-5 and 7-10 to perform a physical assessment of you and baby, help with breastfeeding, and perform the newborn metabolic screening test. There is always an option to be seen more often if needed as well. At 3-4 weeks postpartum we have you come back to the office for a check up. This is optional if you feel like everything is going well. You return for a final 6-8 week postpartum visit where we do a final full physical assessment. This includes checking on the healing of a laceration if needed, performing a papsmear if needed, and discussing or placing contraception if requested. We do not see babies at the 6 week visit. Babies transition around 4 weeks to their family practice or pediatric providers. We will send all records of your baby’s early care to his or her healthcare provider.
When do I take my baby to the doctor?
We like to see the mother and baby exclusively during at least the first four weeks. During this time if anything is notable we consult with your baby’s chosen healthcare provider. Care of the baby is officially transferred to their healthcare provider at 4 weeks and we suggest bringing baby in to be seen around that time.
What about vaccines?
We work with families who choose all, some, or no vaccines after thoughtful research. We expect you to learn and make the choice that is right for your family and we support you in your informed choice. We do not administer vaccines.
Is there breastfeeding help if I need it?
Yes. Our whole team has many years of experience supporting the breastfeeding relationship and troubleshooting through some of the basic challenges that sometimes come up. If the difficulties exceed our level of knowledge or experience we will give a referral to a local lactation consultant. Working exclusively with our mothers and babies helps us to follow the individual needs of the nursing pair. There is no extra charge to you for lactation support from us during the six weeks postpartum.
Will my insurance company pay for my homebirth care?
In most cases, insurance companies reimburse for part of or all of your care, depending on the type of policy you have. We do accept Medicaid. We are out of network for all insurances and our biller works directly with your insurance to get as much covered as possible. Once you give written consent for us to care for you, we contact your insurance provider and obtain the necessary prior authorization in writing. Your insurance will not be billed until after you have had your baby. We will bill for your pregnancy and birth, and newborn care. Most reimbursement occurs between four weeks to six months after your birth. We work with a professional biller and follow up for up to one year from the date of service to try to get your insurance to cover your care in full.
What if I need to go to the hospital?
At your 36 week home visit, we will develop a personalized transfer plan with you. We look at how close to the nearest hospital you are, vehicles we may use to transport you, and availability of 911 services. When you have private homebirth midwifery care, most signs of problems can be recognized and addressed before they become emergencies. If you or your baby needs a higher level of care, we contact the appropriate facility to make the transfer, ensuring that the receiving hospital understands your situation. The midwife will fax over records to the hospital and will go with you to the hospital. We will remain with you as an advocate in the hospital as appropriate. We are still able to bill your insurance for the care we have provided and often are able to get paid in full from them.