Ask the Midwife

What is a Licensed Midwife (LM) & Certified Professional Midwife (CPM)?

A Certified Professional Midwife (CPM) is a knowledgeable, skilled, and independent practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The Certified Professional Midwife credential, issued by NARM, is accredited by the National Commission for Certifying Agencies (NCCA), whose mission is to promote excellence in credentialing for practitioners in all occupations and professions. The NCCA accredits many healthcare credentials, including the Certified Nurse-Midwife. The CPM is the only NCCA-accredited midwifery credential that includes a requirement for out-of-hospital experience.

The main purpose of a certification program is to establish entry-level knowledge, skills, and abilities necessary to practice competently. A Certified Professional Midwife’s (CPM) competency is established through training, education and supervised clinical experience, followed by successful completion of a written examination. The goal is to increase public safety by setting standards for midwives who practice “The Midwives Model of Care” predominately in out-of-hospital settings.

CPMs are trained and credentialed to offer expert care, education, counseling and support to women for pregnancy, birth and the postpartum period. Based on the MANA Core Competencies, the guiding principles of the practice of CPMs are to work with women to promote a healthy pregnancy, and provide education to help them make informed decisions about their own care. In partnership with their clients, Certified Professional Midwives carefully monitor the progress of the pregnancy, labor, birth, and postpartum period and recommend appropriate management if complications arise, collaborating with other healthcare providers when necessary.

CPMs are not doctors, nurses, or nurse-midwives, nor are they trained as such. This means that in they cannot provide medical care in a hospital or write prescriptions.

Do Licensed Midwives work in hospitals?

No, Licensed midwives are trained for exclusively out-of-hospital births. Licensed midwives work in birth centers or home births. Licensed midwives are not trained as nurses, and therefor cannot provide medical care in a hospital. Certified Nurse Midwives are midwives who provide medical care in a hospital.

Is home birth safe? The studies say YES.

The safety and benefits of midwifery care have been proven again and again in countries across the world, including the United States. The World Health Organization statistics show that births attended by midwives have lower infection rates, lower cesarean section rates, fewer complications and healthier outcomes—thus, lower overall medical costs—than physician-attended hospital births. In addition, there is no difference in infant mortality between midwife-attended and physician-attended births for low-risk women. Countries such as the Netherlands, Sweden and New Zealand, which have the best birth outcome statistics in the world, use midwives as their main maternity care providers. About 2/3 of all babies in these countries are born at home with midwives.

“Low risk women in primary care at the onset of labor with planned home birth had lower rates of severe acute maternal morbidity, postpartum hemorrhage, and manual removal of placenta than those with planned hospital birth. For parous [at least one prior birth] women these differences were statistically significant. Absolute risks were small in both groups. There was no evidence that planned home birth among low risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.”

Home Birth Safer Than Hospital Birth: Nation-wide Study Netherlands

According to the Journal of Midwifery & Women’s Health 2013, the C-section rate for low-risk women giving birth in hospitals is approximately 25% versus 6% for those delivering at home or birthing centers in the United States.

The Journal of Midwifery published a study in 2014 called “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North American Statistics Project, 2004-2009.” It tracked planned homebirths over a span of six years and revealed an impressive array of evidence supporting the practice as plentifully safe for low-risk moms and their babes, as di dthe study that came before it, “The CPM 2000 Project,” published in 2005 and examining 5, 418 planned homebirths.

Of the 16, 924 women planning to give birtha t home, fully 89.1% of them accomplished just that. Of the 11% who were taken to the hospital – mostly for trouble progressing – another 4.5% (for a grand total of 93.6%) were yet able to birth spontaneously, while 1.2% managed instrumentally assisted vaginal births and 5.2% birthed by cesarean section. Most babies were born in excellent condition with five-minute APGAR scores of seven or greater.

These stellar results were accompanied by a tremendous measure of client satisfactions and were achieved at a fraction o f what is typically costs for birth to be accomplished inside the American hospital system.

Homebirth: Safe and Sacred by Kim Osterholzer

Home Birth Safety Outcomes – Midwives Alliance of North America (MANA) This study, which examines nearly 17,000 courses of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published.

Outcomes of Planned Home Birth with Registered Midwife versus Planned Hospital Birth with Midwife or Physician – Canadian Medical Association Journal

The Most Scientific Birth is the Least Technological – Alice Dreger, professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine

Why home birth?

In most cultures throughout history, women have given birth at home. The majority of women worldwide continue to birth their babies in non-hospital settings today. The advent of obstetrics in this century had a tremendous effect on childbirth customs in the United States. By the 1950s, most births in the US were taking place in hospitals. Cesareans, epidurals and heavy doses of pain medication became the norm. Women were denied the feeling and experience of birthing naturally, and drugs were having adverse effects on mothers and babies. Many people were led to believe that the only safe birth was a hospital birth. Though doctors and hospitals took credit for statistics that indicated that birth was more successful than in previous centuries, in reality better nutrition, hygiene, and disease control improved outcomes. Even today, US statistics do not support the premise that the only safe birth is a hospital birth. For women with a low-risk pregnancy who have had good prenatal care, homebirth is actually the safest option. There is a cascade of interventions at most hospitals that has become routine that may be the culprit of many problems during and disrupt a normal labor and delivery.

The benefits of home birth include autonomy, freedom of movement and choice of position, freedom to eat and drink in labor, decreased risk of infection and disease, decreased risk of complications, no forced exams or interventions, no time limits on normal labor and birth, respectful one-on-one individualized care, empowering and encouraging support, trust in you and your body’s ability to birth naturally, a physiologically intact atmosphere that promotes early bonding and establishment of a healthy breastfeeding relationship, involvement of the whole family, and a peaceful, private, and familiar environment that is free of disruptions and distractions.

Is Homebirth Right for You?

The Homebirth Choice – Midwifery Today

There’s No Place Like Home – Midwifery Today

Why Choose Homebirth – Midwifery Today

Homebirth: What Are the Issues? – Midwifery Today

Are there any medical conditions which would prevent me from being able to see a licensed midwife and plan a home birth?

Yes. Medical risk factors which would prevent a woman from being a candidate for a safe homebirth with a licensed midwife include, but are not limited to: cardiac disease, diabetes, hepatitis B, high blood pressure, substance abuse, a blood clotting disorder, or a seizure disorder.

Medical reasons which could develop during pregnancy which risk a mother out of a safe homebirth and would necessitate transfer of care to a hospital physician during pregnancy include, but are not limited to: active genital herpes, baby with known congenital defect, uncontrolled gestational diabetes, high blood pressure, low iron in the blood (anemia), placenta previa (placenta implanted partially or completely covering cervix), preeclampsia, preterm rupture of membranes or labor (<37 weeks gestation), and Rh negative blood type with positive antibodies.

If I had a previous c-section, can I still have a home birth?

Yes! At least 75% of women who had a previous c-section can have a successful VBAC (Vaginal Birth After Cesarean). I have attended many beautiful VBACs at home and in the hospital. During your consultation visit, we can discuss the risks and benefits of VBAC, and whether you are a good candidate for a home VBAC.

I have some information on VBACs on my Resources page.

This is a great article on the truth about uterine rupture via VBAC.com. Visit VBAC.com and VBACfacts.com for more great information.

Who is a good candidate for a home birth?

  • Women who are in generally good health with no pre-pregnancy medical risk factors, and who are having a low risk pregnancy and a low risk baby. (see above)
  • Women who take initiative and responsibility to educate themselves about pregnancy, nutrition, childbirth, home birth, newborn care, and breastfeeding and prepare as well as possible for a natural birth. 
  • Women who have a responsible and self-reliant attitude towards their own care during pregnancy and labor and are willing to take full responsibility for the outcome of their choice to birth at home.
  • Women who take excellent care of their own body: physically, emotionally, and spiritually to the best of their ability. 
  • Women who take responsibility for their health during pregnancy so as to continue to be a low-risk candidate for home birth, and seek to maintain a healthy pregnancy through: eating well, taking good quality supplements, moderate exercise through safe, regular activities/movement, and avoidance of harmful substances such as smoking, drugs, alcohol, toxins, etc.

What if there is a complication?

Studies have repeatedly shown that for women with normal, healthy, uncomplicated pregnancies, planned homebirth with a skilled birth attendant is as safe, or safer, than hospital birth, and 90% of all births progress normally with no complications. However, risks are involved in childbirth no matter where or how it occurs, and no midwife regardless of her experience can guarantee a safe home delivery. I am certified in both adult and infant CPR, carry equipment and medications to handle certain rare complications that can occur at home, including maternal hemorrhage and newborn breathing difficulties, and have managed many different types of emergencies. By carefully monitoring the well being of mother and baby during labor and limiting unnecessary interventions, most complications and emergencies can be avoided. Transports are usually for non-emergency situations, such as a long labor with maternal exhaustion. We will create a hospital transfer plan by 37 weeks of pregnancy so that we will be prepared if a transfer becomes necessary.

For more info, please check out: But What if Something Goes Wrong? How Midwives Handle Complications at Homebirths

Complications and Homebirth Midwifery

What is your hospital transfer rate?

Mother, during labor or immediately after birth: 8%

Newborn, immediately after birth: 4%

Do you offer water birth?

Yes! Birthing or laboring in water is wonderful for managing the intensity of labor contractions.  Warm water soothes muscles and joints and buoyancy provides easier movement.  Professional strength inflatable birthing tubs are more comfortable and spacious than a typical bathtub, yet can fit easily in most rooms. Tub dimensions are 65″ x 57″. I offer use of my tub for a small extra fee. You will also need to purchase some additional supplies, including a disposable liner for the tub, hose, and faucet adapter.

Waterbirth Basics

If you have more questions about water birth, visit the waterbirth.org website.

Do you take insurance?

No we don’t. Most licensed midwives do not take insurance and are considered “out-of-network” providers. Hello Baby Homebirth accepts direct payments from the client only and does not bill insurance.

Some insurance companies may cover home birth, others will not, or will provide only limited reimbursement. This will depend on their policies, and your specific plan’s deductible, co-pay, and co-insurance rates. I contract with a billing service who can help you determine if your insurance plan covers home birth and assist you to request coverage. The average cost of a homebirth is about 1/3 of the cost to your insurance company for a typical hospital birth and usually less than your out-of-pocket deductible. If any coverage for homebirth is available it will not be sent by the insurance company until at least several months after the birth. Therefore, regardless if insurance coverage will be pursued, the full fee for midwifery care must be paid to Hello Baby Homebirth by 34 weeks of pregnancy.

Verification of Benefits through Birth Professional Billing

Can I pay for midwifery care out of my HSA/FSA account?

Yes! I can charge an HSA/FSA card in my office (though there is an additional service fee for use of any card to pay for services in my office), or you can contact your HSA account and have them issue a check to me directly to avoid the service fee.

Can I pay for midwifery care using a healthshare?

Yes! Each healthshare will have different ways of operating, so we will look into your specific healthshare to find out how and when to secure payment. Samaritan Ministries is the one I most commonly work with and it is very straightforward and easy. Sometimes healthshares can take a number of months for payment to come in, if that is the case, the client is still responsible to pay according to the payment schedule of $500 at first visit, and $250 at each subsequent visit.

How much do you charge?

Please contact me and I would be happy to send you an informational handout detailing the cost of my homebirth package, what it includes, optional items that may be added on, and my refund policy.

The cost of homebirth with a midwife varies greatly based on state and region, and I keep my rate comparable to other midwives in the area. The cost of a home birth is about 1/3 of what a hospital would bill your insurance company for a typical hospital birth, and usually close to or less than the out-of-pocket insurance deductible you would pay for care from an OB and giving birth at a hospital.

More resources: Affording Homebirth: The Money Aspect of Midwifery Care

10 Ideas for Affording a Homebirth

What payment methods do you accept?

I accept cash, personal checks, Paypal bank transfer, Venmo, Zelle, or Cash app. Clients may also use a credit or debit card, however there is a service charge for this option.

If I need to transfer to the hospital during labor, do I get a refund?

No. Clients hire a licensed midwife to guide them toward a safe home birth, if possible, but it is also the midwife’s role to recommend transfer if a situation arises that makes a home birth no longer a safe option for mom or baby. During labor, a midwife is to use her best judgment and experience to determine whether the birth can safely occur at home or there is a need to transfer care to a medical facility. Conditions or situations that place the mother or baby at higher risk for adverse outcomes will require transfer of care to a hospital. If clients are able to have their planned birth at home, the midwife has done her job. If the need arises and the midwife recommends a medical transfer for the safety of mom and/or baby, she has also done her job. Just like hiring a doctor in a hospital will not guarantee a successful vaginal birth! Birth is by nature unpredictable now matter how or where it occurs. No midwife, regardless of their experience, can guarantee a safe home birth or birth outcome. Even with the most attentive care during labor, birth, and postpartum, unpredictable medical complications can arise. Hiring a midwife cannot and does not guarantee a successful home birth. I cannot and do not offer any guarantees for the outcome or location of a client’s birth, other than that I will do my best, with the knowledge and experience I have at the time, to provide them with a safe and rewarding birth experience. 

If I need to transfer to the hospital, can you still be my care provider?

In the event of a hospital transfer, I will do my best to accompany clients to the hospital to facilitate transfer of care to a hospital care provider and, if possible, will stay with them to offer advice, emotional support, and encouragement until care has been established with the new provider. I cannot, however, provide medical care in a hospital because I am not a doctor, nurse, or nurse-midwife, nor am I trained as such. Once the mother and baby are released from hospital care, I will resume postpartum care for them.

Do I need to see a doctor also if I choose midwife care?

Unless there are medical concerns in your pregnancy that need to be co-managed by a doctor, you do not need to attend appointments at a doctor or OBGYN office when choosing midwifery care! During prenatal appointments, I test your urine, check your weight, take your vital signs such as blood pressure and pulse, listen to baby’s heartbeat and more, just like they do at a doctor’s office. I also perform all necessary lab work in my office so you don’t even need to go anywhere else for to have your blood drawn. I don’t perform ultrasounds in my office but can refer to other providers for those.

Where do prenatal appointments happen?

All prenatal care except for one home visit in the client’s home at approximately 36 weeks is done at my office here in Taylor, which is conveniently located at approximately highways 79 and 95.

When do you start prenatal care?

It is important to start looking for a midwife as soon as possible as I have very limited spots available for the number of clients I accept with due dates in a particular month! After the free consultation appointment where we can discuss midwifery care, homebirth, and find it if we might be a good fit for working together, I typically schedule your first regular appointment between 10-12 weeks along in your pregnancy when we will usually be able to hear the baby’s heartbeat with a handheld fetal doppler. This will give us months of appointments over the course of your pregnancy to get to know one another, for education and discussion on having a natural birth at home, and to develop a caring, trusting relationship that is crucial to midwifery care and will give you the best chance at a successful home birth.

Mothers may also schedule the SneakPeek gender blood test, which is a simple blood draw, as early as 6 weeks pregnant, and then we can schedule their first regular appointment a few weeks later. If mothers wish to have an early dating ultrasound I can refer them for a sonogram as early in pregnancy as they wish to have one.

Do you accept transfers to midwifery care later in pregnancy?

Midwives typically book up early and I may or may not have any space available for late transfer clients. If I do have a spot available during the month you are due, I am more than happy to set up a consultation to find out if it might be a mutually good fit for us to work together toward a home birth. As long as there are no medical concerns, the mother can share records for the previous care she has received, she is confident, knowledgeable about home birth and midwifery care, and willing to take responsibility for the outcome of her choice to birth at home, I am certainly open to considering a transfer of care to me later in pregnancy.

What is prenatal care with you like?

I offer a free, no-obligation consultation appointment at my home office, giving us the opportunity to discuss your questions and get to know each other. The earlier you are in touch, the greater chance I will have an opening over the time you are due, though I can also begin care late in pregnancy under most circumstances. All prenatal care except for one home visit in the client’s home at approximately 36 weeks is done at my office here in Taylor. Prenatal appointments last about an hour and happen every 4 weeks from start of care until 28 weeks, every 2 weeks from 28-36 weeks, and weekly thereafter until birth. For your 36 week visit, I come to your home for your appointment. In addition to normal prenatal appointment items, this visit includes a discussion of set up and supplies for the birth, roles and responsibilities, your birth plan, and a hospital transfer plan.

Prenatal care includes monitoring baby’s growth, listening to baby’s heart beat, maternal vital signs, any indicated lab work, ongoing nutritional and herbal counseling, mother’s overall physical and emotional well-being, resources and discussion on how to prepare for a natural labor and birth, and collaboration or referral to other healthcare providers if needed. We will discuss evidence-based research and information on current prenatal and newborn procedures, and you have the freedom to make an informed choice on which tests are performed.

Prenatal appointments allow plenty of time for questions and answers and meaningful discussions to explore and help resolve fears and concerns you or your family may have. Caring attention will develop a trusting and nurturing relationship between us that will go a long way to assisting you to labor and give birth naturally, safely, and confidently.

Are there any medical conditions that could come up during pregnancy which would require me to transfer care to a doctor?

Yes. Medical reasons which risk a mother out of a safe homebirth with a licensed midwife and would necessitate transfer of care to a hospital physician during pregnancy include, but are not limited to: active genital herpes, baby with known congenital defect, uncontrolled gestational diabetes, high blood pressure, low iron in the blood (anemia), placenta previa (placenta implanted partially or completely covering cervix), preeclampsia, preterm rupture of membranes or labor (<37 weeks gestation), and Rh negative blood type with positive antibodies.

What is home birth with you like?

In the weeks preceding birth, we discuss signs that can indicate labor may be coming. I will keep in touch with you and/or  your support person during early labor, and we will decide together when is the best time for me to come once you are in active labor. Once I arrive, I will help maintain a sense of calm to the birth environment. Throughout labor, I will ask permission to perform and explain any procedure to you and your family. I maintain a non-interventive, hands-off style, while remaining attentive and available should you need support or encouragement. I will unobtrusively monitor the labor, watching for complications or signs of distress in either mom or baby. The birthing process is allowed to take its own course and set its own pace. I may suggest different activities and positions as needed to help facilitate labor progress, such as a walk outside or kneeling. In the safety and security of her own home, you are likely to be less inhibited about trying different labor positions and locations. I encourage you to eat or drink as you are able to keep up your energy and strength.

During labor and birth, I assist to protect and maintain your autonomy, freedom of movement and choice of position, freedom to eat and drink in labor; practice no forced exams or interventions, no time limits on normal labor and birth, empowering and encouraging support and suggestions, trust in you and your body’s ability to birth naturally; and facilitate a physiologically intact atmosphere that promotes early bonding and involvement of the whole family, establishment of a healthy breastfeeding relationship, and a peaceful, private and familiar environment that is free of disruptions and distractions. Comfort techniques include massage, hydrotherapy, relaxation, breathing, visualization, position changes or suggestions, heat/ice, acupressure, herbs, essential oils, and homeopathics. When it’s time to deliver, you can birth in whatever position feels most natural and comfortable to you.

I attend each birth with an assistant; this is included in your global fee for maternity care. After the birth, I will assess newborn APGAR score and complete a full newborn examination which includes weight, length, reflexes, make sure breastfeeding is established, perform continued assessment of maternal vitals, check for tears and perform suturing if needed, assist you to take a shower if you desires, and prepare something nourishing for you to eat and drink. Before myself and my assistant leave about 2-3 hours after birth, we will make sure mommy and baby are happy, healthy, stable. We’ll give few last minute instructions, tuck your new family in bed for a much deserved rest, clean up any messes, start the laundry, and quietly see ourselves out the door.

Check out the Resources page for some beautiful videos which share a glimpse of what a typical homebirth is like!

Homebirth Info

The Homebirth Choice – Midwifery Today.

Do I need a doula for my homebirth?

A doula is an essential part of the birth team, even when hiring a midwife! For first time mommas or primary VBACs (first vaginal birth after one or more cesarean births) I especially recommend a doula for labor support. First-time moms and primary VBACs usually involve longer labors then subsequent births, and having a doula present for support and suggestions has been shown time and again to be a crucial part of having the birth outcome you desire. Once you are in active labor or transition, I provide some labor support services, similar to what a doula may provide. However, in order to preserve by mental and physical energy to make sure you and your baby are safe during active labor, birth, and postpartum, I do not offer continuous labor support in early labor. A doula is there to do just that! They focus on labor support, while a midwife focuses on the medical safety of mom and baby. In the event of a transfer, it would be so helpful to have a doula present who understands your desires for birth and can communicate and coordinate with hospital staff to help you achieve them.

I have lots of great info on doulas on my Resources page.

Do I Need a Doula If I’m Planning a Homebirth

Can my other children come to my prenatal appointments and birth?

Yes! Siblings are welcomed to all prenatal visits and the home birth setting. I have a toy basket in my office to entertain children while Momma and I meet. If you decide to have your other children attending the birth, I require that you have one reliable caretaker available at home (not your partner!) whose sole responsibility is caring for your children so that you can focus on the delivery. Besides this, whomever else you choose to have present at your birth is up to you. The most important thing is that you feel totally and completely at ease and comfortable with whomever is present, as this can majorly impact the outcome of your birthing experience.

6 Birth Videos to Prepare Siblings

Inviting Your Older Kids to Your Upcoming Homebirth

What supplies do I need for a home birth?

It’s simple, really! I ask all my mommas to order a simple birth kit by 34 weeks. There are additional items to add when planning a water birth in one of my inflatable birth tubs. Your birth kit, along with with a stack of towels, washcloths, and an extra set of sheets; there just isn’t much to it! People are often surprised at how little mess is involved at a homebirth. Included in your birth kit are disposable waterproof underpads (“Chux” pads) and a plastic shower curtain, which we use to protect surfaces, such as the bed and carpet for the actual birth. These things get thrown away after the birth. We will gather up all trash and  laundry as we go, and myself or my assistant will start the laundry before we leave your home if you’d like. We also make sure to tidy things up so that you aren’t left with clean up.

Home Birth Mess

But What about the Mess?

Still have questions? Feel free to call 913-283-5768 or email.