What is a midwife?
Midwife means “with woman” in old English, and in its truest meaning is exactly that. A midwife is extensively trained to assist a client from pregnancy, through labor and birth, and into the postpartum period. She is the pregnant person’s care provider in every sense; she provides comprehensive care including blood work, referrals for ultrasounds and tests, as well as active listening and guidance surrounding the normalities and low-risk complications of normal pregnancy, birth and postpartum. Under the care of a midwife there is no need to establish care with an OB if everything stays low-risk and normal. Midwives are always assessing the person and their baby’s care for signs of well-being, and knows the right times to interfere out of medical necessity. She holds space for the emotional, psychosocial, mental, and physical transition of growing, birthing and caring for a baby.
How is having my birth at home different than the hospital?
Birthing at home allows you to A) be comfortable in the safety, smells, lighting, etc of your home, B) means you do not have to get in a car while in labor, and C) avoid exposing yourself or your baby to foreign bacteria in an unfamiliar environment. We are typically most comfortable in our homes; the space where we have created comfort, pleasing aesthetics and ease with our families. It is where we feel most comfortable in our routines such as using the bathroom, showering/bathing, and making love. Why not have our baby here too? We find that birthing people feel most comfortable and able to open to the vulnerabilities of labor while in the safety and comfort of their personal space. They have developed immunities to their own home, animals and lifestyle and are less likely to contract illness from an environment rich in other germs. They are uniquely aligned to inoculate their new baby with the microbiome that will provide a healthy digestion and immune system for life. Midwives bring everything necessary for a normal, low-risk birth, and clean up as well after the birth.
What is the difference between a midwife and a doula?
The most common question we are asked as midwives! A midwife is a birthing person’s medical care provider. They are responsible for the lives of birthing parent and baby including assessing risk, monitoring vital signs, evaluating labs, discussing procedures, etc. A doula serves as a physical and emotional support for a birthing person. They are not a medical provider. They are well-versed in the normalities of labor, birth and postpartum, as well as common procedures performed in a hospital or at home. They are able to discuss options and provide support both emotionally, as well as physically including back support, massage, use of rebozo or peanut ball, etc.
Home birth can be very safe as long as a person has had regular prenatal care and has no outstanding risk factors. Home birth is intended for healthy, low-risk clients. Midwives use extensive time in the prenatal period to constantly assess whether someone is a healthy candidate for a home birth. Studies have shown that home birth with the care of midwives has shown a decrease in interventions during labor, decrease in cesarean sections as well as a decrease in postpartum complications. See links below for evidence on the safety of home birth.
MANA Stats study: This study uses the data collection tool called Midwives Alliance of North America Statistics Project (MANA Stats) to get accurate reflection of home birth outcomes in the United States. MANA Stats collects information anonymously from midwives about client care from the onset of prenatal care through their last visit postpartum. Midwives enter data nationwide, which allows for a grand collection of birth outcomes for out of hospital birth. This particular study is from 2004-2009 and based on the outcomes for 16,924 planned home births. The outcomes were as follows for the 16,924 clients:
- 89.1% of women gave birth at home
- 93.6% of women had a spontaneous vaginal birth
- 1.2% of women had an assisted vaginal birth (use of forceps and/or vacuum)
- 5.2% of women had a cesarean birth
- 11% of women transferred to the hospital with a majority of transfers being due to failure to progress and only 4.5% required pitocin in hospital and/or epidural
- 87% successful of those who attempted a VBAC birth
- 86% of babies exclusively breastfed at 6 weeks postpartum and 98% partially breastfed
- Half of women had an intact perineum after birth
See more statistics in this project at: https://www.ncbi.nlm.nih.gov/pubmed/24479690
Planned Home Versus Planned Hospital Births for Low-Risk Women: https://www.ncbi.nlm.nih.gov/m/pubmed/29408739/
Planned Out of Hospital Birth and Birth Outcomes: https://www.ncbi.nlm.nih.gov/pubmed/26716916
Assessment of Risk Profiles for Women Electing Out of Hospital Birth: https://www.ncbi.nlm.nih.gov/pubmed/28332220
Planned Home Birth: Risks, Benefits & Opportunities (international): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399594/
Is home birth safe?
The cost of midwifery care varies city to city as well as midwife to midwife. Santa Cruz Home Birth charges a total of $5,500-$6,000 sliding scale for our complete care package. This includes hour-long prenatal visits throughout your pregnancy, on-call for you during your due window, labor and birth attendance, as well as postpartum visits in your home and in the office. Several extra visits are including if needed prenatally or postpartum. We believe that sustainability is an important aspect for creating health and balance and therefore work together as a team. When you have two licensed midwives you are guaranteed to have a well-rested, well-resourced midwife on your birth team at all times. We offer sliding scale as an opportunity for families who need a little financial flexibility to enable them to have a home birth. Please use the sliding scale with integrity and honesty so we are able to continue offering this as an option.
How much does having a midwife cost?
At this time insurance coverage varies throughout insurance companies and plans. We work with a biller who directly works with you to discover what kind of coverage you will be able to receive for a home birth. Typically insurance coverage does not reimburse until after the delivery of your baby, so it is standard to have to pay the entire midwifery fee out of pocket before reimbursement. Then once your claim is filed you will get reimbursement directly from your insurance company. Contact our biller below to get a sense of what kind of reimbursement you can expect through your plan. To verify that your insurance covers home birth click on the verification of benefits link below and pay the one time $85 fee. For questions you can contact Favored medical billing on their website at https://favoredmedicalbilling.com.
Benefit Verification at the cost of the patient: https://favoredmedicalbilling.com/midwifepayment.php
Claims Submission at the cost of the patient: https://favoredmedicalbilling.com/ClaimSubmissions.php
Frequently Asked Questions on Billing, Reimbursement, and Verification Processes: https://favoredmedicalbilling.com/faqs.php
Can I get insurance coverage for a home birth?
In regards to pregnancy, labor and birth, and the postpartum period, yes. Midwives are trained medical professionals. We discuss and perform all the same procedures such as blood work, genetic screening, gestational diabetes screening, and newborn procedures such as vitamin K and erythromycin administration. We are also trained in resuscitation for birthing parent and baby as well as suturing for birthing parent if needed. However, our breadth of knowledge is specialized to the childbearing year and we do not have the extensive training of medical school that is required by a MD or DO.
Are midwives able to do everything doctors can?
If circumstances arise that necessitate you going to the hospital for your care, your midwife will discuss with you the best plan of action at the time and help you make the decision that will keep you and your baby safe and healthy. In non-emergent transfer of care situations, your midwife will discuss your options and help you find a practitioner that can meet your needs in the most ideal way possible. If you choose to continue with midwifery care while also receiving care from an OB, we can discuss what this looks like. In more emergent situations, your midwife will help you make quick decisions including calling ahead for you to get the fastest and smoothest transfer available. She will go with you to the hospital and stay with you to help you make informed decisions about the care being offered. In either case, she will consult with the physician by phone or in person and transfer your records as appropriate.
What if I have to go to the hospital at any point in my care?
Yes. Midwives are extensively trained to handle emergencies related to childbirth out of the hospital. They are required to certify every two years in adult and child CPR for healthcare providers as well as neonatal resuscitation. They are authorized to carry certain medications including medicines to stop bleeding after birth or IV fluids, as well as oxygen for birthing parent and/or baby. While true emergencies in childbirth are rare, midwives are highly skilled in assessing and managing complications that may arise, this may include transferring to a hospital for more extensive medical care.
Do midwives carry equipment for emergencies?
We will see you for prenatal care visits once every 4 weeks until you reach the 28th week of pregnancy. Between 28-36 weeks of pregnancy we see you every 2 weeks and from 36 weeks until you birth we see you once a week. Once your baby is born, we come to your home on day 1, day 3-5 and day 7-10 postpartum. We see you again in the office at 2 weeks, 4 weeks and 6 weeks for follow up. If at any point during your care you need an extra visit for support or follow up on a specific issue, we will schedule that with you. Visits are usually 60 minutes and cover the variety of clinical, emotional and psychosocial aspects of your care. We will leave plenty of time to ask and answer questions and make any recommendations that may be appropriate.
How often do we meet for prenatal visits? What about after my baby is born?
The options you have for pain relief at home are a little different than in hospital or birth center. We encourage an environment high in oxytocin, the love hormone, which is shown to decrease pain by enhancing pleasure. Oxytocin is released with orgasm, sharing love with your family, sharing food, etc. When you birth at home we encourage an oxytocin high environment by keeping voices and lighting low, distractions minimal, and only the people you know and feel safe with. We also use touch as a way to ease your muscles and relax your body. Another tool we have when labor increases is a birth pool. We bring the inflatable pool to your home, blow it up and fill it with warm water. Many birthing people find this tremendously helpful due to the warmth as well as release in gravity it offers. Some people choose to birth in the pool as well, or just use it for relief. After the birth we drain the tub and remove it from your home. We do not offer nitrous oxide, narcotics, or an epidural at home.
What are my options for pain relief in labor?
Yes! Many birthing people really appreciate being able to use water during their labor and/or want to give birth in the water. We are supportive either way and believe it is a tremendous tool to use. We will keep the water temperature not too hot and not too cold. We want it to be warm enough for the baby to transition smoothly at birth. Water that is too hot can increase the birthing person and baby’s heartbeat. We include the use of a birth tub in our care package fee. We typically drop it off in your home at your home visit at 36 weeks pregnancy, then drain and take it with us after the birth. There is some extra associated cost with using it such as a new hose, a faucet adapter and a new tub liner.
Do you do waterbirth at home?
An LM is a Licensed Midwife by the Medical Board of California. They provide maternity and well-woman care to low-risk women in an out-of-hospital setting. They are not required to work under the supervision of a physician. They are extensively trained to oversee the care of pregnancy, birth and postpartum for the birthing person and baby. They have training in emergency procedures for the birthing person and baby and are authorized to carry certain medication for these purposes.
A CPM is a Certified Professional Midwife. They are certified by the National Association of Registered Midwives (NARM). They have completed extensive didactic and clinical training and are qualified to provide the midwives model of care which has a focus on continuity of care, evidence based practice and individual informed choice.
A CNM is a Certified Nurse Midwife. They are extensively trained to provide maternity and well-woman care and have also been trained as a Registered Nurse (RN). They are licensed by the Medical Board to provide care to low-risk families. They work under supervision of a physician and have hospital privileges. They can provide collaborative care for higher risk pregnant women alongside an OB. They work in hospitals, medical clinics and occasionally offer home birth.