Our Frequently Asked Questions
Here is a list of the most frequently asked questions about home birth and my practice.
Is home a safe place for me to have my baby?
Only you can answer this question. The safest place for you to give birth is the place you feel the safest. Studies repeatedly document the safety of planned midwife attended home birth for healthy low-risk women and their newborns. This is especially related to the reduced exposure to infection, the decreased use of interventions at home which often lead to many of the complications seen in hospitals.
Women who choose homebirth are low-risk (as defined by Midwifery Standard of Care) and assume a great deal of responsibility for decision making based on research, taking classes and working through any unresolved concerns. A steadfast belief in the normalcy and safety of physiologic birth is essential as is the understanding that your TRUE prenatal care is how you care for yourself between appointments with your provider. I encourage you to talk to women that have given birth, both in home and hospital settings, interview a few midwives and some doctors and then ultimately look within yourself for the answer.
No one can birth this baby besides you! If you are unsure about about risk status or have been told you are high risk due to a previous cesarean, your age or a gestational diabetes diagnosis, I encourage you to call me for a consultation so we can determine if you are an appropriate candidate for a homebirth based on your individual health history.
How do the home visits work?
I will come to your home for all of your prenatal visits, the birth, as well as post partum until you are 36 weeks then weekly until the birth. Postpartum I will come at 24-36 hours, 72 hours, 7-10 days and at 5-6 weeks. If you prefer, I do have a home office located near 2222 & 360 in West Austin where we can meet for some or all of your prenatal visits. We will see each other every 4 weeks until 28 weeks gestation, every 2 weeks until you are 36 weeks then weekly until the birth. During the prenatal visits I will assess your general well-being, check your vitals, perform any labs or blood work that may be needed (i.e. Pap Smear, CBC, gestational diabetes screen, urine dips, Group-B Strep swab, etc.), We will measure your belly to check baby's growth, listen to your baby's heart rate, determine baby's position and spend a lot of time getting to know each other. These visits are relaxed and can be done on your couch, bed or other comfortable area.
Will I also need a doctor?
I am licensed by the State of Texas and nationally to provide comprehensive maternity care including ordering any testing that would be ordered by a doctor, including referring for ultrasounds if needed. I can draw/perform labs in your home and utilize Quest Laboratory. Your medical insurance typically will pay for your lab work. You do not need to see another provider unless indicated. Emotional and physical safety is a priority and I am skilled at diagnosing factors that may adversely affect you or your baby. I work collaboratively with you to reduce the risk for complications using nutrition and herbs. If a condition arises that is cause for concern, you'll be referred to an appropriate medical provider.
Can I have a water birth?
Yes! Laboring women love the birth tub/pool. In the moment, if it feels right to you, you can absolutely give birth in the water. If you are in need of a birth pool to rent or buy, I can aid you on where to order one.
What about the mess?
Birth isn't as messy as TV would like you to believe! You will order a birth kit that contains many of the same supplies and disposable underpads used in the hospital to catch fluids. I take precautions so that the ﬂoors, carpets and pillows stay clean. After the birth, all soiled linens are laundered, disposable items are thrown away and the trash is taken out. You will be so busy gazing at your beautiful baby and breathing in your amazing accomplishment that you won't even notice the clean up process!
Can I VBAC at home (HBAC)?
In my experience, VBAC women are some of the most well researched, educated and determined moms choosing homebirth today. Of course, until I review your health history and surgical report I cannot tell you for certain whether you meet the criteria for an HBAC. Approximately 80% of women who attempt a VBAC are successful. The main risk for VBAC’s, although rare, include uterine rupture and/or uterine dehiscence at the incision site. Five out of 1000 women will experience uterine rupture after a prior uterine incision, which is less than 1% of appropriately attempted VBAC’s. In the event of a complication arising in a VBAC at home (often called HBAC or Home Birth After Cesarean), prompt recognition, transport, and emergency management in a hospital can minimize serious consequence. Before the birth we will have an emergency plan in place and during labor vitals and fetal heart tones will be monitored more frequently. Both the National Institute of Health (NIH) and The American College of Obstetricians and Gynecologists (ACOG) support VBACs. The NIH states that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. ACOG states similarly that most women with one prior cesarean and some women with two prior cesareans are candidates for VBAC. I do attended woman who have had 1 prior cesarean with or without ever birthing vaginally who had a low transverse incision. Let's meet so we can determine if homebirth is right for you!
What equipment and supplies do you bring to the birth?
I carry to your birth, supplies such as oxygen and resuscitation equipment, medications to control bleeding, IV fluids and sterile suturing materials. I bring sterile instruments needed to clamp and cut the baby's cord. Your baby’s heart rate is monitored with a Doppler and your vital signs are regularly assessed during your labor. I also bring other items to use as labor support tools such as homeopathic, herbal, and aroma-therapeutic remedies. I bring equipment necessary to perform a comprehensive newborn exam.I can even administer prophylaxis eye ointment if you have agreed. I also bring a skilled set of hands to each birth in the form of another licensed midwife. This midwife is in the background to assist me with equipment, some charting, collaboration and whatever task I may need her to provide so I can take focus on providing you with continuous support. In the event it becomes needed, there will be one midwife for mom & another for your baby. Most likely you will have already met her at one of your prenatal appointments. I also bring my heart, a clear head and my experience.
What if we transfer to the hospital during labor?
If there is an issue that arises during labor or birth that requires medical attention we will transfer to the hospital. A transport plan is discussed prenatally. Most transfers are not emergencies. There are also times when we transport for issues with the baby – again, most commonly it is not an emergency, but a situation where we feel safer being in the hospital so that your baby can be continuously monitored. Typically, these births turn out perfectly ﬁne with healthy moms and healthy babies. I will call the hospital first to let them know we will be coming in and why, since I utilize electronic medical records I will send your records over to labor and delivery, and we will calmly drive to the hospital in our own cars and are welcomed by people who are expecting us. If the situation is emergent, 911 will be called and the transport will take place via EMS. I stay with you, help you make decisions and provide emotional support until your baby is safely born and you are both resting together. Postpartum appointments will then continue as planned, as well as breastfeeding and parenting support. Again, this is rare. Most low-risk women who are appropriate candidates for a homebirth stay at home!
What is the most common reason to transfer to the hospital during labor?
Maternal exhaustion is the most common reason for transfer, usually the mom just needs some pain medication so she can rest a bit and then go on the have a vaginal birth. Transfer rates are low, most are first time moms who have experienced a very long labor or extending pushing phase.
I am over 35 and have been told I am "advanced maternal age", can I still have a homebirth?
As long as your are otherwise healthy, age is not a factor. Your risks of having a baby with certain genetic defects are increased, certain tests will be offered to you, however you can always opt out of genetic testing if you choose.
I have read that women have to have their baby by their "due-date", do you induce at 40 weeks?
No, I will not induce a woman because she is 40 weeks. You are considered to be at term between 37 and 42 weeks. Most first time moms have a gestation of 41 weeks and 1 day. After 42 weeks you would considered post=term. A few days before you reach the 42 week mark I would ask that you have a type of sonogram done that is called a Biophysical profile, this is a comprehensive look at how your baby is doing as well as measuring the amniotic fluid surrounding the baby. If baby is doing fine, I am comfortable with taking the pregnancy out to 42 weeks. The risk of complications does increase after 42 weeks and after this time it may be safer for you to deliver in a hospital setting. However, before you reach 42 weeks, there are natural things we can discuss for you to try that may help you get your labor going.
How many births do you attend in a month and what if you have two people in labor at the same time?
I currently attend about 2 births a month. Overlapping labors are rare, but if two women are in labor at the same time, I have a back up midwife, if necessary, to assist when the baby is ready to be born. Again, it is extremely rare to have two mothers give birth at the exact same time.
How does payment work? Will my insurance cover a midwife or homebirth?
Clients pay my fee directly to me in advance of the birth (by your 35th week gestation), I ask for a deposit at your initial visit and then we discuss payment options. After your baby is born and at your final post- partum visit, I am happy to provide you with a Super bill with the codes for my services which you can then submit to your insurance company for possible reimbursement. I cannot guarantee that you will be reimbursed for your out of pocket expenses. I have had some clients get reimbursed fully or in part for their home birth costs, but it may take time and persistence to make that happen. Your insurance information can be given to Quest Diagnostics and they will bill your insurance company for labs. Most insurance companies will pay for your labs without issue even when doing a homebirth with a midwife.
What midwifery credentials do you possess?
I am a Licensed Midwife (LM) who specializes in out of hospital birth, and routine prenatal gynecological care. I am also a licensed Certified Professional Midwife (CPM), which is a North American certification. An LM is an autonomous provider educated in midwifery and licensed by the state of Texas. I am certified in both Adult and Child CPR and Neonatal Resuscitation.
How is my partner involved in my care?
Partners are invited and encouraged to be a part of care as it is important that their questions, concerns, and hopes for the birth are discussed during pregnancy. I am skilled at supporting partners in participating during the birth in a way that feels right for them. Some partners prefer to be directly involved while others provide background support. Either way we acknowledge that birth of a baby is a transformative experience for all members of your family and we are there to support you both as “newborn parents“. If you have other children that you want to participate in prenatal visits or at the birth, I will help facilitate that as well.
What might disqualify me from a homebirth?
Pre-eclampsia, Uncontrolled diabetes, certain Heart and Pulmonary disorders, HELLP, Active Genital Herpes, certain Mental Health issues,, prior uterine rupture, ICP, preterm delivery, Breech presentation, Multiple Gestation, and unsafe living conditions. Some of these are absolute no goes for a homebirth, others require further testing and monitoring, decisions will be made on an individual basis using informed consent.
I don't have insurance, do I have to have blood work or ultrasounds?
There are certain blood tests that need to be done in pregnancy, these include Blood type, rubella immunity status, HIV and screenings for anemia. Ultrasounds are not mandatory if there is no indication of a problem, however, I do prefer that you get an ultrasound around 20 weeks to rule out any fetal anomalies that would require a hospital birth or collaborative care with a medical provider. Other testing, like genetic testing, is optional.
We have a lot of pets in our home, is this a potential problem?
Depends. A home needs to be neat and tidy, and a woman should be aware of the risks of toxoplasmosis if she has cats. Generally if you had cats before pregnancy you are less likely to get toxoplasmosis, and toxoplasmosis can be acquired from other sources, but it's generally a good idea to err on the side of caution and avoid changing the litter box while pregnant. Litter boxes must also be kept very clean and changed regularly. Cats also should not be around if you are planning a waterbirth with an inflatable tub. Kitty claws and vinyl birthing tubs do not mix well. I have certainly attended my share of births where the woman was a pet owner so having pets in and of itself is not necessarily an issue. If you have dogs in particular, they may need to be put in a separate room for the labor and birth because dogs are generally protective of their owners and may not understand that I am just trying to help you, monitor the baby, etc.
What about my newborns birth certificate and social security card?
I will file your baby's birth certificate after the birth, about 8 weeks later you should receive the social security card in the mail. The state will not automatically mail the birth certificate, however you can & should order one online once you have received your baby's social security card. One can be ordered through the Texas Dept. of State Health Services Vital Statistics.