Frequently Asked Questions About My Midwifery Services
1. Do you accept insurance?
Insurance companies and plans vary in their coverage of homebirth midwifery services. I am NOT currently in-network with any insurance company, so all services are considered out-of-network. If you are interested in submitting a claim with your insurance plan, I can process a verification of benefits with your insurance to get an estimation of covered services. At the conclusion of care at 6 weeks' postpartum, I will provide you with a document for you to submit to your insurance company for any potential reimbursement. Whether you plan to submit for reimbursement from your insurance plan or not, the complete fee for the homebirth midwifery package is due in full by the end of the 36th week of pregnancy. Many families find that, with or without insurance coverage, home birth is more reasonably priced than uncomplicated vaginal birth in the hospital, and sometimes even lower priced than the average hospital co-pay. The complete fee for out-of-hospital midwifery services are generally 60% less than similar services provided in the hospital setting. Just remember that you can expect to have the out-of-pocket expenses of your co-insurance and out-of network deductible regardless of location of birth: home, birth center, or hospital. If you have a HSA, HRA, or FSA, you may use that to help pay for your midwifery care, as well.
2. Is it too late for me to start care with you?
It’s never too late to find a provider that cares, listens, and respects your choices, and that’s the right fit for your family, whether that is me or receiving care from another provider. I happily accept clients in any trimester of their pregnancy. I will assist you in obtaining prenatal records from your previous provider, if you already established care elsewhere. My licensure, however, does require that prenatal care be initiated by 28 weeks' gestation, if you haven't already established care elsewhere.
3. Should I see an OB as well?
This depends on the individual circumstances of each pregnancy, but the vast majority of clients choose to see only their midwife. The same testing (lab work, sonograms, etc.) that would be done during routine prenatal care with an OB can be done with a midwife. Most women see a physician only if a complication develops.
4. What if an emergency happens and I or my baby need to go to the hospital?
In the unlikely event of an emergency, I am equipped with all routine emergency equipment/medications. I and my midwife's assistant are trained and capable of caring for mothers and newborns until an ambulance arrives. Most transfers that happen are for completely non-emergent reasons such as a stalled labor requiring medication or a request for pain medication, in which case transport happens by private vehicle at an unrushed pace. I and my assistant maintain certifications in CPR/Healthcare Provider Basic Life Support & Neonatal Resuscitation.
5. What is a Certified Professional Midwife (CPM)? Licensed Midwife (LM)?
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), has passed the NARM exam, and is qualified to provide the midwifery model of care. Certified Professional Midwives (CPMs) are community health care providers that are specially and specifically trained in out-of-hospital birth. The state of Minnesota offers voluntary licensure as a direct-entry midwife, and provides the LM designation.
6. May I interview the midwife?
I offer a free interview. This “meet and greet” is a great time to speak with me, the midwife, ask questions, and get a feel for whether this is a good “fit” for you. An interview can be made by calling me at 218.790.8685.
7. What happens at my first visit?
The first visit is a very important time for me to get to know you and your family. A thorough history is taken; I need to know about you, your family and your history. Your diet, exercise habits, etc., are very important to the health of you and your baby. I will suggest you on changes or additions to your current regime that I feel may provide an optimal outcome.
We will discuss your plans and the course of your care; routine testing, available genetic screening, and ultrasounds, that you may want or choose to decline.
This also gives you the opportunity to ask questions.
8. What happens at subsequent visits?
Our appointments are scheduled for 45 minutes - 1 hour, and depend on your gestation, any testing being done, and your individual needs. I follow a routine course of visits, generally once a month until 28 weeks, then every two weeks until 36 weeks (the 36th week appointment is a home visit), and then weekly back at the office until you deliver. Of course that may vary according to your specific situation and needs.
9. What screening/tests are required? May I decline any?
As a midwife, I evaluate each client to ensure they are low risk. Only low risk women may birth at home; the vast majority of pregnant women are low risk. Tests may be done to ascertain that both you and your baby are, and continue to be, low risk. You are highly encouraged to have initial blood work done during your first trimester. I need to know that you are not anemic, that you are immune to Rubella, or whether or not you have ever been exposed to any STIs. I must know what your blood type is, and whether or not you have developed any antibodies.
Later in pregnancy, you will need to have your iron checked to insure you are not anemic. This is also a time for you to consider a gestational diabetes screen. A GBS culture is completed between 36-37 weeks' gestation, if you consent.
Labs are completed locally, and are not included in the midwifery fee. You can anticipate basic obstetric labs to total: $250 - $300; most insurance plans cover lab costs.
I order complete fetal anatomy ultrasounds, and subsequent ultrasounds, if needed. Many insurance plans cover ultrasounds, if your insurance does not cover ultrasounds, the 20 week complete ultrasound costs about $285.
I place a high priority in supporting patient’s rights for informed consent and informed refusal.
10. Should I hire a doula?
I encourage each client to consider having a doula at their birth. Doulas provide continuous emotional, physical, and informational support before, during, and after birth. However, unlike midwives, doulas don't provide any medical care. Doulas are great at offering comfort measures and supporting both the laboring woman and her partner from early labor until after baby is born. To learn more about doulas in our area visit: Doulas of the Red River Valley.
11. Can I choose an epidural or pain medication?
Epidurals and pain medications can not be administered out-of-the-hospital. I do have over a decade of experience educating and guiding families with comfort measures to utilize during labor. I can also offer the use of a TENS unit for labor relief to clients. However, some labors prove to be longer or harder than anticipated, and if needed or wanted, I can accompany you to the hospital. I support you and will help you to get that care as quickly as possible.
12. If I have risk factors, can I still give birth at home?
There are some risk factors that risk me out of attending your homebirth: twins, breech presentation, labor before 37 weeks gestation, labor after 42 weeks 0 days gestation, certain medical conditions including, but not limited to insulin dependent diabetes, or a primary active herpes outbreak. There are also risk factors that can arise during pregnancy that would risk you out of homebirth midwifery care with me, and there are conditions that would risk you out during labor which require transport to the hospital. We discuss these specific issues during our prenatal visits, in-depth.
13. How do you monitor the baby’s heartbeat during labor?
I monitor the baby throughout labor using the hand-held Doppler, listening intermittently at prescribed intervals according to the stage of labor, and what I am hearing. The Doppler can be used underwater for waterbirths. I follow the accepted national guidelines for intermittent monitoring. They are proven to be safe and efficient at following the well-being of the baby during labor. Of course, if at any time, I hear a heart rate that is non-reassuring we would transfer from the home to the hospital.
14. What if I need to go to the hospital during labor?
While no one wants to consider the possibility of changing plans, it is a reality that we do sometimes need to birth at the hospital instead of at home for safety’s sake. In that event I try and make the transition as smooth as possible. Care is then managed by the on-call physician at the hospital that you either choose (time-allowing) or we go to, based on your medical need. I remain with you in the case of a transport, and act as a support person.
15. How long do you stay after the baby's birth?
After your natural birth, you and your baby will get tucked in and made comfortable in your bed, and be encouraged to breastfeed and bond. I stay for a minimum of 3 hours after birth, and insure both mom and baby have had an uneventful course of care and are in stable condition.
I will come to your home 24 hours after birth to follow-up with a home visit. I will examine both you and your baby; check vital signs, and overall well-being. Assess the baby for jaundice, complete newborn screenings (if you wish). I will help & support breastfeeding, answer questions, and offer guidance, all in the comfort of your own home.
16. Does my baby get the routine tests after birth?
Usually within the 2nd hour after birth, your baby will have their first physical examination performed in your room and in your view by the midwife. Vitamin K & erythromycin eye ointment is given at this time, if you desire. I will weigh and measure your baby at this time. Your baby will have the newborn blood spot screening, hearing screening, and critical congenital heart defect screening performed on the 1st postpartum day, if you consent.
17. I have other children at home. Can I bring them to my appointments?
I believe in family-centered care. The growth of a family is a family event, and I welcome your family at the office for your prenatal visits, if you desire.
18. Can they be at the birth?
Of course! You may have whomever you desire to be of support and present at your birth, including your other children. You can chat with me throughout the pregnancy about how best to prepare your older children for the birth. I do require that an extra support person be available and assigned to any children throughout your labor and birth.
19. What is a Rebozo? What Rebozo due you recommend for use during pregnancy, labor, and delivery?
I attended an intense one day workshop with fourth generation Mexican traditional midwife Angelina Martinez Miranda, who instructed me in the time-honored traditions of utilizing a Rebozo (traditional Mexican shawl) for helping to ease pregnancy and labor discomforts and as an aid to facilitate optimal labor and delivery. Prior to that, I received my Rebozo certification from Gena Kirby. I wholeheartedly recommend the traditional Rebozo, and love extending this gift to my clients. For those on a budget, I endorse the Lohee as an alternative form of this traditional shawl.