What is a midwife?

Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, resulting in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. Many midwives also provide preconception care and routine well-body reproductive care throughout the life cycle.

The Midwifery Model of Care is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Our model of care includes:

• Monitoring the physical, psychological and social well-being of the birthing parent throughout the childbearing cycle

• Providing the birth parent and family with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support

• Striking the balance between unnecessary and necessary medical intervention.

What are the benefits of homebirth?

The latest research on planned home birth, released in 2014 by the Midwives Alliance of North America (MANA), found that among 17,000 families:

• Better outcomes for babies: 97% of babies were carried to full-term, and weighed an average of eight pounds at birth. Only 1% of babies were transferred to the hospital after birth, most for non-urgent conditions.

• Low rates of intervention: Only 4.5% of the 17,000 study participants required oxytocin augmentation and/or epidural analgesia. This is much lower than average for the United States, where 26% have oxytocin augmentation and 67% have epidurals.

• Low rates of cesarean birth: The 2014 MANA study also found that of the 17,000 planned home births, only 5.7% ended up birthing their babies via cesarean. This is compared to the national average of approximately 31% for full-term pregnancies.

• High VBAC success rate: For low-risk individuals, the chance of having a vaginal birth after cesarean ranges from 68-87% when birthing outside the hospital.

Other benefits of choosing home birth with midwives:

• Individualized care: All decisions about your care are made together with you. We will have thorough conversation about your needs, preferences, and values, your individual health, and the evidence regarding the options available to you. We respect you as the expert of your own body and your baby's primary care provider.

• Continuity of care: Your midwife will follow you throughout the course of your prenatal, birth, and postpartum care. At every point in your parenting journey, you will see the familiar, comfortable, friendly face of your very own midwife.

• Evidence-based care: We stay current on the research around pregnancy, birth, postpartum, and breastfeeding so that we can provide up-to-date information to assist you in your decision-making.

• Your own environment: For many families, the comfort and security of your own home cannot be matched. You choose who attends your birth and who cares for you. You choose what to eat and drink. Walk, dance or sleep uninterrupted - it's your birth!

• Incredible postpartum care: From the first minutes of your baby's life to your six week postpartum checkup, Refuge Midwifery provides attentive, personal support and education necessary for your baby's growth, help your family bond with your newborn, develop long-lasting breastfeeding or chestfeeding relationships, and heal your body in the postpartum.

Is homebirth safe?

Homebirth is a safe option for those whose pregnancies are without complications, are full-term at the start of labor, and when monitored and attended by professional midwives. For some babies and parents who are at higher risk for complications, a hospital birth is a safer option. To learn more about the safety of home birth, check out these studies:

• Outcomes of planned homebirth with CPMs in North America

• Outcomes of planned homebirth after regulation in British Columbia.

Can I have a water birth?

Yes! Waterbirth is a lovely option for those who desire it.  Many families choose to have birth tubs for comfort in labor, regardless of whether the family plans to have the baby in or out of the water. 

Can I have a VBAC (Vaginal Birth After Cesarean)?

It is an option! Trying for a home VBAC has a high success rate - up to 87% - but there are some additional risks during labor, and some people are better candidates for home VBAC than others. The risk of uterine rupture is 0.2% if you have had one prior c-section, have waited at least one year to be pregnant after a cesarean, and have a low transverse incision.

Of course each scenario is different and we can talk more about your personal history during a consultation.

What equipment do you bring with you to births?

So much stuff! Our equipment includes:

• Fetal heart rate doppler, blood pressure cuff and stethoscope, thermometer, and infant stethoscope.

• Supplies for the newborn exam and any newborn procedures that you choose, including a scale, measuring tape, erythromycin ointment, vitamin K, and pulse oximeter.

• Antihemorrhagic drugs (Pitocin, Misoprostal, Methergine, and TXA) to treat excessive postpartum bleeding.

• IV fluids to manage dehydration and for antibiotics in labor if that is what has been chosen

• Resuscitation equipment for baby and birth parent: a bag and mask resuscitator and oxygen.

What do you do after the baby is born?

While every birth is a little different (depending on if you, your partner, your child, or your midwife catches your baby), at a typical birth we will wait for you to take your baby and bring them onto your stomach or chest, and we will keep a close eye on your bleeding and your baby's adjustment to life outside the womb. After the placenta is born and the baby's cord is done pulsing, we ask you if you are ready to cut the cord and who is going to be the one to do it, and we help clamp and cut the cord. Then we give you some space for family time, staying close by with an ear out for your needs and checking on you periodically. Whenever your baby is interested in nursing, we offer help with positioning and latch if you would like it. After a thorough newborn exam when your family is feeling comfortable and ready for a nap and we’re satisfied that you and baby are healthy and stable, we leave. Then I will return in about 24-36 hours for your first postpartum visit.

What happens if something goes wrong?

Safety starts before labor begins.

All of your prenatal care is an ongoing assessment for the safety of home birth. The are conditions that can come up prenatally that change the planned place of delivery.

When labor starts at home, we’re starting at a very low risk place. There are very few complications that arise without some sort of risk factor or warning.

Some of the more common complications that we can resolve at home are a malpostioned baby (sunnyside up babies), postpartum bleeding that needs medication to resolve, a shoulder dystocia that happens after an otherwise normal labor, or a resuscitation for the baby.

While midwives are trained to handle these complications, my goal is to encounter as few emergencies as possible. I aim to transfer to the hospital when risk factors arise, rather than transfer when it’s become an emergency.

What about the mess?

We aim to leave the house as clean as it was when we arrived! During your pregnancy I will give you a link to a website where you will order a "birth kit" which includes all the disposable supplies for your birth. Many of these supplies are meant to keep your house clean during the birth. While you have family bonding time with your new baby, we quietly tidy up.

Do I need to see a doctor for my prenatal care?

Most of the time, no. There are some instances where your preferred back-up hospital will need to keep you in care in order to be available for a transfer, or for your insurance to cover a hospital delivery.

There are some circumstances where you can stay in midwifery care, but we like to have the collaboration of a hospital based provider (like gestational diabetes or anemia that needs to be corrected with iron infusions). We have our preferred back-up hospitals but will of course go wherever the client prefers.

How much does it cost? 

Cedar Birth and Baby offers a sliding scale to cater to our diverse community of clients. Fees for full midwifery care are on a sliding scale from $4500-5200. 

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What is Sliding Scale?

A sliding scale allows families to pay for services based on their income and financial situation. This system helps make midwifery care more accessible to a wider range of people, including those with limited financial resources. You will select your care fee in the range of $4500-5200. Care is the same for all families, no matter what they select for their care fee and no income verification is required. Full payment is due by 34 weeks. 

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Are there additional costs outside of your fee?

There are a few expenses which are not included in the fee. 

• Lab work or an ultrasound.

  • I am contracted with Quest Labs and provide labs at very reasonable rates!

  • Ultrasound will be billed by the place of service.

• Birth supplies to gather for your birth.  We will provide you with a list of these items.. The cost of the kit is $50-135 depending on your needs. 

• Rhogam

• Vitamin K Injection

• Birth Pool Rental

• Recommended supplements, herbs and teas

• Referrals to other health care providers

Does insurance cover midwifery?

I have had good luck with HSA, FSA and Health Share accounts, but private insurance is more complicated.

It’s best to plan for the fee to be an out of pocket expense. Some insurance policies with decent out-of-network coverage are the most consistent with reimbursements for midwifery services, but many insurance companies won’t cover Certified Professional Midwife attended births. I have a relationship with a third party biller, that specializes in home birth and out of hospital midwifery care. She can complete a verification of benefits and help submit a superbill at the completion of care.

You will pay for your care in full by 34 weeks. Any reimbursement provided by insurance will be handled by you/the biller and sent directly to you. Usually this is months after care is complete.