So, what does a midwife do?

We are experts at:

1. 1. Supporting a normal, healthy woman to enjoy a normal, healthy labor and birth of her baby
   

2. 2. Recognizing complications if they arise and quickly re-normalizing the process or transferring to a medical facility when necessary (about 10% of the time transport occurs, 1-2% for Cesarean delivery) and continuing to support a positive birth experience as a doula in that setting.
   

3. 3. Providing Continuity of care during pregnancy, labor, birth and breastfeeding including performing or arranging most/all tests, procedures, Ultrasounds if/when necessary and being present throughout labor, birth and breastfeeding. Being on call 24/7 to answer any questions or concerns that arise at any time throughout pregnancy and breastfeeding.
   

Prenatally - I monitor your health, and your baby’s health. I address any questions or concerns and help you prepare for your childbearing experience. I keep a close eye on anything that may be abnormal needing normalizing and inform you so that your planned home-birth is likely to proceed as planned.

During Labor - I am present with you and intermittently monitor the health of you and your baby gently in a way that you should barely notice as you are concentrated on the powerful and important work of laboring.

During Birth - I am there with you as you birth and welcome your new baby into the world.  You follow your natural birthing instincts. If you ask/need assistance, I am there to serve you.

After Birth - I observe you bonding with the newest member of your family, monitoring gently in a way you should barely notice, that all is well, baby is breastfeeding and you are adjusting comfortably.

Postpartum Care - I meet with you 5-6 times until about 6 weeks postpartum, continuing to gently monitor that all is well with you, your baby and your Breast-feeding relationship.

Interventions - Most of us in our modern society have been told that there is a right way to breathe, labor, push and even breast-feed. However, my philosophy is that Mother, Baby and Father instincts - if listened to - will bring you through the process wonderfully. I am there to support you to listen to your natural birthing instincts.

Even breathing and pushing instructions are considered interventions and will only be given if something abnormal is noticed, so as to re-normalize the process. As midwives, we are trained to deal with more serious complications if they arise and initiate transport if necessary.

You are the authority on what is done to your body. As midwives, we monitor and inform you of your status, you are the decision-maker.

What is a midwife exactly though? - Midwives are “with-woman”. We are with you. During pregnancy, we get an idea of your expectations for this birth and we do what we can to help you to achieve your goals. During birth we are with you. We are not standing over you, looking down on you, making sure that you are performing adequately, and managing your birth.  We are being there with you, at your level, attending to your needs and protecting the sacred nature of birth.

Commitment to Non-Toxic, Organic Supplies

I have a commitment to myself and my clients to use the least toxic supplies during appointments, consultations and other interactions with clients. I avoid PVC Vinyl, BPA, Plastic(when possible) and other materials known, evidenced or strongly suspected to be toxic whenever possible. I try to use Silicon (eg. feeding tubes, milk storage containers), PVC-free, BPA-free, Non-toxic, organic/holistic materials and supplies in my interactions  with clients whenever possible because I understand that the unborn, the newly born, and childbearing women are especially sensitive to their needs for a pure, toxin-free environment, in all aspects.

Problems Getting Your Homebirth in California Reibursed?

Quote, Email, Fax *and* Snail Mail the following to your insurance company along with your Pre-approval call during pregnancy to them:

California Insurance Code Section 10354

(a) (1) Every policy of disability insurance issued,

amended, or renewed on or after January 1, 1994, that offers coverage

for perinatal services shall contain a provision for direct

reimbursement to licensed midwives for perinatal services rendered

under terms and conditions as may be agreed upon between the

policyholder and the insurer.

(2) The licensed midwife may collect payment for any unpaid

portion of his or her fee, as provided under the policy for other

providers.

(3) Reasonable consideration shall be given to licensed midwives

by disability insurers contracting for services at alternative rates.

For the purposes of this section, "reasonable consideration" shall

have the meaning provided in Section 10180.

(b) For purposes of this section, "direct reimbursement" means

that after the policyholder files a claim for the perinatal service

provided under those terms and conditions as may be agreed upon

between the policyholder and the insurer, the insurer pays the

licensed midwife directly.

Section: Previous 10350.2 10350.3 10350.4 10350.5 10350.6

10350.7 10350.8 10350.9 10350.10 10350.11 10350.12 10351

10352 10353 10354

I am not currently practicing, but here is my advice to you if you are planning a homebirth with a midwife:

*Address this issue thoroughly and prenatally, hire a midwife billing service if necessary

*Document all communications with your insurance companies (names and conversation content, recorded is great, safely save correspondence letters, etc)

*Pay your midwife in full by at least 37 weeks.

*Follow-up or hire a billing service to follow up with your insurance company postpartum, do this promptly and no more than a month postpartum ideally

*Be persistant

*If you are having trouble getting your insurance company to follow the law and they keep telling you that they don’t or wont cover homebirth, give them the legal system. They are legally required to reimburse your homebirth with a licensed midwife in california

*When you get reimbursed, be sure they reimburse the entire amount. Let your insurance company know how lucky they are to have saved money by following the law and paying for your homebirth

*If your midwife gets reimbursed, expect her to refund the portion reimbursed.

*Remember, don’t give up. You have legal rights here, as outlined above. Any insurance company that covers a Nurse Midwife must cover a Licensed Midwife. Stay strong, be firm. Also don’t forget that you don’t have to do this work yourself, there are many midwife billing services that do this very work on a daily basis. If it’s too stressful for you, use their help. If they are able to gain reimbursement for you, their fees will have paid off.

                              Is Homebirth Safe?

A question you will be asked by many well-meaning family members, friends, work associates and random acquaintances after informing them of your birth plans...

Let’s talk about Birth first. For a woman who has confidence in her body’s ability to birth and who takes responsibility for the care of herself and her unborn child, birth itself becomes something relatively safe.

Let’s talk about safety next. Safe for who? Safe for the mother? Safe for the Baby? Safe for the Birth attendant(obstetrician/midwife)? Safety is a relative thing. Life is risky, but usually safe. Birth being apart of life follows the same law. One woman may have a completely safe birth, for another woman a complication may occur. The next question is: what affects whether or not a woman will have a complication? The answer is: the woman. Her body, her baby, her lifestyle, her beliefs, her choice of pregnancy support and birth attendants, her choice of birth location.

Which body? A normal relatively healthy female body with a pelvis that has not been injured to the extent of obstruction of the birth canal(extremely rare) Which baby? [A normal, healthy baby.] Which lifestyle? [regular activity, some yoga or similar activity, exercise, healthy well-balanced diet, drug-free, low-stress family life] Which beliefs? [that her body was designed to birth safely] Which pregnancy support? [support that encourages and supports the mother to remain healthy and have faith in her body to birth safely & informs her on her options and birth choices without coercing her to choose any particular option] Which birth attendants? [Birth attendants that do not interfere with normal birth and do not intervene without good cause. Most often midwives, though whether an attendant is a midwife, an obstetrician, a nurse a rocket scientist or the woman’s husband - they all have the ability to interfere with birth, the important thing is to have an attendant willing to do nothing, if nothing is required, since when left alone - birth does its job.]

Statistically speaking, the following statement remains true about the safety of homebirth:

*Planned Home birth* with a *Registered/Licensed Midwife* has been shown, time and again in studies to be as safe or safer of an option for *normal, healthy* pregnant women as a hospital birth, with fewer interventions. *Prenatal care* and *birth attendance by a Registered/Licensed Midwife* are important factors in keeping birth as safe as possible. There are no guarantees with either home birth or hospital birth as each individual situation is unique.

I have found that the woman’s own belief in her body’s ability to birth normally seems to be the most important factor.

Books:

Safer Childbirth, Marjorie Tew, Chapman and Hall

Where to be Born, the debate and the evidence, Rona Campbell and Alison Macfarlane,National Perinatal Epidemiology Unit, Oxford

Childbirth at Home, Marion Sousa,Prentice-Hall

Home Birth, Alice Gilgoff, Bergin and Garvey Publishers, Inc.

Homebirth, Sheila Kitzinger, Dorling Kindersley, Inc.

Spiritual Midwifery, Ina May Gaskin, Summertown, Tennessee

Sensitive Midwifery, Caroline Flint, Butterworth-Heinemann Medical

Obstetric Myths Verses Research Realities, Henci Goer, Bergin & Garvey

There are many studies to show the safety of planned homebirth. Here is the most recent, largest study done in North America, involving Certified Professional Midwives (one of my credentials):

http://www.bmj.com/content/330/7505/1416.full

There was a statistician, Marjorie Tew who set out to show with research that Homebirth was not a safe option for pregnant women. Instead she discovered the opposite, that homebirth with a registered midwife was statistically proven to be as safe or safer than a hospital birth for low-risk women and even for some high-risk women. Her book is called:

Safer Childbirth

Medical Doctors are joining the increasing trend of families to have homebirths. Here is a link to a free online interview of several Medical Doctors who have chosen to have their babies at home:

Doctors choose Homebirth

Though no midwife (or Obstetrician) can offer guarantees about birth, registered midwife-attended homebirth can boast mortality rates as low or lower than a hospital. Birth, no matter what the setting carries risk, though as a midwife I believe that risk can be decreased by birth education, informed choices, reduction of unnecessary interventions and positive support and empowerment of the birthing women and her support team.

Most transports that we midwives make to hospitals (1-10% of planned homebirths) are not due to emergencies, but due to requests for pain medication or labor augmentation.

About 1-2% of planned out-of-hospital births end in c-sections, and those are rarely done under true emergency conditions. Even in an emergency situation, the hospital can be informed in advance of arriving to prepare for a c-section (usually takes about 30 minutes)  while the homebirthing mom is en route to the hospital, thus no time is lost by having attempted a birth at home. It is ideal to live close (within 30 min of a hospital) or to plan to birth in a vacation rental within 30 min of the hospital so that help is near if needed.

Conditions are such at home with no routine interventions and fewer interventions overall that emergencies are rare, but they do happen occasionally. When they happen, I as a midwife am trained to act appropriately and support the initiation of emergency services, and accompanying you to the hospital for continued labor & birth support.

Thankfully there are OBGYNS and a hospital in Monterey County available for consultations, referrals and transports if necessary. Update 9/14/2011, there are no longer Physicians available within 30 minutes of Pacific Grove or Monterey willing to accept transfers if necessary. Though I rarely need to transfer a client, it is crucial to have this option available if necessary. Also I am legally bound to have a local Physician agree to accept transfers of care if necessary, which is not currently the case.

If you would like to help change this law (unique to California) which restricts access to safe and legal maternity care for women who choose to birth at home with a licensed midwife, please write to:

Congressman *Sam Farr*, Assemblyman *Bill Monning*, and Governor *Jerry Brown*.

The law that needs to be changed is the requirement that licensed midwives and licensed nurse-midwives have a “Supervising Physician” who agrees to assume care should complications arise. The law makes it a misdemeanor for any midwife to accept a client without a local Supervising Physician who has agreed to be the back-up.

Besides making an unsafe situation for midwives and their clients (because in the event of transfer, the midwife fears legal recourse and the client often deals with harrassment from the on-call Obstetrician, this law also is also hard on Physicians who may genuinely wish to be the back-up but cannot formally agree to because they would very likely loose their Professional Malpractice Insurance - and other professional associations since they would be formally supporting Homebirth.

If you would like to change this law for future pregnancies you may have and for your children when they are pregnant and wanting safe options for homebirth, please write to your congressman, assemblyman and governor.

Contact Me

If you are in Monterey, check out the “Monterey County Birth Group” on Facebook