Are you a Certified Nurse Midwife?
No, I (MeriBeth) am not a licensed medical professional or Certified Nurse Midwife (CNM), I am a Traditional Homebirth Midwife. I do have EMT-B training and carry a current certification in Neonatal Resuscitation.
What do you do at prenatal visits? Prenatal visits consist of nutritional reviews, BP checks, listening to the baby, measuring your fundal height, testing your urine, some review of Childbirth education, preparing your family for a homebirth and ideas for preparing your home, and and of course recording your weight gain.
Without sonograms and blood work and some of the other typical tests OBGYNs run how do you know if the pregnancy is healthy and normal? Pregnancy is normal. So, I begin your care understanding that your pregnancy is normal unless something "shows up" that causes me to believe you need further testing to ensure that your pregnancy is normal. I don't look for something to be wrong. That's the OB line of thinking. The OB line is what makes normal healthy pregnant women think they are ticking time bombs that need medical intervention. I am not going to tell you you need medical intervention until you really do. If your blood pressure begins to go hay-wire or your baby doesn't appear to be growing based off of your fundal height, or you begin throwing alarming levels of sugar or protein in your urine...all of those things tip me off that things aren't quite right and you need further follow up care or testing.
Do you do visits monthly?Yes up until your 32 week and then I see you every two weeks until your 37th week appt when we normally see each other weekly.
And are all prenatal visits included in your fee? The midwifery fee is for the full package deal. All prenatals, postpartums and my assistant are included in the fee. The only thing not included is your birth kit and other consumables like prenatal vitamins.
Do you take any insurance? We can try charging the insurance but I can't guarantee they will cover anything. At this time in PA, non-nurse midwives are legal but are not offered licensure, so third party reimbursement isn't always consistent. I am happy to provide you with a billing statement and billing codes to seek reimbursement from your insurance company.
What would your extra mileage charge be? mileage fees are based on exact distance a current gas prices for both my assistant and myself to travel to your home at least 3 times. It can be as little as $50 or as expensive as $800 depending on the distance. Our normal travel distance includes a 60 mile radius. Any mileage beyond that would involve a mileage fee.
Do you have a home birth kit? Yes homebirth kits are available through www.preciousarrows.com under custom birth kits.
What do you do if there was tearing and stitches needed? Impatience is one of the main culprits for perineal trauma. I have never had a woman that required repairs. Patience is the name of the game. If given the time to stretch, the skin will stretch.
Are you able to do that or would there have to be a hospital transfer just for that? No I can do repairs if they are required. But again---by God's grace, I haven't ever needed the skill.
Have you had all your kids at home? 3 of my sons were born in hospitals. 3 of my sons were born at home. Two of my daughters and my youngest son were home waterbirths.
Were all your labors uncomplicated? I suppose that depends on your definition of "uncomplicated". My pregnancies were healthy. My labors were normal. My deliveries were safe. My babies are healthy. I am healthy. In that regard, yes, my labors were uncomplicated. If you are asking me if they were unique in that they had something that wasn't textbook perfect, I can tell you that I have two births with compound presentations and three precipitous labors that lasted less than two hours. I have also had a baby that was a persistent posterior and was born "sunny side up." Each held their own challenge but not necessarily any complications.
Have you had any water births of your own? If so did you like it? I am very at home with water birth. I attend a lot of them. 3 of my children have been waterbabies.
Do you have a pool for delivering in or would we need to buy one? Can it be done in a bath tub? Occasionally, I have a pool you can use based on availability. I highly recommend you buy a pool from www.preciousarrows.com or www.yourwaterbirth.com I do suggest buying a pool liner for around $30 with shipping. Bath tubs are rarely large enough. But if you have a large garden tub, that would very likely work fine.
Have you ever worked with a women who also worked with her OBGYN? This method is what we call "parallel care". Many women who have insurance coverage will choose this option. The OB care is received alongside of midwifery care. The unspoken plan is to have a homebirth.
If you were willing to do this would your charge be the same? Yes. My services rendered and responsibilities remain the same regardless of parallel care.
1. Are photos included in the home birth package? I can't guarantee that Myself or my assistant can take pictures. If you want a photographer, I can try to help you locate a professional that will attend births.
2. What kind of payment schedule do you typically set up? Full payment is expected by your 37 week appt. unless other arrangements have been made. Many need the payments broken down monthly. Monthly payments are preferred. I am pretty flexible though. Some clients make two large lump sum payments, others make a larger down payment and then smaller monthly payments. As long as I know the game plan, I am willing to work with you. In times of financial concern, I have accepted small monthly payments while waiting on tax returns and then gotten a final payment at that time.
3. What is the cut off for premature delivery? IE, can we deliver at home at 36 weeks? If you have a family and personal history of delivery before 36 weeks, we will talk more about the probability of you birthing at home prior to 36 weeks. All other homebirths must be considered full term to be safe for a homebirth option.
4. If the baby comes very early, 36 weeks or sooner and it is a hospital birth because of extenuating legal or medical reasons is there any refund or change in the payments because home birth midwife care was not provided? (I am not referring to a transfer to hospital once in labor, I mean if the baby actually comes very very early.) If the baby comes early, I will actually go to the hospital with you to provide support during the birth and will then provide support in the postpartum time as well. Refunds are available based on how much been paid at the time the baby is born and services that have been rendered up to that time. An itemized break down of services is on the service contract.
5. Have you had any experience with the local Hospitals or staff? If so how was it? Do you have any doctors to suggest for back up care? I have worked with some of the staff at local hospitals.Most experiences with local hospitals and staff have been positive experiences. I can not suggest any back up options at this time.
6. Is it ok for all of my children to be present at the birth. YES! I only ask that someone be present specifically to tend to the needs of the children.
7. How do we obtain a birth certificate? I take care of that and that baby's SSN.
8. What do we do if I tear while delivering the baby? Tearing is not a normal occurrence in childbirth. Although it has been made a normal one as a result of excessive force and intervention during the actual birth of the baby. Many precautions will be taken to ensure an intact perenium. Honestly, I have never had a woman tear to the point of needing stitches. Those minor tears that may happen are better left alone.
9. Do you help to clean up after the birth? Yes. I don't leave until I feel that the mess is adequately cleared.
10. What do the prenatal visits consist of? Prenatals consists of urine test, BP check, Measuring fundal height and of course listening to baby. But it also consists of talking over your nutrition and fluid intake, addressing any issues you may have including emotional and stress. We also discuss preparations for the birth and your birth vision. Most prenatals take 1 1/2 to 2 hours.
11. What is the protocol if I am GBS positive? GBS is a normal part of vaginal and intestinal flora. It only becomes a concern in cases of prolonged membrane rupture and an over-growth of yeast. If the environment is ripe for yeast, it is ripe for GBS. SO the precautionary step would be to eat garlic, pickles or vinegar and take Vitamin C so that there is no chance of GBS or yeast getting over-grown. Should you be further concerned or have tested positive in past, treating the baby's mucus membranes with colliodal silver, which is a great "antibiotic" against Strep, is a simple and non-invasive defense.
12. What do we do about vitamin K and routine blood screenings? I do the newborn screening if you want it. You are able to decline it should you choose to. I also carry oral vitamin K.
13. What is your hospital transfer rate and what is the number one reason that most women transfer? My transfer rate is 2% I have had one woman ask to transfer and that was because she wanted a c-section. Not kidding.
14. How do we handle shoulder dystocia? Shoulder dystocia is RARELY seen in home birth. Free movement and upright positions for birth are the best defense against it. Should the baby require help with rotation, There are several maneuvers (such as the Gaskin Maneuver) that will help break the baby free and allow birth to continue normally.
15. Have you had experience with cord prolapse? I have not. I have only heard of one midwife in our area that has ever had to deal with a true prolapsed cord.....she had delivered over 3800 babies. Prolapse is an extremely rare complication. It is truly life threatening to the baby. In that specific situation, all precautions are made to keep the cord warm and moist and to keep the baby off the cord until delivery can be completed safely (most likely in the hospital via c-section).
Should you have any other questions, please feel free to ask.
I think I want a homebirth. But I have
Questions! Questions! Questions!
Who can try for a homebirth?
Any low risk, healthy woman can make plans to birth her baby at home.
I live in a small house or apartment, can I have a homebirth?
Yes, as long as it is tidy and you have a space to give birth, you can have a homebirth.
I want a homebirth but my partner/husband doesn't want me to have one, can you convince him/her to let me birth at home?
I am certainly willing to meet with you and your partner/husband to discuss the pros and cons of homebirth, but ultimately it is your decision where you are going to feel most comfortable birthing. It is not my job to convince anyone of anything, and if your husband/partner is not supportive of your decision to homebirth, than a homebirth is probably not a good option for you.
I'm over 35 and have been told I am advanced maternal age. Can I attempt a homebirth?
As long as you are otherwise healthy, age is not a factor. Your risks of having a baby with certain defects are increased with age. Therefore you may want certain tests that would be offered to you through an OB office but you always have the option to opt out of genetic testing.
What guarantee can you give me that I will have a successful, uncomplicated birth at home?
I can't guarantee anything, and no provider would be able to do that, regardless of setting. Having all the monitoring and testing offered to you, won't give you a guarantee. On the flip side, if you have a technology free pregnancy, labor, and delivery that doesn't promise you the perfect outcome either.
What happens if we transfer to the hospital during labor?
Because I am not a licensed provider, I can't continue to provide you care once you are transferred to the hospital. I will accompany you in the event of a transfer. Once there I can continue to act as a support person.
What is the most common reason for a transfer during birth?
Maternal Exhaustion. Usually mom only needs some pain medication at the hospital and she will go on to have a vaginal birth. My transfer rate is about 3%, and most transfers are mothers who have long labors or long pushing phases.
I had a c-section with my last baby. Can I have a Homebirth?
Many women go on to have successful vbacs. And many decide to have a Homebirth After a C-section (HBAC). Every woman is assessed individually for her risk factors if she has had a prior c-section. Any woman considering a VBAC option is encouraged to make fully informed decisions! Please visit International Cesarean Awareness Network for more information on Vaginal Birth After a Cesarean.
I have been induced for each pregnancy. Are you comfortable with a mom going past 40 weeks?
Yes, The due date is simply an estimated time frame in which your baby is likely to arrive. Most first time mothers have an average gestation of 41 weeks. After 42 weeks you are post dates or "late". Some mothers have longer gestational times and that's OK. Each woman is cared for on an individual basis according to her pregnancy history.
If I have a homebirth, do I need a pediatrician or care provider for my baby?
Yes. I am not a pediatrician and I recommend you have a family physician or pediatrician lined up for your baby's continued care for after the birth. I will do the initial newborn exam and screenings after your birth, and will weigh and do a quick checkup on your baby at 24 hours of age. However babies should have a care provider in case of any problems or if you are wanting to vaccinate. I do not administer vaccinations.