I thought I would take a moment to address some of the most common questions I am asked interviews. There is alot to know and questions to ask if you are looking into midwifery care for the first time.
Who is a good candidate for midwifery care and out of hospital birth?
Midwives serve low risk, healthy women. What does this mean? It means that in general your health is good and you are committed to a healthy pregnancy through nutrition and exercise. It also means that you do not struggle with chronic health conditions that may make out of hospital birth unsafe for you like, essential hypertension ( high blood pressure) , cancer, heart disease or previous heart surgery, diabetes, HIV or previous uterine surgery other than low transverse cesarean section.
Sometimes a woman starts out low risk and develops a condition that would make a transfer of care to a physician necessary. These types of conditions could include placenta previa, uncontrolled gestational diabetes, Polyhydramnios ( to much amniotic fluid) Oligohydramnios ( not enough amniotic fluid) IUGR ( Intrauterine Growth Restriction or a baby that is not growing properly), Genetic anomalies detected in the baby, Hypertension, Pre-eclampsia, ICP ( Intrahepatic Cholestasis of Pregnancy), though these conditions tend to be rare, they can occur and the safest option for you or your baby would be to deliver in the hospital under physician care.
Do you attend Twins, VBAC’s or Breech births?
Yes, I do. Each of these situations comes with their own set of risk factors that will be discussed with you and with a full understanding of those risks and evaluation of the pregnancy. I will attend twins, VBAC & VBA2C ( Vaginal Birth After 1 or 2 Cesarean section births) and Breech births after a thorough evaluation and discussion with the parents on risks and benefits. Not every mother and pregnancy is a good candidate and a thorough medical history will be obtained as well as ongoing assessment and evaluation of your progress.
What is your transport rate?
This question always makes me think for a second….what information does the woman asking me think the number tells her? Does she feel a low transport rate proves I am a good midwife or not? I think it does not.
Here are my thoughts: my transport rate is exactly what it should be. Do I know the number? Nope…Do I care? Nope. Why? Well, a transport in labor is not a failure of midwifery care. A transport to the hospital during labor is midwifery working exactly as it should be. If you or your baby’s health warrants intervention that I cannot give at home, then the hospital is where you need to be for your safety.
If you become exhausted, stop coping and start suffering, pain medication may be what you need to help you have good memories of your birth, no one should suffer for the sake of a birth plan. There is a line that tips the scale from coping to suffering. If a woman is suffering, and I cannot help her get back to coping, it is in her best interest to explore options for pain relief which may warrant a trip to the hospital. Again, not a failure on the part of the mother or the midwife, but a change of plan based on the circumstance we are working with.
I will say, when mothers commit to out of hospital birth and healthy pregnancies, when they follow the guidelines I have developed over the years and through my experience of what works for successful homebirths, and through the knowledge I have gained by consulting with physical therapists, personal trainers, doulas, organizations that specialize in the mechanisms of birth, my transports drop to near zero. When they don’t…..transports go up.
Sometimes a transport is necessary even when you have done everything in your power to get you to your goal. Life, is unpredictable. But I am committed to working as hard for your birth plans as you are working. I will be right by your side, advising, supporting and hopefully working towards your goal of a safe and happy homebirth experience.
My hospital of choice for non emergency transports is Baylor University Medical Center - Dallas , emergency transports go by ambulance to the nearest appropriate hospital.
Is birth center or homebirth safer?
The only difference between homebirth and birth center birth is proximity to a hospital. Texas law requires birth centers to be within a max of 30 minutes from the nearest hospital with a L&D department. Most homebirths also fall into that category. At a homebirth, I bring all safety equipment and medications that I would have had at the birth center…only I come to you instead of you coming to me. I bring oxygen, resuscitation equipment for baby and for mom, I have IV fluids and antibiotics should you need them or choose that treatment option for Group B strep, I carry both pitocin and misoprostol for postpartum hemorrhage, I have an NASG ( Non-pneumatic Anti-Shock Garment) for transported hemorrhages ( that I have never had to use). I can suture 1st & 2nd degree tears and yes, you get numbing medicine for that! I have a large selection of herbal remedies and homeopathic medicines I am trained to use and a few essential oils. I maintain NRP (Neonatal Resuscitation ) & Adult CPR certification. Midwives travel in pairs, which means as you near delivery, I will call in a second licensed midwife to assist me. Two sets of skilled hands make managing complications smoother.
How long will you let me go past my due date?
This question is asked often. In my experience pregnancies more often are within a normal range of about 41.3 weeks. That is common. The laws that govern our scope of practice recently changed (2019)to say that 42.0 weeks a client must either be transferred for induction OR have appropriate prenatal testing to ensure a healthy pregnancy. I will order an ultrasound called a Biophysical profile & A Non Stress Test to meet that requirement.
In my experience, pregnancies rarely go to 42 weeks or beyond. If you have experienced longer gestation pregnancies, there are options that I can offer you in the third trimester that may help bring your baby closer to 40-41 weeks. If we are nearing the 42.0 week mark, we will discuss options , encouragements and you can choose the path you want to take.
Have you ever had a mother or baby die in labor?
Thankfully I have not had this experience.
What is required for continuing education for midwives?
The State requires 10 CEU hours a year. I typically accrue around 30-40 hours of continuing education hours each year. Some classes I take online and some are in person workshops. I keep a notebook of all the classes I have attended throughout the 2 year renewal periods and you are welcome to see it any time. I take continuing ed seriously. If we are to be evidence based providers, we must keep up on the evidence. I also believe in taking workshops where hands on skills are practiced regularly. I have attended several breech delivery workshops, Managing complications in out of hospital settings, Group B Strep, Infant Microbiome, Optimal positioning and body work and the list goes on.
I also attend Peer Review. Any time a transport is made midwives are encouraged to review the case with her peers to evaluate her assessments and decision making skills to determine if the transport was made appropriately and what were the circumstances leading to transport. We also review difficult birth, losses and any time a midwife feels she needs the input of her peers. Peer Review is not a place for your sister midwives to tell you how good you did, it is a process to hold your feet to the fire which we believe keeps midwifery safe for all the mothers and babies we serve.
Can I opt to not have any labs or sonograms?
In my practice the answer is no. There are some things choices can be made on but I feel that it is my duty to practice safely and within the scope of law that my license is governed by. I cannot prove a mother is low risk without assessments to back that up. This is for your safety and for mine. I keep lab work to the minimum I feel is necessary unless a condition arises that says “hey, this warrants deeper investigation” . There are some labs where you have a choice on how to perform the test such as gestational diabetes screening. You may choose to forgo Group B strep Screening after a thorough conversation on the risks. The state requires HIV, Syphilis and Hep B in the first and third trimester or at the onset of labor .
I require one sonogram at 20 weeks for most mothers. Should you want more, I will order them for you. I believe, at minimum, the 20 week anatomic survey lets us know your baby is currently growing on target, your placenta is in a good position ( especially important for moms looking to VBAC), you have a 3 vessel cord, the baby looks as if all his/her organs are where they should be and that this, by all accounts, looks to be an appropriately developing baby . Sometimes we see something that may need follow up in the third trimester such as a low lying placenta or at some point I feel like there may be to much or to little fluid, or maybe I can’t quite tell on palpation if your baby is breech and we need to get a good position on him/her. Most of my clients start care at around 12 weeks and so many do not have an early dating sonogram. If you begin care early we can certainly order it or if you are uncertain of your conception we can have a dating sonogram .
Will you be at my birth?
Generally speaking the answer is yes. Over the years I have missed , I think, 4 births. I schedule vacations a year or more in advance and inform prospective clients of when they can expect me to be out of town so they can decide if they are comfortable with that scenario or not. Midwifery is a very demanding profession and breaks are necessary, but I make every effort to be at the births of my clients babies. I have a “partnership” …really more of a sisterhood with 2 other midwives in the area. We back each other up for unexpected emergencies or illnesses & time off. We assist each other and work closely together. We have similar styles of practice and work well together. On rare occasion, you may labor to fast for me to make it! Be assured I am on my way or, if I know you live in close proximity to a sister midwife I may call her to head to you as I am on my way. I make every effort to have your birth attended!
How much is this going to cost? Do you take Insurance?
I prefer to discuss finances in person. I like to be able to answer your questions face to face when it comes to money.
If you have a healthshare, they generally pay well. If you have commercial insurance, you will access out of network benefits. I will have you pay my fee then give you a coded receipt at the 2 week postpartum visit(OB billing is done with the date of birth or the baby) to send to your insurance. If they pay, they will send the check directly to you.
What is included in your fee?
All prenatal & postpartum visits Birth Tub ( if available, I have 2 tubs)
Labor and birth care Payment of the second midwife at your birth
Routine Labs Birth kit of disposable supplies
Medications and suturing at birth if needed
What is not included?
Ultrasounds Non disposable supplies ( towels, sheets etc) at birth
RhoGam ( Rh- mothers medications) Non Routine Labs ( billed to you at my cost or filed to your insurance)
Prenatal Genetic Screening ( If you choose this option, Natera bills their own labs to insurance or as self pay)