Frequently Asked Questions

Is homebirth safe?

People from Holland, which has an abundance of educated midwives, 30-40% homebirths, much less infant mortality and 1/3 of our Cesarean rate, think Americans are pretty neurotic about birth and wonder why they are so frightened. The American approach to birth is pathological. A woman is more likely of being hurt or dying riding in a car than while giving birth. You routinely jump in your car assuming you will arrive at your destination safe and sound without much thought. Driving is like midwifery: Prudent drivers/midwives with safe habits and standards have much superior safety records than less careful drivers/midwives. Of course, women today have the ideal situation–access to professional homebirth and access to modern obstetrical units if necessary.

Remember that the majority of women gave birth at home up until 1940. Today, the majority of births in the world still occur in people's homes. Jimmy Carter was the first president to be born in a hospital!

What is labor? Labor is the work a woman does, with her unborn's help, to birth her baby. Labor is work. That is why we call it labor. The first phase of labor, when the cervix or mouth of the uterus is opening, requires breathing,relaxing and surrendering on the woman's part while the uterus is working. We often refer to contractions as "waves". Women are encouraged to follow the waves rhythm. Women often need support when labor goes up a notch to the next level of intensity until she gets used to the new level. The second phase of labor requires active pushing. The woman works with the contractions or waves of the uterus to push the baby down the birth canal and out into the world. The third phase includes parents falling in love with the baby and the woman birthing her placenta. The fourth phase is about relaxing and enjoying the wonder of the new baby and this new role of parenting a newborn.

How would I deal with labor discomfort at home? It is amazing how better women cope with labor discomfort in the comfort and privacy of their own home than in the hospital setting. Of course the women who choose homebirth are willing to do the hard work of labor. They don't have to deal with the stress of traveling to the hospital or the stressors within the hospital such as interacting with strangers, filling out forms, answering a deluge of questions or dealing with routine hospital procedures or policies. They are not encouraged to stay in bed and are not attached to a monitor afraid to move.

Women at home move freely. They are surrounded by people who care about them and believe in them. The midwife and assistant had normal unmedicated births and we believe in her. We know she can meet labor's challenges and come out victorious. The midwife and assistant bring a calming and reassuring presence. We talk to women softly and with encouragement. We adapt ourselves to work around her labor. We know normal labor is a healthy process that promotes a healthy mother and baby and strong bonding. We don't want to "save her from her labor". One of us is with the woman at all times (unless she wants to be alone). The midwife is present or immediately available in the home. Women know who will be with them at birth.

Many women use warm water tubs for strong labor. We carry herbs and homeopathic medicines if they are needed. Why do women fear labor so much? What is it about our society that women aren't empowered to trust themselves? Why are most of the babies in this country born drugged to one extent or another? Even with epidurals medications leak to the baby. We need to remember that women for thousands of years and whales, dolphins, horses, cows etc. labor intinctually without needing pharmaceuticals.

Labor is intense. Even easy labors are intense. Labor is supposed to be intense. The intensity causes a woman to find a safe spot removed from the activity of the world to labor. The intensity causes a woman to remove her senses from the distractions of the world and become more and more one-pointed and focused. The baby goes through a similar process. When the baby is born both the mother and baby (and father) are so present and focused that they are all wide open to bond with each other. Decreasing the intensity of a normal labor has harmful consequences. Nature did not design babies to slither out while you were asleep. Labor is supposed to be intense!

We do acknowledge that medications can be useful when women are very frightened. But why aren't women supported in coping with their fears prenatally? Of course medications can be very useful in abnormal labor situations.

Are Nurse-Midwives considered Obstetricians/Gynecologists or doctors? No. Nurse-Midwives are advanced practice registered nurses similar to Nurse-Practitioners. All Ob/Gyns are physicians and surgeons. Ob/Gyns specialize in the diagnosis and treatment of complicated pregnancies and gynecologic disease. Treatment is usually by pharmaceutical medications or surgery. Only physicians perform Cesarean Sections, forceps deliveries and treat serious gynecologic problems such as cancer. Only physicians care for women with serious obstetrical complications.

Nurse-Midwives, especially in homebirth practices, specialize in the holistic care of the well-pregnancy and well-gynecology. We focus on improving your health on all levels and on preventing complications whenever possible. We are educated in the recognition of complications, treatment of common complications, and providing emergency care when necessary. You will be referred to an obstetrician if needed.

What does a Certified Nurse-Midwife have to offer? Certified Nurse- Midwives are considered the most highly educated midwives in the U.S. and probably the world. They are the most well researched midwives and practice in hospitals, birth centers, medical offices and the home. They are respected professionals that work in corporations and government hospitals. CNMs are the only midwives that meet all the following criteria: are first R.N.s, graduate from accredited nurse-midwifery schools, have supervised clinical experience, meet core competencies, adhere to national standards, are nationally certified and are legal in all fifty states. They are the only type of midwives endorsed by the American College of Obstetricians and Gynecologists.

What unique characteristics does your practice offer? I am experienced with home and hospital births. I have been a professional lecturer for RNs, was at the forefront of waterbirth education in the US and have decades of background in holistic health and healing. I have a beautiful office suite attached to my home in Grass Valley and an office in a professional building in Auburn that I share with an acupuncturist. I bring a trained birth assistant to all births (usually an RN) and carry extensive & excellent equipment to all births.

What are your safety standards? We screen out women with serious medical problems or drug abuse issues. We offer state of the art prenatal care and access to all diagnostic testing parents desire. We do births within 30 minutes of a hospital and bring a trained birth assistant to all births. I carry excellent equipment and know how to use it. I have years of hospital experience with intravenous insertions, resuscitation, anticipating and detecting complications etc. I have done presentations to local paramedics to enhance the smoothness of transports. I have an excellent reputation with local doctors and the nursing community. I keep up to date with the latest advances. I am current in CPR, neonatal resuscitation and fetal heart rate monitoring.

What are average hospital transport rates? Average labor transport rates for nurse-midwives is 15%. An average transport rate reflects adhering to general safety standards. Abnormally low transport rates are associated with higher rates of serious or critical transports and poorer outcomes in general.

Are Nurse-Midwives doulas? All midwives and birth assistants are also doulas since we are experts in supporting laboring women and their families. The continuous presence of a woman with a woman in labor has been shown to decrease Cesareans and interventions. Women have been supporting women through birth for thousands of years. "Doulas" are trained to emotionally support women in labor, birth and postpartum. D.O.N.A. (Doulas of North America) certified doulas have taken 10 hours of doula instruction; doulas are not educated to provide clinical services or give clinical advice.

We know any woman having her first baby in the hospital is greatly benefited by having a doula. In homebirth the midwife is present continously or immediately available in active labor and a trained birth assistant is also present for the birth so some women don't feel the need for additional support. If women desire even more support and can afford a doula they are a welcome addition to any birth experience. We love working with doulas! Most doulas meet with you several times before and after the birth. They have the advantage of giving you their undivided attention since they don't have clinical responsibilities as the midwife and birth assistant do.

What medical/midwifery equipment do you carry? I carry extensive and excellent equipment. To every birth we bring a portable ultrasonic digital Doppler Fetal Heart Rate Monitor (no belts or attachements to laboring woman). We can monitor your baby's heart rate every beat if necessary in labor. Your unborn baby's heart rate is monitored according to national standards. We also always have a birthing chair, oxygen tanks, resuscitation equipment, blood pressure equipment, suctioning equipment, emergency medications, intravenous supplies, blood sugar testing supplies, herbs, homeopathic birth medicines, etc. Through years of hospital experience I am comfortable with emergency procedures such as intravenous (IV) starts and newborn resuscitation though they are not commonly needed. We can monitor your baby's heart rate every beat if necessary in labor. Your unborn baby's heart tones are monitored according to national standards.

Is ultrasound or sonograms safe? Ultrasound exams of the baby are considered safe by most medical experts. Doppler ultrasound is known to be stronger ultrasonic waves. There may be more subtle side effects of ultrasound that have not been discovered yet. Dolphins use sonic waves to interact with the ocean environment and have been known to detect diseases in humans. All our clients read and sign information that routine ultrasounds have advantages and disadvantages. We offer non-ultrasonic fetoscope (old fashioned stethoscopes to hear baby's heartrates) for women who wish to avoid ultrasonic exposure to their infants during prenatal care. Families can choose not to have ultrasounds during their pregnancy.

What do you do if there are complications? Please realize that midwifery care is focused on preventing complications whenever possible. Midwives promote good nutrition, excellent prenatal care and healthy lifestyles. Nurse-midwifery care has been shown to decrease preterm labor rates. When complications are detected, a nurse-midwife’s actions depend on the type of complication and the situation. We attempt to reverse complications whenever possible. Many complications can be detected during good prenatal care such as breech presentations, toxemia or preeclampsia, twins, placenta previa (the placenta coming before the baby) and premature labor. Women with these complications are referred for physician-hospital care.

Many common labor and birth complications can be dealt with in the In-Home Birth Center such as dehydration requiring intravenous fluids, the common umbilical cord around the baby’s neck, meconium-stained fluid, a baby’s delayed breathing, afterbirth bleeding etc. Serious unsuspected complications occur in the lowest percentage in healthy women with healthy pregnancies; the incidence is about 1% according to the American College of Nurse-Midwives. Women are transferred to medical care with appropriate emergency measures if these complications occur.

Is it safer to have my first baby in a hospital? It is well-known that women having their first child in a hospital suffer the most unnecessary interventions and have an excessively high rate of preventable Cesarean sections. It is known that first time pregnancies tend to go to 41 weeks gestation compared to 40 weeks for woman with subsequent pregnancies. This fact isn't calculated into most practitioner's decisions regarding inductions of first time labors. Artificial inductions of labor and having labor sped up with artificial hormones are disturbingly frequent. Inductions, since they are more painful and stressful, lead to more use of narcotics and anesthesia. All this contributes to higher cesarean rates. Women will have greater success in having a normal birth in the comfort of their own home with equipped and knowledgeable attendants.

I am Rh negative blood, is this a problem? No, we offer you 28 week Rhogam injections and post-birth baby's cord blood testing for blood type and Rhogam if the baby is a positive blood type.

Do you test for Group Beta Strep? We recommend testing for this bacteria at 36 weeks per the Center for Disease (CDC) guidelines. Women who test positive are counselled about the current CDC's recommendations to prevent their newborn from becoming ill. We offer the standard antibiotic prophylaxis and also an herbal program. Most clients prefer to test but can refuse the test with written informed refusal if they choose.

What if my baby is breech or I have twins? Breech babies are only 3-4% of pregnancies at term. I begin to determine the unborn baby’s position about 3 months before your due date and watch this at every visit. If a baby persists in being breech there are many alternative ways to encourage him/her to turn head down. If these methods are not successful a woman can have an obstetrician turn the baby through her abdomen so that a In-Home birth may proceed. If the baby is not successfully turned, I refer women for hospital birth since breech babies have a higher rate of complications. I have physician referrals who will consider doing vaginal breeches for women in the hospital if they meet certain safety criteria. I also refer women with twins to an obstetrician since twins have higher rates of prematurity and other complications.

Do you believe all women should give birth at home? No. Only women who are essentially healthy carrying an essentially normal pregnancy should give birth at home. These women ideally should not smoke (or be willing to cut down dramatically) and eat a healthy diet. In addition, families that choose an In-Home Birth Center birth must be reasonably stable and have sufficient social support available. Families who desire homebirth also need to be willing to educate themselves and make the numerous decisions that need to be made during pregnancy, birth and afterwards in caring for a newborn. Women with serious heart disease, insulin dependent diabetes, twins, breech babies, previous Cesareans etc. are usually safer in a hospital according to currently accepted national guidelines. We also follow the guideline that client's give birth within 30 minutes of a hospital.

What happens if I am transported to a hospital in labor? If you are transported I will call the labor/delivery area and give report to the charge nurse. I may call the physician on-call and give him/her report or I may give it to them at the hospital. I give the hospital a copy of your chart. I transfer your care to the physician and remain with you as a labor support person and a technical consultant. Having worked in hospitals for many years and being familar with all the technology of hospital birth, I can help guide you through the decisions you will need to make at the hospital.

Can I have an In-Home Birth Center Birth in an apartment? An apartment is usually a more than adequate place to give birth. Hot water, heat and electricity are usually basic necessities for homebirth but we have done births in yurts and domes without all the usual basics.

Is giving birth at home really messy? Usually birth at home has less blood loss than hospital births since episiotomies (vaginal surgical incisions) are rarely done; episiotomies lead to extra blood loss. The birth place and your bed are specially prepared and protected. Linens are laundered quickly to remove any soiling. We rarely get blood on the carpeting but hydrogen peroxide removes any small blood spots out of carpeting.

What happens to the placenta (afterbirth)? The placenta was made, just like your baby, from the union of the woman's egg and the father’s sperm. The placenta is truly a biological engineering feat that helped create and support your baby’s life. Most parents bury their child’s afterbirth in a garden with a special "birth plant" to grow as the baby grows. This plant is a reminder of the very special day that your child came into this world. Occasionally a family disposes of the placenta in a plastic bag in the trash. When I was a young nurse, hospitals gave placentas to cosmetic companies to put in highly desired commercial shampoos in the US until the AIDS epidemic.

What if the weather is bad? I have an All-Wheel drive SUV that I take to all births. I have photos of me pulling into the driveway of one laboring family during a serious snowstorm. The county came and plowed the road since they knew a woman was laboring during the storm. If someone’s home has poor bad weather access we make an alternative plan for a birthplace in case of bad weather.

What if two women are in labor at the same time? Usually a qualified birth assistant would be sent to stay with the woman less active. When we are approaching a busy time I will ask another midwife and assistant to be available whenever possible. We could also, if needed, make two separate birthing rooms at our office suite to accomodate both families.

What if you are sick or out of town when I go into labor? I was paged once to a laboring woman about five minutes after I fractured my kneecap in a mountain bike accident. I wrapped my knee in an ace bandage and attended to her for eleven hours. It would have to be a very serious illness for me not to be able to attend your birth. I would call another midwife to serve you or you could choose to go to the hospital. When I commit to being your midwife I plan to be available for approximately three weeks before and two weeks after your due date.

How do you plan your vacations? I usually plan vacations when no one is due; occasionally, I have another midwife cover me for vacations. You will be aware if I ever have another midwife covering me around your due date, you will get to meet her in advance and be in agreement with the plan.

What if I don't have a good home to give birth? Some families who don't feel their home is appropriate for homebirth because of various circumstances may give birth at our GV office which was designed to be converted into a birthing room if needed. We charge a service fee to use our office as your birthing place. You can have a birth tub in our birth room as well.

What if I had a previous Cesarean? With Cesarean sections now at 27% or greater the issue of Vaginal Birth After a Cesarean (VBAC) is of growing interest. VBACs were on the rise but have fallen to only 10.6% in 2003 compared to 31% in 1998. Physicians saw an increase in uterine ruptures with attempted VBACs due to a variety of reasons including the recent one layer surgical repair of the uterus that has become popular especially in busy hospitals (previously the uterus was always sutured in two layers); the use of prostaglandins for induction; the use of Pitocin for induction etc. With this increase rupture rate associated with technologic interventions the American College of OB/Gyns now only recommend VBACs in large medical centers where a Cesarean can be performed very quickly. Most community hospitals can not do a Cesarean very quickly; doctors may not be in-hospital when needed.

A recent report of VBACs in freestanding birth centers with CNMs showed some problems with ruptures as well. There have been incidences of ruptures also in home births though the incident is very low. The American College of Nurse-Midwives does not support out-of-hospital VBACs any longer. Unfortunately, women often are only offered repeat Cesareans in the smaller hospitals and some hospitals aren’t very VBAC supportive even if they are offered. We believe women expecting their first child should consider homebirth to prevent unnecessary Cesareans in the first place.

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