What is a licensed midwife?
An independent health care professional, a licensed midwife receives her training and experience through a three-year, post secondary midwifery education program or the equivalent thereof. To become licensed, a qualified candidate must pass a national certification exam administered jointly through the North American Registry of Midwives (NARM), and the Medical Board of California.
Why did you become a midwife?
During my pregnancies, I would often ask other mothers about their birthing experiences. To my surprise, their stories were most frequently “not positive”.
After the births of my two sons’, I felt a strong desire to find a way to help mothers/couples have better birth experiences. I started with education, then labor support in the hospital, which were good starts, but I felt like I couldn’t do enough. There was a controlling power that even the most assertive had difficulty not succumbing to the pressures imposed by a technocratic system. My plan to become a midwife was strongly influenced by what I saw and my desire to give women back their births and put the control in their hands. Now I am able to facilitate a gentle respectful birth experience for mother and baby.
How long have you been practicing and how many babies
have you delivered?
I have been working as a midwife since 1990 and have had my own practice since 1993. As a primary care provider I have caught (delivered) nearly 500 babies.
How often are visits scheduled?
Your initial visit is approximately one hour and includes medical and obstetrical history, physical exam and labs as appropriate. Regular prenatal visits are once a month until 28 weeks, then every other week until 36 weeks, then weekly until birth. Additional visits will be scheduled if indicated.
Between 35-38 weeks a visit in your home is scheduled for prenatal care, to meet others attending the birth, to check home supply readiness and to assure we know how to get to your place. At this time we review your birth plan, when and how to contact us when you are in labor, and discuss your specific desires for your birth.
A postpartum home visit the first few days after birth and follow up care at the office at 1-2 weeks, 4-6 weeks and 8-12 weeks are also provided for comprehensive care and guidance through this delicate time in your life. Newborn care is also provided at these times.
How is my baby monitored?
Prenatally with your permission we will use a Doppler until 20 weeks and thereafter a fetoscope. If you desire we will use the Doppler throughout your care. During labor it is more convenient for mother and midwife to use the Doppler. We will use a fetoscope if that is your preference as long as we can adequately hear your baby’s heart. This will take more cooperation on your part to move into positions that will enable us to hear your unborn baby’s heartbeat.
What prenatal testing do you recommend?
We will offer you all tests that are considered “standard of care” [recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM)] as well as those of the State of California. We will provide education on the various tests and screenings, so that you can make an informed choice. Some of these screens include:
• "Prenatal Panel" to show your complete blood count (CBC), blood type, Rh factor, antibodies, rubella, hepatitis B, and syphilis status
• HIV screening*
• Pap smear offered if indicated or requested
• Gonorrhea and Chlamydia screening*
• MSAFP *(Maternal Serum Alpha-fetoprotein) screening between 15 - 20 weeks of pregnancy
• Diabetes Screening Test* and Anemia screening between 26 and 28 weeks
• Group B Strep (GBS) screening at 36 weeks
• Ultrasound* (indications may be suspected twins, unknown date of last menstrual period or conception)
• Non-stress test (NST)*
• Biophysical Profile (BPP)*
* Indicates test is not routinely indicated. With the exception of the prenatal panel, other tests may be deferred or declined.
How do I get my lab work done?
We will collect your lab work in the office and the lab will pick it up for testing. The results will be sent directly to our office.
What method of childbirth education classes do you offer?
Our on-staff childbirth educator is ALACE certified. This 8-week course includes such topics as:
• The history of midwifery from as early as the 1400’s
• Birthing options
• Comparison of home, hospital and birth center settings
• Emotional and spiritual preparation
Also covered are the traditional topics covered in a good natural childbirth education class with an emphasis on home birth preparedness. Referrals to other methods are available in our office.
How many midwives are in the practice?
Birth Matters has always emphasized continuity of care. Michelle Freund is the midwife who will serve you in this practice. An experienced assistant will be present with her to assist her in assisting you during your birth.
What happens if two women are in labor at the same time?
Michelle has been attending births in the same community for such a long time and has a good professional and personal rapport with the midwives in her community. She has midwives that she will call to place on call for the families in her practice should the need arise. If this should happen, the assistant that you have become familiar with during your care will stay with you to provide emotional support, assistance and continuity of care.
Do I need to see a doctor during my pregnancy?
It is preferable and advised to see a physician who provides obstetrical care at least one time during your pregnancy. We hope that you will secure a collaborative relationship with this doctor so that if you should need physician care or hospital based medical care during your pregnancy, birth or postpartum, it is available to you by someone of your choosing. You may choose to do “ co-care” where you see the doctor and the midwife at their prospective offices throughout the course of your pregnancy. If your insurance is an HMO, it is wise to stay in contact with your assigned doctor where labs and other tests will be covered and in the case of a transport hospital based care.
What kind of labor complications have you handled?
In fourteen years of midwifery, I have encountered complications such as meconium, fetal distress, tight cord around the neck, shoulder dystocia, postpartum hemorrhage and respiratory distress, of which most have been successfully resolved at home without incident.
What type of emergency equipment do you carry?
Although used very infrequently, we carry similar equipment that you would find in a labor and delivery room at your local hospital with the exception of the continuously used fetal monitor machine. We intermittently monitor your baby’s heart rate with the use of a hand held Doppler. Approximately 10% of newborns will need some resuscitative measure. We discreetly set up all the necessary equipment needed to provide complete neonatal resuscitation, so in that rare event it is at our fingertips. We carry IV equipment and herbs for various uses and have at hand oxytocic medications, which we will use only in the case of excessive bleeding and after your baby has been born.
Do you carry pain medication?
We do not carry any pain medication that you would find in a hospital because their use does increase risk to you and your baby, which we are not willing to or authorized to use in a homebirth setting. However we do use a variety of traditional modalities such as herbal tinctures, raw herbs, homeopathy and essential oils. Our greatest traditional pain remedies are the tender loving care that you receive and hydrotherapy (use of water in labor).
When would you transport to the hospital?
Transports to the hospital are usually not an emergency. The most common reason for transport from home to hospital is lack of progress in a first time mom. This is after the midwife has done all that she can offer naturally and safely at home to help you progress. Other reasons for transport may include unresolved fetal distress, thick meconium with birth not eminent or excessive blood loss. Because mother and baby’s safety and well-being are of primary concern, when necessary we will not hesitate to transfer to a hospital. With this as our philosophy, we are pleased to be able to report a transport rate of less than 10% and less than 1% of these a true emergency.
What are your fees? When is payment due?
Does insurance or Medi-Cal cover your services?
Please contact our office at (760) 757-8650 regarding current fees. We accept cash payment plans to be paid in full by your 36th week and accept most insurance, which we will verify for you. Unfortunately, we are currently not able to accept Medi-Cal and are not covered on any HMO plans.
Are labs charges included in your fees?
All lab fees and other diagnostics such as ultrasounds, amniocentesis, non-stress testing, etc will be billed directly to you or your insurance and are not included in our fees.
What about water birth?
Water births are wonderful! They are extremely relaxing for mother and provide an unbelievable gentle transition into the world for baby. We are happy to assist you with a water birth and will help you with the additional preparations in planning for one.
How long will you stay after the birth?
We stay for at least two hours after mom and baby are stable. This means you and your baby will be evaluated for signs of wellbeing such as normal vital signs, normal amount of bleeding and uterine tone, breastfeeding established, healthy normal baby with normal respiratory effort and appropriate bonding.
Do you examine the baby?
We provide a complete newborn exam prior to our departure but ask that you bring your baby to a pediatrician or care provider of your choice within one week after the birth. Check with your care provider as to when they would like to evaluate your newborn.
What newborn procedures do you offer?
We offer routine antibiotic eye prophylaxis, which is an ointment used to prevent infection caused by bacteria in the birth canal. The law requires that we offer this treatment, which you may refuse. Another standard for newborn care is routine vitamin K. A small amount (0.5ml) is injected to prevent hemorrhagic disease, which is rare. An oral application may be substituted with advance notice. This is not considered standard of care however most pediatricians are not opposed to this route of delivery. At the home visit we will offer the Department of Health Services Newborn Screening Test, which is a heel stick for blood collection (also known as the PKU test). This is also a required test. If you choose not to have this test, you simply sign a waiver. Aside from hand-outs and discussions during your office visits, it is our hope that you will educate yourselves as much as possible to make informed decisions about your baby’s care.
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