Frequently Asked Questions
BACKGROUND, EDUCATION, PHILOSOPHY
Q: What is your educational background? How long have you been in practice? Are you certified or licensed?
A: I have a BS in Secondary Education. I am a Licensed Midwife in Delaware and I am a Certified Professional Midwife. I have over 17 years experience as an independent practitioner and am an expert in providing home birth midwifery care.
Q: How many births have you attended? How many of these have been home births? What is your philosophy of pregnancy and birth?
A: I have attended over 300 births at home and over 500 total. I feel that for most women, pregnancy is a time of growth and major change. I also believe that the births of our children are some of the most important and special events in our lives. Our purpose as midwives is to encourage, facilitate and share with couples the process of implementing their wishes for a safe and pleasant experience. The concepts of informed consent and shared decision making are central to this philosophy. We also believe that childbirth is a natural, normal, blessed event. It is a great privilege to attend someone during the birth process.
PRACTICE ORGANIZATION
Q: Is your practice a group or individual practice? What back-up arrangements do you have if you are not available to attend my birth?
A: Birth At Home Delmarva is an individual practice. I am personally on call for your birth from the 37th week of pregnancy until your baby is born. If there is ever a conflict we will mutually determine a course of care.
Q: Do you know of anything now that may cause you to be unavailable around the time of my birth, including other women who may be due around the same time or travel plans?
A: I make no travel plans if there is a client due, and I am on call and will not take two clients within the same due date window.
COST
Q: How much do your services cost? Are there possible extra costs that I should know about?
A: Global midwifery fees are about $3,000.00-10,000.00 Complete details as to covered and excluded expenses are part of the Informed Disclosure documentation.
Q: Do you participate in my insurance plan?
A:. Most state and federal laws require insurance companies to pay healthcare providers that are licensed or recognized in their state.
You should check with your insurer to confirm coverage. Regardless of insurance coverage, you are responsible for payment.
Q: Do you accept alternate payment arrangements, such as sliding scale, time payments, or barter?
A: Yes. The inability to pay should not preclude any woman from seeking our services. Special arrangements can be made for those who are sincere in their need.
HOME BIRTH
Q: What preparations would I need to make in advance? Would I need to get any supplies or equipment? What do you bring with you?
A: Each client orders a birth kit of consumable materials. We carry oxygen and all state approved medications including anti-hemorrhagic skills and supplies. I bring durable birth supplies and a birth tub can be reserved as part of my services also.
Q: At what point in my labor would you come to my home?
A: We usually come when asked or when active labor is established.
Q: Who would come with you? What would that person’s (or their) role be? How would I get to know that person (those people) before the birth?
A: My assistant is a certified doula and you will get a chance to know her prenatally.
PRENATAL CARE
Q: What are your goals for prenatal care?
A: To partner with you in maintaining a healthy, low-risk pregnancy.
Q: What schedule of prenatal visits do you recommend, and what happens during those visits? Where would they be?
A: We would ideally like to see you at least once a month, after we have established a working relationship, until you are 28 weeks gestation. Twice monthly from 28 - 35 weeks, and weekly from 36 - 42 completed weeks.
Q: How do you define "high-risk"? When would I fall into this category?
A: The state of Delaware is very clear about the parameters surrounding high risk conditions. These are detailed in all Informed Disclosure documentation.
CARE DURING LABOR AND BIRTH — COMPANIONS
Q: Do you have any policies that limit the number of people who may be with me during labor and birth?
A: No, you have complete control over who is and is not welcome at your birth.
Q: Can the baby’s siblings be present? Is there an age restriction?
A: Children of all ages are welcome at birth. However, it is usually a good idea to have a designated adult there for them in case they have questions or needs which you are too busy laboring, to address.
Q: Do you have experience with trained labor support (doulas) during labor and birth? Do you encourage use of doula care?
A: Yes, a trained birth attendant is welcome if you choose. We encourage support of whatever means you feel is appropriate.
CARE DURING LABOR AND BIRTH — INTERVENTIONS
Q: How do you monitor the well-being of the baby during labor? Do you use a doppler (hand-held ultrasound device to monitor the baby’s heart) or fetoscope (stethoscope for listening to the baby’s heart)?
A: It is necessary and prudent to monitor the baby via a Doppler or fetoscope in labor. Studies have shown that intermittent monitoring is as effective as continuous EFM (electronic fetal monitoring).
Q: What are your usual policies and practices about mobility, nourishment and positioning in labor?
A: Home birth allows freedom to be active and move about in labor while eating and drinking in labor and assuming optimal positions for birth.
Q: What is your usual care if a labor is progressing slowly?
A: Patience, while monitoring the baby and the mother, and avoiding maternal exhaustion are the keys to managing a long labor.
Q: What percent of the time do you find it necessary to cut an episiotomy?
A: I have never needed to cut an episiotomy ( incision in the perineum in order to enlarge the vaginal opening) for a birth.
CARE DURING LABOR AND BIRTH
Q: How would you recommend that I prepare for managing pain during labor and birth?
A: All of the things that contribute to increased comfort and reduced while pregnant, also work in labor. Childbirth classes, Le Leche League groups and reading books on natural childbirth are good preparation.
Q: What drug-free measures for pain relief can you provide?
A: Massage, hydrotherapy, relaxation, acupressure, guided imagery, herbal and nutrition therapies are just a few drug- free pain management measures.
Q: What happens if I decide that I want an epidural and cannot be deterred?
A: Those clients requesting pain medications will be transferred to a medical facility.
COMPLICATIONS AND/OR TRANSFER OF CARE
Q: What proportion of the women you work with switch to hospital birth during pregnancy? During labor and birth? What are the main reasons for making this change?
A: When a mother needs or desires medical care that cannot be provided in a home setting, we will refer you to other care providers. Statistical studies show rates of hospital transfers to be around 10-15%, mostly for non-emergent reasons.
Q: What emergencies could arise during labor and birth, and how would you handle them? What emergency supplies and equipment do you have on hand? Is there anything I would need to do to be prepared for this situation?
A: Although true emergencies are rare, emergency medical personnel will be summoned, the mother or baby will be stabilized if possible, and transport by ambulance to the nearest facility will occur.
Q: What arrangements do you have with doctors and/or hospitals if consultation or transfer become
necessary? Would you continue to have a role in my care?
A: If transfer is necessary, we will accompany you in a supportive role but will no longer be able to provide care in the hospital setting.
Q: What would the procedure be if I transported to the hospital during labor and birth? What hospital would my baby be taken to, in the case of an unforeseen complication?
A: In Delaware, each client is required by law to have a specific emergency plan detailing transport conditions which addresses consultation with other health care providers; emergency transfer procedures; and access to neonatal intensive care units and obstetrical units.
Q: What percentage of your clients have cesarean sections?
A: Less than 10%
Q: Are you certified in neonatal resuscitation? What kind of resuscitation equipment do you have?
A: Everyone facilitating your birth is required to be certified in neonatal resuscitation. We care oxygen and an ambubag.
POSTPARTUM AND NEWBORN CARE
Q: What is your approach to newborn care? What newborn care is routinely provided or offered if a baby is healthy?
A: We believe in the maternal/infant dyad. We perform a complete newborn assessment and aid in establishing breastfeeding, attend to nutrition and answer any questions or discuss concerns. We are required by the State to file a Birth Certificate and Offer Newborn Screening.
We weigh and measure the baby and assess normal behavior in regards to sleep/wake time, nursing, etc. at each visit. We have information on immunizations and normal development.
Q : How long do you stay after birth? Would I have access to you by phone?
A: A minimum of 2 hrs. but we routinely stay until everyone is stable, clean, fed and resting. You will have complete, immediate access for any questions or concerns.
Q: How many visits would we have after the birth? When and where would they be?
A: We visit you in your home on Postpartum Day 1 and Day 3. We ask that you come to us at 1 Week, 3 Weeks and 6 Weeks postpartum to access normal adaptation and functions.
REFERRALS
Q: Can you supply names of three women whom you have assist home, for reference purposes?
A: Yes. References are available upon request.
Q: What is your educational background? How long have you been in practice? Are you certified or licensed?
A: I have a BS in Secondary Education. I am a Licensed Midwife in Delaware and I am a Certified Professional Midwife. I have over 17 years experience as an independent practitioner and am an expert in providing home birth midwifery care.
Q: How many births have you attended? How many of these have been home births? What is your philosophy of pregnancy and birth?
A: I have attended over 300 births at home and over 500 total. I feel that for most women, pregnancy is a time of growth and major change. I also believe that the births of our children are some of the most important and special events in our lives. Our purpose as midwives is to encourage, facilitate and share with couples the process of implementing their wishes for a safe and pleasant experience. The concepts of informed consent and shared decision making are central to this philosophy. We also believe that childbirth is a natural, normal, blessed event. It is a great privilege to attend someone during the birth process.
PRACTICE ORGANIZATION
Q: Is your practice a group or individual practice? What back-up arrangements do you have if you are not available to attend my birth?
A: Birth At Home Delmarva is an individual practice. I am personally on call for your birth from the 37th week of pregnancy until your baby is born. If there is ever a conflict we will mutually determine a course of care.
Q: Do you know of anything now that may cause you to be unavailable around the time of my birth, including other women who may be due around the same time or travel plans?
A: I make no travel plans if there is a client due, and I am on call and will not take two clients within the same due date window.
COST
Q: How much do your services cost? Are there possible extra costs that I should know about?
A: Global midwifery fees are about $3,000.00-10,000.00 Complete details as to covered and excluded expenses are part of the Informed Disclosure documentation.
Q: Do you participate in my insurance plan?
A:. Most state and federal laws require insurance companies to pay healthcare providers that are licensed or recognized in their state.
You should check with your insurer to confirm coverage. Regardless of insurance coverage, you are responsible for payment.
Q: Do you accept alternate payment arrangements, such as sliding scale, time payments, or barter?
A: Yes. The inability to pay should not preclude any woman from seeking our services. Special arrangements can be made for those who are sincere in their need.
HOME BIRTH
Q: What preparations would I need to make in advance? Would I need to get any supplies or equipment? What do you bring with you?
A: Each client orders a birth kit of consumable materials. We carry oxygen and all state approved medications including anti-hemorrhagic skills and supplies. I bring durable birth supplies and a birth tub can be reserved as part of my services also.
Q: At what point in my labor would you come to my home?
A: We usually come when asked or when active labor is established.
Q: Who would come with you? What would that person’s (or their) role be? How would I get to know that person (those people) before the birth?
A: My assistant is a certified doula and you will get a chance to know her prenatally.
PRENATAL CARE
Q: What are your goals for prenatal care?
A: To partner with you in maintaining a healthy, low-risk pregnancy.
Q: What schedule of prenatal visits do you recommend, and what happens during those visits? Where would they be?
A: We would ideally like to see you at least once a month, after we have established a working relationship, until you are 28 weeks gestation. Twice monthly from 28 - 35 weeks, and weekly from 36 - 42 completed weeks.
Q: How do you define "high-risk"? When would I fall into this category?
A: The state of Delaware is very clear about the parameters surrounding high risk conditions. These are detailed in all Informed Disclosure documentation.
CARE DURING LABOR AND BIRTH — COMPANIONS
Q: Do you have any policies that limit the number of people who may be with me during labor and birth?
A: No, you have complete control over who is and is not welcome at your birth.
Q: Can the baby’s siblings be present? Is there an age restriction?
A: Children of all ages are welcome at birth. However, it is usually a good idea to have a designated adult there for them in case they have questions or needs which you are too busy laboring, to address.
Q: Do you have experience with trained labor support (doulas) during labor and birth? Do you encourage use of doula care?
A: Yes, a trained birth attendant is welcome if you choose. We encourage support of whatever means you feel is appropriate.
CARE DURING LABOR AND BIRTH — INTERVENTIONS
Q: How do you monitor the well-being of the baby during labor? Do you use a doppler (hand-held ultrasound device to monitor the baby’s heart) or fetoscope (stethoscope for listening to the baby’s heart)?
A: It is necessary and prudent to monitor the baby via a Doppler or fetoscope in labor. Studies have shown that intermittent monitoring is as effective as continuous EFM (electronic fetal monitoring).
Q: What are your usual policies and practices about mobility, nourishment and positioning in labor?
A: Home birth allows freedom to be active and move about in labor while eating and drinking in labor and assuming optimal positions for birth.
Q: What is your usual care if a labor is progressing slowly?
A: Patience, while monitoring the baby and the mother, and avoiding maternal exhaustion are the keys to managing a long labor.
Q: What percent of the time do you find it necessary to cut an episiotomy?
A: I have never needed to cut an episiotomy ( incision in the perineum in order to enlarge the vaginal opening) for a birth.
CARE DURING LABOR AND BIRTH
Q: How would you recommend that I prepare for managing pain during labor and birth?
A: All of the things that contribute to increased comfort and reduced while pregnant, also work in labor. Childbirth classes, Le Leche League groups and reading books on natural childbirth are good preparation.
Q: What drug-free measures for pain relief can you provide?
A: Massage, hydrotherapy, relaxation, acupressure, guided imagery, herbal and nutrition therapies are just a few drug- free pain management measures.
Q: What happens if I decide that I want an epidural and cannot be deterred?
A: Those clients requesting pain medications will be transferred to a medical facility.
COMPLICATIONS AND/OR TRANSFER OF CARE
Q: What proportion of the women you work with switch to hospital birth during pregnancy? During labor and birth? What are the main reasons for making this change?
A: When a mother needs or desires medical care that cannot be provided in a home setting, we will refer you to other care providers. Statistical studies show rates of hospital transfers to be around 10-15%, mostly for non-emergent reasons.
Q: What emergencies could arise during labor and birth, and how would you handle them? What emergency supplies and equipment do you have on hand? Is there anything I would need to do to be prepared for this situation?
A: Although true emergencies are rare, emergency medical personnel will be summoned, the mother or baby will be stabilized if possible, and transport by ambulance to the nearest facility will occur.
Q: What arrangements do you have with doctors and/or hospitals if consultation or transfer become
necessary? Would you continue to have a role in my care?
A: If transfer is necessary, we will accompany you in a supportive role but will no longer be able to provide care in the hospital setting.
Q: What would the procedure be if I transported to the hospital during labor and birth? What hospital would my baby be taken to, in the case of an unforeseen complication?
A: In Delaware, each client is required by law to have a specific emergency plan detailing transport conditions which addresses consultation with other health care providers; emergency transfer procedures; and access to neonatal intensive care units and obstetrical units.
Q: What percentage of your clients have cesarean sections?
A: Less than 10%
Q: Are you certified in neonatal resuscitation? What kind of resuscitation equipment do you have?
A: Everyone facilitating your birth is required to be certified in neonatal resuscitation. We care oxygen and an ambubag.
POSTPARTUM AND NEWBORN CARE
Q: What is your approach to newborn care? What newborn care is routinely provided or offered if a baby is healthy?
A: We believe in the maternal/infant dyad. We perform a complete newborn assessment and aid in establishing breastfeeding, attend to nutrition and answer any questions or discuss concerns. We are required by the State to file a Birth Certificate and Offer Newborn Screening.
We weigh and measure the baby and assess normal behavior in regards to sleep/wake time, nursing, etc. at each visit. We have information on immunizations and normal development.
Q : How long do you stay after birth? Would I have access to you by phone?
A: A minimum of 2 hrs. but we routinely stay until everyone is stable, clean, fed and resting. You will have complete, immediate access for any questions or concerns.
Q: How many visits would we have after the birth? When and where would they be?
A: We visit you in your home on Postpartum Day 1 and Day 3. We ask that you come to us at 1 Week, 3 Weeks and 6 Weeks postpartum to access normal adaptation and functions.
REFERRALS
Q: Can you supply names of three women whom you have assist home, for reference purposes?
A: Yes. References are available upon request.
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