What is a Licensed Midwife?
A Florida Licensed Midwife is a graduate of a three-year academic Midwifery program. The Licensed Midwife also has eight semesters of clinical internship and must attend 75 deliveries, with 50 labor and delivery managements. The Licensed Midwife must pass the state board exam which is the North American Registry of Midwives national certification examination. Licensed Midwives in Florida are autonomous maternity care providers for low-risk, healthy women. Midwives also work collaboratively with physicians and offer childbirth services in the patient’s homes, birth centers, clinics and hospitals. Florida Licensed Midwives are eligible for reimbursement by private insurance and Medicaid.
Am I eligible for Midwife care?
Any healthy woman experiencing a healthy pregnancy and expecting a normal delivery is eligible for Midwife care. When you first call us, we will ask you some questions about your health and your medical history to see if you are eligible for care. Then at your first visit, we will do a complete physical exam and lab work to verify that you are in good health. The Midwife will continue to monitor your health throughout your pregnancy.
Do you do VBACs (Vaginal Birth After Cesarean)?
We accept VBAC patients and do VBAC births at home. Our consulting obstetrician will see you and review your medical records to approve your VBAC.
For more information on VBAC, recent studies, risks and benefits of both VBAC and elective repeat cesarean, please go to ICAN’s website. There is an excellent article there, found at http://www.ican-online.org/vbac/fighting-vbac-lash-critiquing-current-research.
How do I begin care with Sweet Child O’ Mine?
After you have had a chance to look over our website, please contact us. We will discuss with you your eligibility and answer any preliminary questions you may have. Then we will schedule a free initial consultation for you to meet the Midwife to discuss in detail your options for your care and answer any questions you may have. If you decide to join us, we will give you a password to download forms from our website. You can fill out the forms and bring them with you to your first visit. At your first visit, we will do your lab work and physical exam, as well as regular prenatal care monitoring and a full orientation to your care. If you’ve already begun care with another provider, we will have your records faxed over to us.
What about payment? Do you take Insurance and Medicaid?
Midwife care offers a significant savings to you. The fees for Midwife care and homebirth are less than one-third the cost of obstetrical care and hospital birth. Your maternity care at Sweet Child O’ Mine includes all prenatal exams, home visits, labor and delivery, initial postpartum care, the services of the birth assistant, complete newborn exam, 24-48 hour postpartum visit, a two week postpartum visit, a six week postpartum exam, and filing of the birth certificate. Please call us for information regarding the fee for our services. We do accept Private Insurance and Pregnancy Medicaid.
Florida Law mandates that Medicaid and Private Insurers cover the services of Licensed Midwives. To find out if you are eligible and to apply for Medicaid coverage, go to http://www.myflorida.com/accessflorida
where you can apply online. If you are pregnant, we recommend that you apply immediately because it can take 45 days to receive approval. Pregnancy testing for your Medicaid application is available through us at no charge to you. Call us today for a free consultation.
If you are covered by insurance, we will bill your insurance company for you. You are responsible for paying your deductible and co-payment according to a payment plan and to cover any incidentals that are not covered by your insurance plan.
If you do not have insurance coverage and are not eligible for pregnancy Medicaid, we offer a flexible payment plan. An early payment discount is available as well. We accept cash, money order, VISA and MasterCard. Services and products that are not included in the fee are vitamins, lab fees, ultrasound, RhoGAM, medications, specialist services, childbirth classes, birth supplies, Doula services and waterbirth tub purchase or rental.
When should I begin prenatal care?
You should begin care as soon as possible. It is best to begin care in the first trimester, before 13 weeks pregnant. Early prenatal care will give you an advantage, because the Midwife can assist you with nutritional counseling and easing of common discomforts such as nausea. We can usually hear your baby’s heart beat at about 10-11 weeks gestation (that is 10-11 weeks after your last menstrual period). Many women schedule their first appointment for right around this time.
Do I need an Obstetrician in addition to my Midwife?
No. Licensed Midwives offer complete prenatal care and lab testing. You will be referred to an obstetrician if any situation arises that requires obstetrical care.
I am only weeks away from my due date. Can I switch care?
Yes, you can transfer into care at Sweet Child O’ Mine at any point in your pregnancy. We will request your records from your previous care provider.
What does prenatal care include?
Prenatal care includes all your lab work (blood testing, urine testing, pap smear and cultures), ultrasound, monitoring of vital signs and weight, assessment of your physical and emotional wellbeing, measuring your uterus to determine if your baby is growing well, assessing the position of your baby, and listening to the baby’s heart beat. In addition, prenatal visits are full of education on topics of nutrition, exercise, childbirth preparation, concerns related to pregnancy, emotional health, preparation for parenting, and important decisions that you will make concerning you and your baby’s health care. A typical prenatal visit will last about 30 to 45 minutes. You will have plenty of time to discuss your questions and concerns with your Midwife.
May my family and children come to prenatal visits?
We highly encourage family participation. Children love to be a part of prenatal exams, especially listening to the baby’s heart beat. This is all part of the important bonding process for your family.
Why should I have a homebirth?
Freedom—At home, you are in control. You can walk around, eat and drink freely, pick your birth position, and avoid routine IVs and continuous fetal monitoring. You can even wear your own clothes! We will monitor you and the baby throughout labor, but in a very non-intrusive way.
Comfort—You will be more relaxed in your own home which will encourage labor to progress quicker and with less discomfort. You will be surrounded by the people and atmosphere that you chose. After the delivery, you don’t have to get up and go anywhere. You are already at home tucked in your own comfy bed.
Privacy—You will have complete privacy in your own home. You get to decide who comes to your birth and you are able to create your own intimate atmosphere. Since we are a small staff, you will not be cared for by strangers.
Personalized Care—During your pregnancy, we get to know you and your family, as well as your desires and wishes for your birth. Your birth plan is customized to accommodate your wishes. Would you like to avoid an episiotomy? Would you like to avoid unnecessary labs and procedures? Would you like your partner to catch the baby? Would you like to be the one to announce if your baby is a boy or a girl? Do you want to keep your baby with you at all times? Do you want a waterbirth by candlelight?
Choice—Midwives believe that you should make the decisions regarding your care. In your care, everything is up for discussion and nothing is routine. We will help you be informed and educated, so that you can make the best choices for your family.
Bonding—Your baby will never leave your side. We do not whisk the baby away for an immediate exam and care. After your baby is born, we place him or her on your belly and the baby generally stays skin to skin at your breast until breastfeeding is established. We will do a newborn exam when the baby is one hour old, but we do this with your baby right next to you in the bed. When you get up to shower or bathe, your baby can go with you or can be held by Daddy or any person that you choose. With the whole family present at the birth or immediately after, bonding for the entire family is enhanced.
Avoid Infections—You and your baby’s immune systems are adapted to any germs in your own home, resulting in less maternal and newborn infections.
Breastfeeding Support—We will encourage and assist you to breastfeed your baby soon after birth. We will follow up with a 24 to 48 hour visit and regular phone calls during the first week to help you with any difficulties you may be experiencing. Lactation consultants and the 24 hour LaLeche League hotline (1-800-LaLeche) is always available to you.
Cost Savings—The average cost of prenatal care and an uncomplicated hospital birth is $16,000. Homebirth with a Midwife costs only one-fourth the cost of a hospital birth.
May my family be present for the birth?
You can have as many people with you during labor and birth as you like. Some women like to have a big party, while others enjoy privacy of being alone with their partner. You may also have your children present at your birth, if you’d like. If you decide to have your children present, we encourage preparation for them ahead of time and a support person specifically for them in labor.
May I take pictures and/or videotape?
You can take whatever pictures you would like. We recommend that you plan ahead of time what pictures you want and designate a person(s) for taking pictures. We welcome you to share your pictures on our website.
May I have a waterbirth? Is waterbirth safe?
Yes. Waterbirth is an all-natural method to reduce the hours and stress of labor. You will be more relaxed in the water and experience less discomfort. Your baby will be born in a gentle way into the same environment that he or she is currently in…water. You can birth in your tub at home, whether a regular bath tub, garden or Jacuzzi tub. You can also very reasonably purchase a blow-up kiddy pool, and this is typically less expensive than renting a waterbirth tub.
Waterbirth is safe, because the baby is protected by the “Dive Reflex.” The baby has been in water throughout the whole pregnancy, so until air hits the baby’s face, the baby will not breathe. The baby continues to receive oxygen through the umbilical cord just as he or she did before birth. The Midwife will bring the baby out of the water within a few seconds after the birth.
I live a distance away. How far will you go for a homebirth?
For safety reasons, we would like for you to be within one to one and a half hour drive of our office or one of our midwives. Also, your home should be within 30 minutes of a hospital with a labor and delivery unit. Please contact us if you have questions about whether you are within range to receive care.
What does the Midwife bring to a birth?
The Midwife will bring general monitoring equipment such as blood pressure cuff and stethoscope, thermometer, and doppler for assessing baby’s heart rate. She will also bring sterile instruments, oxygen and resuscitation equipment, medications to control hemorrhage, IV supplies, antibiotics, supplies for suturing, supplies for newborn exam including vitamin K and antibiotic eye ointment, baby scale, and other miscellaneous supplies.
What birth supplies do I need?
You can order your customized birth kit at www.preciousarrows.com for $51. The Midwife will give you a list of other things around your home to gather in preparation for your birth.
Do you offer pain medication at home?
Because pain medicines and epidurals carry a risk of harm to you and your baby, it is not safe to use pharmaceutical pain relief at home. However, we have many techniques to help. One includes laboring in water, also known as the “aquadural”. Studies show that water therapy during labor helps a laboring mom relax, eases the discomfort of labor, and aids in the progression of labor. Other methods of natural pain relief that we use include:
• Continuous Labor Support by a caring & knowledgeable person (your Midwife & Doula)
• Change of Position and Scenery
• Walking
• Patterned Breathing & Relaxation Techniques
• Use of Birth Ball
• Music
• Massage
• Warm Shower or Bath
• Acupuncture, Acupressure, Reflexology
• Heating Pad, Warm Rice Sock
• Aromatherapy & Massage Oils
• Herbal & Homeopathic Remedies
• Avoiding Dehydration
• Hypnosis
• Visualization
In your own home, you are able to move around freely, change scenery, eat and drink as you wish, and have whomever you’d like to be with you. These things make a tremendous difference in your perception of discomfort in labor. At home, you will not be laboring on your back. Laboring on your back is extremely uncomfortable and does not facilitate the labor process. Also in a natural birth, Pitocin is not used. Pitocin makes your contractions abnormally strong, so they feel much worse than normal contractions.
During your prenatal visits and childbirth classes you will be thoroughly prepared for your labor and delivery. Your midwives will train you in relaxation techniques and all the tools you will need for labor.
We understand that if you’ve never had a baby before, you don’t know exactly what to expect in labor; and the unknown can be quite frightening. Also, if you had a bad experience with a delivery in the past, you may feel fearful and want to have options for pain relief in labor. It is true, we can never really know ahead of time how we will handle and cope with labor. However, no matter how much of a “wimp” you may think you are, the discomfort of labor is different than general pain. Pain usually is associated with something being seriously wrong. It is a warning sign that we need to do something to help the problem. The discomfort associated with labor is for a purpose, however. It is “good pain” that is normal and is bringing your baby into the world. This psychological awareness causes us to perceive the pain differently. Through education, we break the cycle of fear, tension and pain. In addition, contractions are not continuous; there are breaks between them which give you time to rest. Labor generally progresses gradually as well, so you have time to adjust to the increasing intensity.
There are some cases, like when labor is very long, that going to the hospital and getting an epidural can be very beneficial. We acknowledge the appropriate use of pain relief. In addition, we support your decisions unconditionally. If you want a natural birth, then we’re here to help you achieve it, and we know that you can do it. If you decide that you need pain relief, we will also support that decision.
What is a Doula?
A Doula is a professional labor support person. The Doula offers information, support, tips for dealing with labor, and helping your partner to be the best labor support person he can be. Achieving a natural birth is a team event. Unlike the Midwife and birth assistant that have other duties, the Doula is there just to support you and give you exactly what you need in labor. If you chose, a Doula will work with you during your pregnancy to come up with a birth plan customized to you. She will then support you and your partner through your whole labor and delivery. There are also postpartum Doulas that help care for you after delivery and assist with breastfeeding.
Is Homebirth Safe?
Research has shown that planned, out-of-hospital birth with a registered, licensed or certified Midwife leads to fewer interventions and complications for both the mother and baby. The chances of you having a cesarean are greatly reduced at home (6% compared to 46% at our local hospital). Your baby will not be forcefully pulled out by forceps or vacuum. Your baby won’t be subjected to unnecessary tests and exams. It has been demonstrated that being confined to bed with continuous fetal monitoring, breaking the waters, and routine use of Pitocin and epidurals cause the majority of complications related to childbirth in the hospital. Avoiding these unnecessary interventions will only aid you in achieving a safe and uncomplicated delivery. Normally, birth is uncomplicated and does not require any intervention. The hospital transfer rate for planned homebirths nationally is about 10-12% and the cesarean section rate is 5-6%. Maternal and neonatal injuries are significantly less at home. According to a recent study published in the Canadian Medical Association Journal, neonatal mortality is less with Midwife attended homebirth than with Midwife or physician attended hospital birth. Researchers found that childbirth at home with a registered Midwife is just as safe as a conventional hospital birth and has a lower rate of complications. [Canadian Medical Association Journal, Janssen et al, September 15, 2009. 181 (6-7)]
What if something goes wrong?
Healthy women with normal pregnancies generally stay healthy and have normal births. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time, and we can calmly plan for preventing or managing a problem.
Your Midwife is highly trained, experienced, and able to quickly identify and manage any situations which are outside of normal. If a complication arises, we have emergency equipment including oxygen, IVs, medications to stop hemorrhage, and resuscitation equipment. All of our team is trained in emergency procedures, including CPR and neonatal resuscitation. If a hospital transfer becomes necessary, your Midwife has a plan in place for transfer and will accompany you to the hospital where you can receive the obstetrical care that you require.
Stalled labor is the most common reason for hospital transfer. Although we must resolve the situation in a timely manner, it is not truly an emergency and we generally have plenty of time to try various natural methods to get labor going again. If we can’t get labor started, the mom can be driven to the hospital in her own car, accompanied by the Midwife
What if the cord is around the baby’s neck?
Actually, this is a rather common occurrence and not an emergency. One-third of all babies are born with the cord around their neck. Rarely, does this cause a problem. Once the head is born, the Midwife will feel around the baby’s neck to see if a cord is present. If the cord is around the neck, then the Midwife will either slip the cord over the baby’s head or will birth the baby’s body through the cord. If the cord is extremely tight, it can be clamped and cut, but that’s usually not necessary.
What about tearing?
We work hard to prevent and minimize tearing. We do this by encouraging good nutrition during pregnancy, perineal massage, perineal support, oil, hot compresses, warm baths, and avoiding episiotomy. Your Midwife will teach you how to push, so that you ease the baby out in a slow, controlled manner. Baths and/or waterbirth are also good ways to help prevent tearing. The warm water softens the tissue and allows it to gently stretch during birth. If you do need stitches, the Midwife will perform the repair after the birth with local anesthesia. If necessary, the Midwife is trained to cut an episiotomy; however, this is rarely necessary.
Who will clean up after the birth?
Your birth team will take care of everything after your birth. Your Midwife and her assistant will feed you a meal, change your sheets, wash the laundry, disinfect the birth area, clean and disinfect the bathtub, and take out the garbage. Within an hour or two after your birth everything will be tidied and no one could tell that you just had a baby there.
How do I obtain a birth certificate and social security card for my baby?
Your Midwife will submit the birth certificate which also requests a social security card, if you desire. A social security card will automatically be mailed to you within 4-8 weeks. To obtain a copy of the birth certificate you will need to contact the Vital Statistics office and pay a fee of $15 per copy.
Do I need a Pediatrician?
Yes. Your Midwife will complete a physical exam on your baby shortly after birth. She will weigh and measure your baby, and administer vitamin K and eye ointment, if you desire. The Midwife will also do the Newborn Metabolic Screening (PKU) test on the second day after the birth. You will be instructed on how to listen and count your baby’s heart rate and breathing, take the temperature and monitor for any abnormal signs. After your baby is born, contact your pediatrician and schedule a visit within 48 hours.