Frequently Asked Questions
What is a Certified Professional Midwife?
A Certified Professional Midwife (CPM)® is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings. To learn more about the CPM credential go to www.narm.org
What is the Midwives Model of Care ™
The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.
The Midwives Model of Care includes:
Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions
Identifying and referring women who require obstetrical attention
The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.
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Who can have a homebirth?
Homebirth is an option for any pregnant person experiencing a healthy, low-risk pregnancy who desires to be supported and to give birth outside of the medical setting, with minimal interventions, in the location of their own choosing. People who chose homebirth are a diverse group. Common threads include a strong sense of personal responsibility, a desire for a greater degree of personal autonomy, and innate trust in their bodies and in the birth process.
When should I contact you if I'm interested in learning more or starting care?
Contact me as soon as you're interested. I offer a free consultation visit and even preconception care. The initial prenatal visit is usually around 10 to 12 weeks (from your last period), which is when we can first reliably hear the baby's heartbeat with a handheld Doppler. Because offering this style of very personal care means taking a limited number of clients each month, it is best to make contact early, but if you are discovering midwifery care later in your pregnancy, don't hesitate to check on availability.
Will I need to see a doctor during my pregnancy?
That is your choice. Many clients choose to have one visit to establish a relationship with obstetric care providers. Most clients do not receive concurrent care with a doctor, as midwives provide comprehensive care, but ongoing care with your midwife and a backup physician is an option. Referral to a backup OB practice is available for clients who wish to have an ultrasound or who have concerns best monitored by a medical team.
Who will attend my birth?
Can I invite others, including my children, to attend?
Your birth team consists of your midwife, an assistant, and occasionally a student (with your permission). It's your birth! You can invite anyone you want. The decisions regarding whom to invite to your birth are very private and unique to each family. Some basic advice is to only invite loved ones who are supportive of your choice to birth outside the hospital and to prepare folks ahead of time that you can't know how you will feel in the moment and may want more privacy. If you plan for your other children to be present, we strongly recommend there be someone there whose only job is child care so you and your partner can focus on labor and birth.
How do you monitor the baby during birth?
We use a hand-held Doppler (ultrasound) to monitor the baby's heartbeat at regular intervals during labor. This allows us to unobtrusively listen to the heartbeat through contractions when mom is in her most comfortable position, and even underwater.
What if there is an emergency?
Since home birth midwifery care is limited to healthy low-risk women and we provide careful monitoring in prenatal care, the risks of a true emergency are small. However, complications do occasionally arise. Births are attended by two care providers trained and current in Neonatal Resuscitation (newborn CPR) and we carry equipment and supplies to address complications such as newborn difficulty breathing or postpartum hemorrhage. Most transports to the hospital in labor are not emergencies, but a gradual recognition, through monitoring, that mom or baby is better served in a medical setting. In the case of any decision to transport to the hospital, I will contact the hospital and the receiving physician, provide information about the transport, accompany the family to the hospital, and remain as labor support once clinical care has been turned over to the medical team. Once you are discharged from the hospital, postpartum care at home resumes as planned.
Is Home Birth Legal in Pennsylvania?
Homebirth is legal in all 50 states. States vary on licensure and recognition of the CPM and Pennsylvania does not yet recognize this credential. However, we maintain a relationship with medical backup in the region and maintain a registry with the state to provide birth certificate filing, newborn metabolic screening, and newborn hearing screening.
What about the mess?
There isn't much. When planning a home birth you will be asked to order a birth kit and gather some basic supplies. A lot of these items, such as underpads, are to help keep things clean. We usually wind up with one half full bag of trash and one or two loads of laundry. Your birth team will tidy things up before leaving.
Do I need to take a childbirth preparation class?
Childbirth preparation classes are not required but are encouraged, especially for first-time parents. There are a wide variety of styles and approaches to childbirth education. We can offer referrals for classes geared toward natural childbirth.
Should I hire a doula?
It is entirely up to you and your partner if you want to hire a doula. While midwives offer emotional and physical labor support in addition to clinical monitoring, many birthing people (and their partners) can benefit from extra support and guidance. Doulas can be a great addition to the birth team. In a homebirth situation, a doula generally does not have to fill the role of natural birth advocate because you know your midwife well and have created your birth plan together.
Can I have a VBAC at home?
Probably. A previous C-section does not automatically rule out a vaginal birth or home birth, and it can be especially fulfilling and healing to birth your babies at home after a Cesarean birth. For most people, a VBAC at home is statistically safer than a repeat C-section. There are additional considerations that we would need to discuss, including reviewing your previous records and your pregnancy and health history. We ask that all clients planning a VBAC have at least one sonogram followed by an appointment with a hospital-based care provider.
For more information regarding VBAC try ICAN and VBAC facts.
What do I need for a waterbirth? Where can I find more information?
A birthing pool and related equipment can be loaned to you at no cost. There are a few extra nonreusable supplies you will need to have on hand, and you are responsible for the set up and break down of the birthing tub. Detailed instructions will be provided to you.
For more information about waterbirth go to Waterbirth International here. We also have waterbirth videos and books available to borrow.
Do you offer pain medication at home?
Pain medications are not available at home due to the risks they pose to you and your baby. Instead, you have the comfort of your own surroundings, the freedom to move and rest in labor as you please, nourishment to keep up your strength and stamina, the option to labor and birth in water, and a caring birth team dedicated to supporting unmedicated births. Of course, going to the hospital for pain medication is always an option, but I find it is very rare for women to request this change.
Will my insurance cover the cost of home birth? If not, how can I justify paying out of pocket when my insurance will cover a hospital birth?
This depends on the insurance company. I am happy to provide an estimated invoice for those who are hoping to be reimbursed by an insurance company or health share organization, but I do not provide billing or diagnosis codes. You can obtain a verification of benefits, and file for reimbursement, or request to have the amount applied to your deductible if you so choose. Some people choose to simply pay out of pocket anyway; with a high deductible or coinsurance, midwifery services are not typically more than a hospital birth would cost. When compared to the full cost of even an uncomplicated vaginal hospital birth, home birth is considerably less. Most clients who pay out of pocket tell us it's worth every penny for the hours and quality of care received.
Here's an estimate of our average time spent with a client:
12-14 hours/prenatal visits
6-48 hours/ labor and birth
3-4 hours/ immediate postpartum
6 -8 hours/ 4-6 individual postpartum visits
8-10 hours of work you don't see: answering your questions via phone, e-mail and text message, coordinating with other care providers when the need arises, researching topics particular to your needs, paperwork, and equipment maintenance.
In addition to our time, the fee includes the cost of the on-call status of the midwife and assistants, the assistant’s fee, access to a midwife by phone 24 hours a day, and the cost of driving to the client's homes. Keep in mind that you are receiving highly personal, individualized care from specialized care providers. Each birth is a once-in-a-lifetime event. Most people budget and plan for things they really want. Birthing a child the way you want to is as important as the special things we expect to pay for out of pocket like a wedding, car, engagement ring, or vacation.
What about after the baby is born? Do you provide breastfeeding support?
CPMs are trained to provide care for mother and baby through 6 weeks postpartum. We recommend that you make an appointment for your baby to see a pediatrician within a week of the birth. We see clients regularly, so are able to support breastfeeding and monitor baby's weight gain. We have lots of experience helping mamas and babies establish a good breastfeeding relationship (an unmedicated birth and immediate skin-to-skin contact is a good start!) and can offer referrals to local lactation consultants for the rare more complex nursing issue.