What is the difference between a Licensed Midwife (LM) and a Certified Nurse Midwife (CNM)?

A Licensed Midwife (LM) is a healthcare professional licensed by the Medical Board of California.  An LM must satisfy specific educational requirements and pass board exams administered by the North American Registry of Midwives (NARM).  Licensed midwives practice natural home birth with uncomplicated pregnancies and no unnecessary intervention.  Many LMs also carry a CPM (Certified Professional Midwife) credential, which is the international credential granted to midwives with knowledge and experience practicing out-of-hospital childbirth.  A Certified Nurse Midwife (CNM) is a nurse who obtained further education in childbirth but not necessarily home birth.  Although most CNMs work in hospital settings, some CNMs have chosen to serve home birth clients.

Why choose a midwife over an obstetrician?

Most obstetricians practice in a hospital-based setting.  Their commitments typically allow them a small amount of time for each office visit.  Many obstetricians also work in teams where the doctor on call varies depending on when you go into labor.  These circumstances can make it difficult to create the relationship of trust between doctor and patient that is so important for a smooth and uninterrupted labor.  You are likely to see an OB only at the very end of labor, but a midwife will be with you through the entire process – either by phone or at your home.

What’s special about a midwife who is also a naturopathic doctor?

A naturopathic doctor can provide care above and beyond what a licensed midwife can offer.  Do you have thyroid issues in your family or do you take thyroid medication?  Your naturopathic doctor can monitor and make adjustments to your thyroid medication as your metabolism changes during pregnancy.  Do you have a history of depression, anxiety, insomnia or digestive problems?  Your naturopathic doctor has a wide range of natural treatment options available to you based on her extensive knowledge of the body in its pregnant and non-pregnant state.  Your naturopathic doctor can also provide well-baby and child care, allowing you to continue with a practitioner you already know and trust.

What’s the difference between a birth doula and a midwife?  Do I need both?

A midwife is focused on the health and safety of mother and baby, while a doula is focused on the comfort and well-being of the whole family.  A midwife is medically responsible for the health and safety of mother and baby, just like a doctor.  A doula focuses exclusively on physical and emotional support and usually comes to your home before a midwife to help support you and your family.  Midwives and doulas love working together and women often choose to have both on their birthing team.

Do you offer water birth?

Yes! Birthing or laboring in water is fantastic for managing the intensity of labor contractions.  Warm water soothes muscles and joints and buoyancy provides easier movement.  Professional birth tubs provide much more room than a typical bathtub.  For $200, we provide a professional grade AquaBorn birth tub and the equipment needed to set it up and take it down.

Am I a good candidate for a home birth?

Probably.  More women discover every day just how safe home birth can be.  The Centers for Disease Control recently published a study marking a 20% increase in home birth in the United States between 2004 and 2008.   One of a midwife’s most important tasks is screening and monitoring her clients to ensure that only low-risk pregnancies are birthed at home.  Most healthy women who do not have specific medical conditions can have a safe home birth – you might even be able to have a healthy home birth if you’ve already had a C-section.  Only doctors and midwives have the training to determine if you’re a good candidate so be sure to consult with us or another licensed practitioner for the safety of you and your baby.

What type of safety and emergency equipment does my midwife bring to the birth to monitor me and my baby?

Your midwife must carry all of the necessary equipment and supplies for normal childbirth, as well as the equipment and supplies necessary to manage an emergency. We bring a blood pressure cuff and a handheld doppler to measure your blood pressure and the baby’s heart rate, intravenous fluids and antibiotics (if necessary), anesthetics and suturing materials in case you need stitches after the birth, several medications to stop excessive bleeding, oxygen for mom and baby, and tools (including a baby scale!) to assess the health of baby when he/she arrives.

Why might I need to transfer to hospital care?

There are emergency reasons and non-emergency reasons to transfer to hospital care, although non-emergency reasons are far more common.  We routinely monitor the health of you and your baby during pregnancy and labor.   For example, we would transfer your care to a hospital if your baby turns over and decides to come bottom or feet first (a “breech birth”) because breech births are more complicated.   We would also transfer your care if your baby decides to come sooner than 37 weeks because your baby’s lungs may not be fully mature.  We are focused on the health and safety of you and your baby.  Having a baby safely is more important than having a baby at home.

What if there are complications during or after the birth?

Complications during labor aren’t always emergencies.  For example, if you develop a fever (we are concerned you or the baby may have an infection) we will go to the hospital and into the care of our backup obstetrician.  The health and safety of you and your baby is of utmost importance to us, and although emergencies are rare we are always prepared to transport if needed.  We create a transport plan in advance of your labor so we know who we will contact and under what circumstances.  When we need to, we call 911 for fast transport to the nearest hospital while we handle the situation at home.  We carry several types of equipment for emergency situations like oxygen, a bag and mask for the baby, medications to stop bleeding and IV equipment and fluids.  All of the midwives and assistants in our practice are certified in CPR and neonatal resuscitation.

What does a home birth cost?

We charge $5000 for prenatal visits, labor, delivery and postpartum care.  Prenatal visits are scheduled once per month for the first 28 weeks, then twice per month until 36 weeks, then weekly until your baby comes – the earlier you team up with us, the more care you receive!  A midwife will attend your labor and birth with a student midwife or assistant and will stay for several hours afterwards to make sure everyone is doing well.  You will get a home visit within a few days of the birth to make sure all is well and that you are having no trouble breastfeeding.  Postpartum visits are scheduled in the office at 1 week, 3 weeks and 6 weeks.  You can reach us by phone, email, text, and pager from the minute you contract our care until your last postpartum visit. We believe that all women deserve access to a midwife, so please contact us for payment options if you are concerned about cost.

Can I use my health insurance?

Yes, probably. Most PPO health insurance plans will cover a portion of home birth so check with your PPO’s customer service department.  Most HMO insurance will not cover your prenatal visits or your home birth, but will cover the cost of your labs, ultrasounds, and consultation with a backup doctor.  We have a medical insurance biller who can work with you to to determine your insurance company’s probable contribution towards your home birth and can handle all the paperwork.