What is a Certified Professional Midwife?
A Certified Professional Midwife (CPM) is a skilled professional 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 CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.
When should I contact you if I'm interested in learning more or starting care?
Contact us as soon as you're interested. We offer a free consultation visit, and even preconception care. The initial prenatal visit is usually around 10 to 12 weeks (from your last period) which is when we can first reliably hear the baby's heartbeat with a handheld Doppler. Because offering this style of very personal care means taking a limited number of clients each month, it is best to contact us early, but if you are discovering midwifery care later in your pregnancy, don't hesitate to check on availability.
Will I need to see a doctor in my pregnancy?
That is your choice. Many clients choose to have one visit to establish a relationship with obstetric care providers. Most clients do not receive concurrent care with a doctor, as midwives provide comprehensive care, but ongoing care with your midwife and a backup physician is an option. We offer referral to a backup OB practice for clients who wish to have an ultrasound or who have concerns best monitored by a medical team.
What about lab work/ blood work?
We offer the same laboratory testing that you would have in a standard medical practice. Together, we decide which tests should be drawn in-office and sent to the lab.
Who will attend my birth? Can I invite others, including my children, to attend?
Your birth team consists of your primary midwife, the support midwife, and occasionally a student (with your permission). It's your birth! You can invite anyone you want. Some basic advice is to only invite loved ones who are supportive of your choice to birth outside the hospital and to let folks know ahead of time that you can't know how you will feel in the moment and may want more privacy. If you plan for your other children to be present, we strongly recommend there be someone there whose only job is child care so you and your partner can focus on labor and birth.
How do you monitor the baby during birth?
We use hand-help Doppler ultrasound to monitor the baby's heartbeat at regular intervals during labor. This allows us to unobtrusively listen to the heartbeat through contractions, when mom is in her most comfortable position, and even under water.
What if there is an emergency?
Since home birth midwifery care is limited to healthy low-risk women and we provide careful monitoring in prenatal care, the risks of a true emergency are small. However, complications do occasionally arise. Births are attended by two care providers trained and current in Neonatal Resuscitation (newborn CPR) and we carry equipment and supplies to address complications such as newborn difficulty breathing or postpartum hemorrhage. Most transports to the hospital in labor are not emergencies, but a gradual recognition, through monitoring, that mom or baby is better served in a medical setting. In the case of any decision to transport to the hospital, the primary midwife contacts the hospital and the receiving physician, provides information about the transport, accompanies the family to the hospital, and remains as labor support once clinical care has been turned over to the medical team. In the years we have served Central PA families, we have only a 7% transport rate, but have experience with all of the hospitals in the area we serve.
Is Home Birth legal in Pennsylvania?
Home birth is legal in all 50 states. States vary on licensure and recognition of the CPM and Pennsylvania does not yet recognize this credential. However, we maintain a relationship with medical backup in the region, and maintain registry with the state to provide birth certificate filing, newborn metabolic screening, and the newborn hearing screen.
What about the mess?
There isn't much. When planning a homebirth you will be asked to order a birth kit and gather some basic supplies. A lot of these items, such as underpads, are to help keep things clean. We usually wind up with one half full bag of trash and one or two loads of laundry. Your birth team will tidy things up before leaving.
Do I need to take a childbirth preparation class?
Childbirth preparation classes are not required, but are encouraged, especially for first time parents. There are a wide variety of styles and approaches to childbirth education. We can offer referrals for classes geared toward natural childbirth.
Should I hire a doula?
It is entirely up to you and your partner if you want to hire a doula. While midwives offer emotional and physical labor support in addition to clinical monitoring, many women benefit from extra support and guidance. Doulas can be a great addition to the birth team. In a homebirth situation a doula generally does not have to fill the role of natural birth advocate because you know your midwife well and have created your birth plan together.
Can I have a VBAC at home?
Probably. A previous C-section does not automatically rule out a vaginal birth or a home birth and it can be especially fulfilling and healing to birth your babies at home after a Cesarean birth. For most women, a VBAC at home is statistically safer than a repeat C-section. There are additional considerations that we would need to discuss including reviewing your previous records and your pregnancy and health history. We ask that all women planning a VBAC have at least one sonogram followed by an appointment with a hospital based care provider. Meadowsweet Midwifery has a 90% success rate for VBAC births.
For more information regarding VBAC try ICAN and VBAC facts.
What do I need for a waterbirth? Where can I find more information?
We offer loaner birth tubs upon request. There is no extra charge, but there are some extra supplies that will be needed and you are responsible for set up/break down.
For more information about waterbirth go to Waterbirth International here. We also have waterbirth videos, books and handouts in the lending library at our office for clients to borrow.
Do you offer pain medication at home?
Pain medications are not available at home due to the risks they pose to you and your baby. Instead, you have the comfort of your own surroundings, the freedom to move and rest in labor as you please, nourishment to keep up your strength and stamina, and the option to labor and birth in water. Of course, going to the hospital for pain medication is always an option, but we find it is very rare for women to request this change.
Will my insurance cover the cost of a home birth? If not, how can I justify paying out of pocket when my insurance will cover a hospital birth?
This depends on the insurance company. We offer referral to a billing service which can tell you the likelihood that your insurance will reimburse you, and they can file for reimbursement for you if you so choose. Some people choose to simply pay out of pocket anyway; with a high deductible or coinsurance, midwifery services are not typically more than a hospital birth would cost. When compared to the full cost of even an uncomplicated vaginal hospital birth, home birth is considerably less. Most clients who pay out of pocket tell us it's worth every penny for the hours and quality of care received.
Here's an estimate of our average time spent with a client:
12-14 hours/prenatal visits
6-48 hours/ labor and birth
3-4 hours/ immediate postpartum
6 -8 hours/ 4-6 individual postpartum visits
8-10 hours of work you don't see: answering your questions via phone, e-mail and text message, coordinating with other care providers when the need arises, researching topics particular to your needs, paperwork, and equipment maintenance.
In addition to our time, we include the cost of on-call status of the primary midwife and assistants, access to a midwife by phone 24 hours a day, and the cost of driving to our client's homes. Keep in mind that you are receiving highly personal, individualized care from specialized care providers. Each birth is a once-in-a-lifetime event. Most people budget and plan for things they really want. Birthing a child the way you want to is as important as the special things we expect to pay for out of pocket like a wedding, car, engagement ring, or vacation.
What about after the baby is born? Do you provide breastfeeding support?
CPMs are trained to provide care for mom and baby through 6 weeks postpartum. We recommend that you make an appointment for your baby to see a pediatrician within a week of the birth. We see clients weekly most times, so are able to support breastfeeding and monitor baby's weight gain. We have lots of experience helping mamas and babies establish a good breastfeeding relationship (an unmedicated birth and immediate skin-to-skin contact is a good start!) and can offer referrals to local lactation consultants for the rare more complex nursing issue.
