Training
Q: What training have you had?
A: My training began in 1983 with Informed Homebirth Teacher Training and Midwifery Skills Intensive (taught by Anne Frye). I did an informal apprenticeship in Las Vegas with Kaye Bullock, my own midwife. While my own children were young, I learned primarily through self-study. In 1999, I did my formal apprenticeship with Sierra Midwifery in Reno until I was certified with NARM in 2002. I’ve also attended workshops and conferences to gain more skills in suturing, woman-friendly pelvic exams, neonatal resuscitation, maternal blood draws (phlebotomy) newborn loss and grief, and IV therapy. In November 2005, I was certified to perform Limited OB ultrasounds in 2-D, 3-D and 4-D. Since that time I have performed over 600 ultrasounds.
I am currently enrolled in a degree program through Aviva Institute. I plan to have a Bachelor of Science degree in midwifery by May 2010.
Find out more
* For more information on NARM certification, see the NARM Position Paper on the Practice of Midwifery.
* The 2001 American Public Health Association’s ResolutionsIncreasing Access To Out-Of-Hospital Maternity Care Services Through State-Regulated and Nationally-Certified Direct-Entry Midwives which recognizes and affirms the CPM credential for direct entry midwives.
* Childbirth Solutions, Inc. also has information on What is a Certified Professional Midwife?
* The California Association of Midwives “supports certification of midwives by the North American Registry of Midwives (NARM) and the title “Certified Professional Midwife” (CPM).”
* The Ohio Friends of Midwives site provides a list of organizations to show Who Is Supporting Access to Nationally Accredited Midwives?
Q: How many births have you attended?
A: Over one-hundred sixty.
Certification
Q: Are you certified or licensed? By whom?
A: I am certified by the North American Registry of Midwives (NARM) as a Certified Professional Midwife (CPM). The CPM credential is an international credential; it is the only credential that validates the traditional apprenticeship training for midwives and the only one that requires out-of-hospital experience. Seventeen states, use the NARM test as part of their licensing process; however, Nevada has no licensing mechanism for midwives.
Fees
Q: How much does a home birth cost?
A: The fees for my services reflect the going rate in my area. I charge $3600 with nearly a 40% discount for cash payment which comes to $2200. I offer a payment plan with no finance charges. The fee includes complete prenatal care, labor and birth, and postpartum care and GBS screening, newborn metabolic screening. . So, if you are paying cash, my total fee is due, in full, one month before your estimated due date. In addition,the birth kit of disposable supplies is purchased separately and costs about $40. The initial lab-work usually runs about $100, and is paid directly to the lab. Diagnostic ultrasounds, genetic testing and Rhogam (for moms with Rh negative blood type) or other special tests that may become necessary or require a referral to a medical-care provider are not part of my fee and are paid for at the time of service.
At this time, I accept cash payment, which can be divided into equal payments after an initial deposit of $300 is made. The balance is to be paid by your 36 week prenatal visit, one month before your due date. If you have health insurance, check to see if they cover midwifery care. We may be able to bill for reimbursement.
Insurance
Q: If I choose home birth over a hospital birth, will my insurance cover your costs?
A: Couples with medical insurance will be directed to my insurance billing agent. She will take all your insurance information and handle all the paperwork after the birth. Insurance companies differ on how much they will reimburse, or if they will at all. It is necessary, then, to pay my fee before the birth and seek reimbursement afterward. I’ve had very good success with this approach since hiring a billing agent. Most insurance companies are happy to write a check because my fees are much lower than a doctor’s fees plus a hospital’s fees. It makes good economic sense for them to cover midwives.
Transporting to a Hospital
Q: Have you ever had to transport a birth mother to the hospital?
A: Yes. There are two categories for transport, complications and emergencies. Complications, the most common reason for transport, include failure to progress, maternal exhaustion, and prolonged rupture of membranes without effective contractions. In these instances, we have time to try various strategies, and can often resolve the problem at home. If we decide to transport, it may be possible for the woman to have a vaginal birth in the hospital.
In the rare case of a true emergency, for example a prolapsed umbilical cord or maternal bleeding, we have to act quickly. My training is to keep mother and baby stable until we reach medical help. The good news is, these situations are rare and often preventable.
Q: What is your criteria for determining when it is necessary to transport?
A: Criteria are based on established protocols applied to the individual situation. Generally, if we’ve exhausted all our efforts with no progress, or if the parents want to, or if there is a true emergency, we transport. Practice guidelines and protocols are available for review.
Q: What happens then? Are you allowed to stay with the birth mother?
A: Yes. When we transport, I accompany the couple to the emergency room. They send us right up to labor and delivery where we give the nursing staff a brief history of events and copies of the woman’s chart. Care is transferred to the physician on-call. I stay as a support person and advocate until after the birth. Usually, if a c-section is necessary only the father is allowed in and I’ll wait and see the mom in recovery. Afterward, we will do one or two follow-up visits.
Q: Do you attend water-births?
A: Yes, I believe that water is a wonderful tool for helping the mom cope with active labor. As long as the birth is proceeding normally, mom may stay in the water for the birth if she chooses. There are several companies that offer tub rentals, set-up & removal services. Some women have a large enough tub in their homes, that it’s not necessary to buy or rent one. My last two children were born in the water. It was wonderful!
Related Stories
Ben’s birth story, a planned homebirth ending in an emergency caesarian. Thanks to Kiara at The Homebirth Reference site.