Midwifery FAQ

What is the difference between a Licensed Midwife (LM) and a Certified Nurse Midwife (CNM)?

A Licensed Midwife (LM) is a healthcare professional licensed by the Washington State Department of Health. An LM must satisfy specific educational requirements and pass board exams administered by the North American Registry of Midwives (NARM). Licensed midwives practice natural home birth and birth center birth with uncomplicated pregnancies and no unnecessary intervention. Many LMs also carry a CPM (Certified Professional Midwife) credential, which is the international credential granted to midwives with knowledge and experience practicing out-of-hospital childbirth. A Certified Nurse Midwife (CNM) is a nurse who obtained further education in childbirth but not necessarily home birth. Although most CNMs work in hospital settings, some CNMs have chosen to serve home birth clients.

Why choose a midwife over an obstetrician?

Most obstetricians practice in a hospital-based setting. Their commitments typically allow them a small amount of time for each office visit. Many obstetricians also work in teams where the doctor on call varies depending on when you go into labor. These circumstances can make it difficult to create the relationship of trust between doctor and patient that is so important for a smooth and uninterrupted labor. You are likely to see an OB only at the very end of labor, but a midwife will be with you through the entire process – by phone, at home, or in our birth center.

What’s special about a midwife who is also a naturopathic doctor?

A naturopathic doctor can provide care above and beyond what a licensed midwife can offer. Do you have thyroid issues in your family or do you take thyroid medication? Your naturopathic doctor can monitor and make adjustments to your thyroid medication as your metabolism changes during pregnancy. Do you have a history of depression, anxiety, insomnia or digestive problems? Your naturopathic doctor has a wide range of natural treatment options available to you based on her extensive knowledge of the body in its pregnant and non-pregnant state. Your naturopathic doctor can also provide well-baby and child care, allowing you to continue with a practitioner you already know and trust. Naturopathic doctors in Washington are fully licensed, fully qualified Primary Care Physicians with the legal ability to monitor and prescribe medication, giving naturopathic midwives a scope of practice well beyond LM/CPM/CNM midwives.

What’s the difference between a birth doula and a midwife? Do I need both?

A midwife is focused on the health and safety of mother and baby, while a doula is focused on the comfort and well-being of the whole family. A midwife is medically responsible for the health and safety of mother and baby, just like a doctor. A doula focuses exclusively on physical and emotional support and usually comes to your home before a midwife to help support you and your family. Midwives and doulas love working together and women often choose to have both on their birthing team.

Do you offer water birth?

Yes! Our birth suites will have tubs specially selected for birth, and we have several birth tubs available for rent for our clients choosing a home birth. Birthing or laboring in water is fantastic for managing the intensity of labor contractions. Warm water soothes muscles and joints and buoyancy provides easier movement. Professional birth tubs provide much more room than a typical bathtub.

Am I a good candidate for a home birth?

Probably. More women discover every day just how safe home birth can be. The Centers for Disease Control published a study marking a 30% increase in home birth in the United States between 2003 and 2008 and a 2013 study noted caesarean outcomes for home births were one sixth as common as for hospital births without any additional risks to the baby. One of a midwife’s most important tasks is screening and monitoring her clients to ensure that only low-risk pregnancies are birthed at home. Most healthy women who do not have specific medical conditions can have a safe home birth. Only doctors and midwives have the training to determine if you’re a good candidate so be sure to consult with us or another licensed practitioner for the safety of you and your baby.

IS OUT-OF-HOSPITAL BIRTH SAFE?

Nothing is completely safe but it’s becoming increasingly clear that out-of-hospital births, when managed within a functional healthcare system, are overwhelmingly safe. A recent study by Oregon Health and Science University, the largest and most inclusive of its kind, concluded that even when midwives were unlicensed, bad outcomes for birth center babies occurred at roughly the same rate as hospital babies. Outcomes for mothers, on the other hand, were better at birth centers – a hospital mother was fifteen times as likely to be induced as a birth center mother and six times as likely to end up with a caesarean section. A similar Canadian study found no increase in adverse outcomes for home and birth-center births as compared to hospital births. Dr. Deborah has contributed to the MANA Stats project since she was a student so that the safety of home birth and birth center birth can be continually evaluated to improve birth for everyone regardless of where they choose to have their children. We cannot guarantee that nothing will go wrong with your birth, but we do everything we can to ensure that you and your baby are as safe as possible.

What type of safety and emergency equipment does my midwife have to monitor me and my baby?

Your midwife has all of the necessary equipment and supplies for normal childbirth, as well as the equipment and supplies necessary to manage an emergency. Regardless of whether you birth at our facility or at home, we have blood pressure cuffs and handheld dopplers to measure your blood pressure and the baby’s heart rate, pulse-ox meters to make sure baby is respirating well, intravenous fluids and antibiotics (if necessary), anesthetics and suturing materials in case you need stitches after the birth, several medications to stop excessive bleeding, oxygen for mom and baby, and tools to assess the health of baby when he/she arrives.

Why might I need to transfer to hospital care?

Our primary concern is the safety of you and your baby, and some labors and deliveries are safer in a hospital setting. Your birth must be managed in a hospital setting if you develop certain conditions during pregnancy. If your baby decides to come out feet first (a “breech birth”) you’ll need more medical protection than we can offer. If your baby decides to come out before 37 weeks she’ll need more intensive care than we can provide in a birth center. We want you to have a safe and healthy birth first and foremost and sometimes, your best bet is a hospital.

What if there are complications during or after the birth?

Complications during labor aren’t always emergencies. For example, if you develop a fever (we are concerned you or the baby may have an infection) we will go to the hospital and into the care of our backup obstetrician. The health and safety of you and your baby is of utmost importance to us, and although emergencies are rare we are always prepared to transport if needed. We create a transport plan in advance of your labor so we know who we will contact and under what circumstances. When we need to, we call 911 for fast transport to the nearest hospital while we handle the situation at home or at the birth center. We carry several types of equipment for emergency situations like oxygen, a bag and mask for the baby, medications to stop bleeding and IV equipment and fluids. All of the midwives and assistants in our practice are certified in CPR and neonatal resuscitation.

Can I use my health insurance?

Almost certainly! We will have a list of providers we’re contracted with available soon. Most PPO health insurance plans will cover a portion of home birth so check with your PPO’s customer service department. We have a medical insurance biller who can work with you to to determine your insurance company’s probable contribution towards your home birth and can handle all the paperwork. Washington Apple Health will cover birth center births for low income families.

What does a home birth cost? What about a birth center birth?

We bill on a sliding scale for families without insurance; check with us to see if we can accommodate your budget. We believe that all women deserve access to a midwife, so please contact us for payment options if you are concerned about cost.

How much do I save by signing up late in my pregnancy?

Nothing. Our first concern is ensuring that you can safely deliver a baby outside of a hospital and in order to do that we need to monitor your health carefully. We want to see you as early in your pregnancy as possible so that we can help guide your journey to motherhood and when you join us late, there’s much we don’t know. It doesn’t make sense for us to incentivize partial care. Look at it this way: the earlier you team up with us, the more care you receive!


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