How do I know if home birth is for me? You know yourself better than anyone else does, so only you can answer this question. One way to ﬁnd out what you want for this pregnancy and birth is to talk to friends, family and acquaintances that have given birth in home, birth center and hospital settings. Also, interview midwives and doctors and ask all of your questions - especially the difficult and vulnerable ones. Read current studies on evidence based research and outcomes, and ask for help in interpreting those studies if you aren't clear on the evidence. After doing this, it is very likely that you will know what you want.
It has been my experience that those who do the best with a homebirth truly feel a calling to birth at home, and often do not feel comfortable with hospital policies, their provider's commitment to informed consent, or the care received during prenatal visits and the postpartum period. Many homebirth families want more personalized services with decision making based on research, birth education, and a firm belief in the normalcy and safety of birth. Some homebirth families chose to stay home based on economics, cultural traditions or past trauma, and many are pleasantly surprised to find that homebirth is a more affordable option that honors these needs in a much more individualized way. The best way to know if homebirth is for you is to consider all of your options and make the best informed decision you can on where, and with whom, you and your family feel safest birthing.
What is the role of midwife? The midwife-client relationship begins the minutes you start care. I provide care and support throughout pregnancy, labor, birth and postpartum. Prenatal care involves a combination of overseeing the physical well being, building a mutually trusting relationship, providing information and linking my clients (not patients - you are not sick!) with community/professional resources. Emotional and physical safety is a priority, so I work collaboratively with you to reduce the risk for complications during pregnancy, childbirth and postpartum. As a midwife I honor the needs and preferences of the family, and respect the cultural, social and spiritual values of the person in my care. I support you in making fully informed, empowered and safe choices.
Do I need to have a doctor too? Generally, for low risk clients I provide complete prenatal care and am able to order most tests, including baseline pregnancy ultrasounds and labs. The majority of my clients do not see a physician for their maternity care, and most will see other holistic providers such as a chiropractor, naturopath or counselor if needed for the very usual discomforts that can arise during the 9 months of pregnancy or postpartum . I work with a great network of care providers. If you or the baby require a consultation with another physician or any other care provider during your pregnancy, birth, postpartum, I will refer to other providers for appropriate medical care or work with your existing care provider. The BEST outcomes for you and your baby are when caregivers work together, and as a midwife the best way I can serve you is to be sure that we work with physicians and other care providers if necessary and needed. I feel absolutely comfortable including any other specialists into your care if that is what you desire or need.
Can I have a water birth? I love water birth – it’s such a gentle way for a new baby to emerge from the womb! Many of my clients use water in labor, though for some it doesn’t feel right to actually give birth in the tub. You can use your tub, purchase an inexpensive tub, or even rent a tub locally that is affordable and works very well! I always say it is nice to have the option of water birth, but ultimately you will decide the best place to give birth for you when that moment comes. There are wonderful studies out on waterbirth in all birth settings - check those out :)
How can I best prepare for a successful birth? My definition of a successful birth is one where you and your baby are healthy, safe and well cared for and that you feel empowered by your experience. It is so important that you are guiding (or being guided by) the process of your own birth - both by being supported in following your body and by being a part of any decisions that need to be made on behalf of you and your baby. Informed choice is at the center of this, as is collaboration and trust built with your care provider. Prioritizing your health during pregnancy is also essential. If ever there is a time, this is it. Treat yourself and your baby to excellent nutrition, regular exercise and physical activity, childbirth preparation class, lots of rest, spending time with other pregnant women & new mothers and including a daily practice of simply ‘being’ instead of ‘doing’- whether that is walks in the woods, meditation, breathing, prayer, yoga, dance or art making.
What about the birth..."mess"? Birth isn’t as messy as many people believe it to be! I give instructions prenatally on how to make up a bed so that the mattress stays protected from amniotic ﬂuid and blood. We also take precautions so that the ﬂoors, carpets and pillows stay clean. We use disposable underpads to help catch ﬂuids during the birth process. We clean up during and after the birth, gathering all soiled sheets and towels and gather all trash. With waterbirth your partner is generally responsible for draining whatever tub you choose to use, generally with a specific pump that is part of any rental, or otherwise. Gardens love this! Bottom line: birth is seriously not that messy. Promise. And for those rare times that it is - the midwives are there to help clean.
What equipment and supplies do you bring to the birth? I bring appropriate medical equipment and supplies to every birth, including oxygen and resuscitation equipment, drugs to control bleeding, and suturing materials. In the majority of the births I attend, I never need to use these items. I also bring a doppler to listen to your baby’s heart rate, as well as skilled hands and labor support tools including homeopathic, herbal, and aroma-therapeutic remedies. I carry a scale and other items for the newborn exam and have vitamin K and eye ointment available if you choose to have us administer them to your baby. I also carry birth items such as a birth stool, peanut ball and all the other "doula" type items for your comfort. I also provide my families with a booklet that outlines what you will need to have at your birth so that you are involved in the planning process and will have everything you need.
What if there is a problem during labor or birth? If there is an issue in labor in which you or your baby are no longer safe at home, we will transfer care to the hospital. Hospital choices and a 'plan B' are discussed prenatally so that by the time you birth we will have discussed all of this in depth. We are familiar with hospital policies and, when possible, call in ahead of time, we will drive to the hospital in our own cars and are received by people who are expecting us. We stay right with you, help you make decisions and support you emotionally until you (or your baby) are both stable.
Homebirth families often struggle imagining birthing or transferring care to a hospital. I know, as a homebirth mom myself, I worried about this and spoke about it at length with my own midwife! I hated even the IDEA of having to be in a hospital! However, I can say that times are changing for parents who are informed and supported by midwives and doulas when they enter into the hospital system. At the national level there is a larger effort to make transfers from home to hospital less traumatic. I am seeing a huge difference in the care, and generally transfer to hospitals where I am familiar with their policies, know the care provider or practice, and try (when possible!) to work with midwives in hospital settings. Arizona is improving, and hopefully will follow the lead of states such as Washington or New Mexico, for homebirth support.
When hospitals are needed, we remain with you as your advocate and maintain our midwifery relationship as much as we can given that you are transferring to a medical person(s) who has the appropriate scope of practice for your care. For homebirth families, a hospital birth occurs TRULY only when it is most needed - you are starting in the least interventive place. I believe that everyone involved will recognize that your intention was to be at home, and although I can't control the behavior of hospital staff and providers, I am seeing huge leaps and bounds in respect for family choice. I always tell my homebirth families to be informed, responsible in doing a birth plan and discussing a transfer of care scenario, and than to set it aside. The majority of times my families remain safe at home - but in the event you don't, we are all prepared!
How many births do you attend in a month and what if you have two people in labor at the same time? I do not take many clients so that helps in reducing the incidence of my missing your birth. Generally I attend 2births a month at most. Overlapping labors are rare, but if two women are in labor at the same time, I have a back up midwife to assist when the baby is ready to be born. Again, this happens rarely.
How does payment work? Will my insurance cover the services of a midwife? We will thoroughly discuss this at your consult visit and any time you feel you need to ask questions or if you have changes in your insurance plan or even economic status. I ask for a deposit at the time of your initial visit and then we discuss payment options. If you have insurance that covers out of network, I work with a billing company that will do a Verification of Benefits (VOB) and will get an idea of what your insurance will cover. Insurance isn't always easy to navigate, but I will offer helpful suggestions in how to work with your insurance company to get proper reimbursement. You can use your HSA card if you have one, and I take ALL forms of payment if your insurance does not cover home birth. I am always happy to work with my families in whatever ways they need to make homebirth accessible as an option.
What midwifery credentials do you possess? I am a Certified Professional Midwife (CPM), which is a North American certification. I am also licensed by the State of Arizona, with a former license held in New Mexico. A CPM is an autonomous provider of maternity services educated in midwifery, trained by apprenticeship and/or formal accredited education (in my case) and licensed by the Arizona Department of Health Special Licensing. I sometimes work with student midwives who learn under my license, and any back up midwife that I use will have years of experience and also be licensed in the State of Arizona.
What education do you have and how do I know you are competent to practice midwifery? I worked for a few years doing a midwifery apprenticeship here in Arizona beginning in the late 1990s, before deciding to go to Maternidad La Luz, an accredited school in El Paso, Texas in 2002, where I did a rigorous program of study that (for me) incorporated three years of education into a 13 months program. I was one of the few people who graduated within that stringent time frame, having completed both my clinical and classroom studies.
I took the exam for the North American Registry of Midwives as well as the New Mexico licensing exam in 2003. I returned to Arizona to work as a midwife and, at that time, Arizona did not accept the National certification exams I had passed. As such, I had to re-apply for licensure for the state and have my clinical numbers and education evaluated again, take the Arizona state midwifery exam to prove my knowledge/ability to pass a midwifery exam, stood before a Oral Board panel that included an OB-GYN as well as an RN and the Director of the licensing program who tested my knowledge orally, and I also performed a practical exam that was overseen by the Director and two midwives. This was extensive testing that is no longer done now that Arizona accepts the national certification.
I continue to learn and meet continuous education requirements, and also advanced learning certificates such as the ALSO course. I am working towards the new "bridge certificate" as endorsed by ACOG and US MERA, and have worked with providers in all settings since 1992.
Do you offer a free initial consultation? Yes, I are happy to meet with you and discuss everything you would like to talk about. Please fill out the contact form and let's meet! Please let me know your due date, if you know it, where you live, and anything else about you I should know :). I am happy to come to your home for the consultation.
What is the schedule for prenatal care and what happens during visits? At a prenatal visit I make sure that you and your baby are doing well. We will take blood pressure, listen to the baby’s heartbeat, palpate your uterus and attend to any necessary lab work. We get to know each other and talk about how you are doing and how the pregnancy is going. It is a time to get any of your questions answered and to share any emotional issues that arise. It is important that clients understand what the pros and cons of any given procedure or test and I offer clients full informed choice in all aspects of their prenatal/postpartum care and birth. We meet once a month through 28 weeks of pregnancy, then every 2 weeks up to 36 weeks. At 36 weeks we begin to see each other every week until your baby is born. After the baby is born we come to your home a 2-3 times during the ﬁrst week. Then, typically I will see you again at 3-4 weeks and 6 weeks postpartum. This schedule can be adapted to ﬁt your individual needs and situations although care ends at 6 weeks. During the entire relationship, I (or my back up or student) am available 24/7 for any questions, concerns or support you may need.
Should my partner come to the prenatal visits? How do you view his/her/their role at the birth? Partners are invited and encouraged to be a part of care at every stage. After all, this is their baby too! Partners are welcome at prenatal visits, as it is important that their questions, concerns, and hopes for the birth are discussed during pregnancy. As midwives we are skilled at supporting partners in participating during the birth in a way that feels right for them. Some partners prefer to be directly involved while others provide background support. We view childbirth as the birth of a family and respect your partner’s unique and essential presence.
What if I can’t handle the pain? It has been my experience that most of my clients birthing outside a hospital setting do not ask for pain relief in labor. Rather, they look to their birth attendants for encouragement when labor takes them to the edge of what they feel they can endure. In addition to supporting many of my families through their unmedicated births, I have also given birth naturally without pain medication at home, so I know first hand the power of the body. From the perspective of this deep trust and also knowing of the challenges of labor, I offer caring physical and emotional support, encourage optimal fetal positioning (to reduce back pain and shorten labor), and suggest the use of warm water (tub or shower). And of course, I honor and respect your choices throughout the course of pregnancy and birth, including the choice to use pain medications if you decide this is what you ultimately need.
What happens after the birth? After the birth I monitor vitals signs of both mom and baby as they recover, check for perineal tears and repair if necessary, perform a newborn exam and provide breastfeeding support. I stay until both mother and baby are stable, fed, cozy and ready to sleep. We will see you 2-3 times in the first week, generally at 2 weeks and then again at six weeks postpartum. I (or my backup and/or student) are available in person and by phone around the clock for all of your questions and concerns. Postpartum is a very important time, so we discuss during your prenatal period to be sure you feel prepared, as do those who will be caring for you and the baby.
Has your license ever been compromised or have you ever had a lawsuit? My license has never been suspended nor have I ever voluntarily surrendered my right to licensure as part of any medical or professional issue. I had a license in New Mexico at one time when I had dreams of working there, but after several years let it lapse once I was settled in Arizona.
I have been fined recently for filing 4 statistical reports late via a new, ever changing reporting system being implemented by the Arizona Department of Health's Special Licensing. These are not reports which affect my clients but are for oversight and statistics gathering by the Department of Health. However, the department will note this as a violation and fine for three years.
I was also sued in 2008 by a client and her husband for not taking their insurance as an "in-network provider" and because they felt they did not expect to pay me for midwifery services if their insurance did not cover their birth. This was not a medical lawsuit by any means as mother and baby both had good, healthy outcomes.
Otherwise, I have been blessed with beautiful outcomes and healthy, long-lasting relationships with my families.