What settings do you provide birth services?

Our care prepares you and your family for the experience of out-of-hospital (OOH) birth. This is primarily geared towards birth in the home setting. Sometimes clients live outside of a safe radius and hotel or other options may be discussed. I, Rebecca do maintain full hospital privileges at Broadlawns Medical Center and may attend birth in the hospital setting in cases of appropriate transfer or medical necessity upon my discretion.

Who is appropriate for out-of-hospital birth.

We believe that birth is a normal physiological event. We also believe that your body is innately designed for the most part to carry and deliver babies. Your age and number of prior pregnancies need not be a factor, unless there are other medical concerns present. In order to birth outside the hospital, your pregnancy must be at least 37 weeks gestation (3 weeks before your due date). We follow international standard of care for out-of-hospital birth appropriate clients. Your midwife will do a thorough review of prior medical records, especially prior births, to help her decide if you are a good candidate.

Midwifery care is risk based care, meaning risk is evaluated all the way through your pregnancy, on a day by day, moment to moment basis. Our goal is to keep you low risk and safe for the best possible outcomes in OOH birth. Midwives work closely with the greater healthcare community collaborating, consulting, and referring as needed with local perinatologists and OB/GYNs. Ultimately, we need both Mother and Baby to be healthy in order to ensure your safety in an out-of-hospital setting. This means that the majority of women will qualify. There are however, certain situations that make out-of-hospital birth less safe. These situations likely risk you out of a homebirth:

• Twins
• Planned breech
• Chronic high blood pressure
• Diabetes requiring insulin
• Placenta previa (the placenta is over the cervix)
• Pregnancy induced hypertension requiring medication or preeclampsia
• Medical problem with the baby (heart defect, etc) that will require special care.

How are you prepared in the homebirth setting for an emergency?

We come equipped with supplies and medications equivalent to a Level I labor and delivery room in a hospital. This would be similar to many of our rural hospitals in Iowa. We have at every birth, all of the equipment necessary for fetal monitoring in labor, full newborn resuscitation and postpartum hemorrhage (includes IV fluids and medications), among many other things. Because our supply list is so extensive, we answer any specific questions you have at your consultation upon request.

We are not able to augment your labor with medications or herbs, and we are not able to perform instrumental deliveries in the home setting. Continuous monitoring is not something we are capable of either.
We are fully equipped to stabilize and transport. We are diligent to follow the international standards of out-of-hospital birth, which includes not being further than 30 minutes from our Level I Trauma Center in the metro area or any of the Level II hospitals here locally.

Do you perform water birth?

Absolutely. We do not provide the tubs, but have a list of local contractors that can rent you a tub for use during labor and/or birth itself, and we are quite comfortable with and have regular experience with water birth.

Do you provide any options for pain management?

That depends on what you mean! Do we encourage the use of a doula to decrease pain? ABSOLUTELY! Do we discuss the use of a birthing tub or hydrotherapy during your labor and birth process? For sure. Midwives and birth attendants are well educated in helping you maneuver pain and commonly make recommendations on coping techniques.

However, if you mean do we have pain medicine, or epidurals in the home setting the answer is no - we do not. We cannot safely monitor Mother or Baby in the home setting for adverse reactions. These medications increase the risk to both Mother and Baby.

Who may be present at my homebirth?

You can have anyone you like present, this is your birth.

That being said, we have some thoughts on who you invite into your birth space, based on our experience in this field, and with regards the needs of the birthing Woman. We encourage you to invite positive and supportive individuals into your birth space. We encourage you to invite people who will positively impact your birth, and not make you feel that you must 'host' or serve them in any way. We encourage you to remember that this is YOUR birth, and obligation alone is never a reason to open up your birthing space to someone. And we gently remind you that we are there to serve the Woman first, and while we happily and joyfully interact with your children, we are unable to attend to their needs before yours.

So the shorter answer is - who do YOU want at your birth?

Do you accept women who have previously had a Cesarean/Surgical Birth?

There is not a straight forward, or across the board answer to this question. Women and families who desire TOLAC/VBAC in the out-of-hospital setting will meet with Rebecca individually to discuss all local options and barriers. TOLAC/VBAC calculators may be used and acceptance into services and care are followed by informed consent decision-making. This is a decision that Rebecca and clients will make together on an individualized basis.

Is homebirth safe?

For women and individuals considered low risk and who understand the mindset and planning going into a planned out of hospital birth. Home is a very safe setting to welcome a new baby into this world. Please check out these research articles about a safety in planned out-of-hospital birth.

• Planned Home Birth: Benefits, Risks, and Opportunities
• Homebirth: An Annotated Guide To The Literature
• American College of Nurse Midwives Position Paper

What are Certified Nurse Midwives?

Certified Nurse Midwives are Advanced Registered Nurse Pracitioners, that have at minimum a Masters Degree in specialized education in Midwifery. These special providers have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the United States since the 1920s. They are known as ACNM's, or CNM's for short.

Why choose a Midwife?

The World Health Organization says: “Midwives are the most appropriate primary health care provider to be assigned to the care of normal birth. Midwives are experts in normal pregnancy, birth and post birth care, and offer personalized care based in the belief that pregnancy and childbirth are normal, healthy aspects of life. Your midwife strives to help you and your family learn to trust and believe in pregnancy and the birth process."

What is a CNMs Scope of Practice?

Midwifery as practiced by certified nurse-midwives (CNMs®) and certified midwives (CMs®) encompasses a full range of primary health care services for women from adolescence to beyond menopause. These services include primary care, gynecologic and family planning services, preconception care, care during pregnancy, childbirth and the postpartum period, care of the normal newborn during the first 28 days of life, and treatment of male partners for sexually transmitted infections.

Are your services covered by insurance?

We are a cash up-front business, but you can return to your insurance company for what's called 3rd Party Reimbursement. Our birth fees are currently out-of-network with major insurance companies. Clients pay in full by 36 weeks gestation and are then provided a receipt for care following their birth to self-submit to their insurance company for reimbursement.

We have some resources available to assist you with this, and reimbursement varies by insurance company and insurance plans.