My Services: What You Can Expect

At Midwife and Doulas Services I pay strict attention to the physical aspects of pregnancy as well as to the emotional and social needs of women. Priority is given to the involvement of the family, continuity of care and to preventative measures such as nutrition and breastfeeding. The women receiving my services exercise greater responsibility and participation in their care, which is conducive to safe, healthy and enjoyable childbearing. You may elect midwifery care, doula services, or a combination of both.

My Services Include:

• A free introductory consultation to determine appropriateness of midwifery care.
• Comprehensive maternity care, including services for mothers carrying twins.
• Diet evaluation and nutrition education.
• Support during and evaluation of the progress of labor and birth.
• Waterbirth option.
• Breastfeeding counseling during the postpartum period.
• Home visits for postpartum care, if indicated.
• Six week postpartum examination.
• Obstetric and pediatric consultation and referrals when appropriate.
• Birthing From Within childbirth education classes.
• Well woman care and family planning.
• Extensive educational video and book lending library.

 

Frequently Asked Questions:

What are the advantages of home birth over hospital birth? Are home births safe? Have you ever lost a mother or baby at a home birth? How do you help women at home manage their pain? Is pain medication available to your home birth patients? What do people who have home births do about the mess? How do you feel about children attending births? What sort of training does a midwife have? How often do midwives transfer women to the hospital? Under what circumstances do you transfer? What happens when you transfer? Who is your medical consultant? What hospital do you use? What supplies and equipment do you bring? What medications do you bring? What do we have to do to get ready? What supplies? When do I start coming to you, & do you do prenatal care? Do you recommend childbirth education classes? How do feel about episiotomy and do you do them?

Q: What are the advantages of home birth over hospital birth? A: Staying in your own home environment when labor is at its strongest is a system that takes your needs into consideration.  Being where you feel the most comfortable and safe (and for most people this is the home) is good for labor.  You have access to your own food, bathroom, family, music, etc., to name a few.  When I come into your home, the dynamic of health care provider/patient shifts to one of mutual responsibility. Back to top

Q: Are home births safe? A: There is no evidence in the medical literature to support the notion that hospital birth is safer than homebirth for low risk women.  Women should birth where they feel safest and most private.  If you don't feel safe giving birth at home then another setting is best for you.  The most important decision you make is your choice of provider.  If you feel safe with that person and believe you will be listened to and your birth vision honored, then where you have your baby is secondary. Back to top

Q: Have you ever lost a mother or a baby at a home birth? A: No, I have not.  And I hope to keep it that way.  The art and science of safe birth is to screen and intervene long before a problem becomes life threatening.  While there are no guarantees in hospital or at home, my commitment to you is to give you 100% of my attention to your birth.  Back to top

Q: How do you help women at home manage their pain? A: Because the home setting is less fearful and more familiar, coping techniques under stressful times are easier to access.  Because you feel freer to express what is happening to you, it is much easier to use alternate comfort measures effectively.  These include simple movement and frequent position change, massage, water (tub or shower), heat, ice, herbs, homeopathy and sometimes acupuncture and hypnotherapy.  One of the most important comfort measures is positive support from the people attending you.   Back to top

Q: Is pain medication available to your home birth patients? A: I do not use pain medication in the home.  When using drugs that can affect the fetus, it is important to be able to monitor the baby with an electronic fetal monitor in a more ‘continuous’ manor and the time honored safety rule for homebirth is:  if you need a fetal monitor to make an assessment then you shouldn’t be delivering at home. Back to top

Q: What do people who have home births do about the mess? A: When I go to your home I make a concerted effort to clean up as I go along.  When I leave a birth, all the laundry is in one bag and the garbage is in another.  I don’t clean your house, but I do try to leave it the way it was when I arrived. Back to top

Q: How do you feel about children attending births? A: Children rarely pose a problem at a birth.  If you have other children, you will need someone familiar to be responsible for them just as you would if you were going to the hospital.  You know your children best and should take their emotional and developmental stage into consideration as well as your needs.  With another responsible adult to care for them, they can be removed with gentle, loving, explanations (or diversions!) if necessary.  You also need to be free from taking care of them when your labor is strong.  The advantage of birth in the home for small children is that you are not taken away from them and it is easier to view the newest competitor for your attention as a normal addition to family life. Back to top

Q: What sort of training does a midwife have? A: To be licensed in Iowa, Midwives need an RN or bachelors of science degree and go on to study midwifery. Midwifery education includes an academic portion and a clinical portion in which the student midwife is supervised attending many births and complications, usually in a hospital setting. Many midwives have Masters Degrees. The ability to attend home births usually follows at least a one year stint in a hospital setting (given that more complications are seen and dealt with there).  Back to top

Q: How often do midwives transfer women to the hospital? A: On average about 5%-10% of women who begin labor at home are transferred to the hospital, usually for failure to progress. Rarely does transfer occur for emergency complications. Back to top

Q: Under what circumstances do you transfer? A: Certain events are better managed in the hospital than at home. Examples are: decelerations in the fetal heart rate, high blood pressure or fever, abnormal vaginal bleeding, or thick meconium. The most common reason to transfer is failure to progress in prolonged labors. Back to top

Q: What happens when you transfer? A: I discuss the need for transfer with the parents. After getting agreement, we call the physician on-call at a local hospital to inform him/her of the need for transfer. Then we all go to the hospital. In an emergency, such as hemorrhage, an ambulance may be called. I no longer maintain admitting privileges at a hospital, so if we have to transfer to a hospital I will stay with you as your support person, until your baby is born Back to top

Q: Who is your medical consultant? What hospital do you use? A: I do not have and am not required to have a 'contractual arrangement' with a designated consulting physician or group.  I have relationships with a number of physicians in the Des Moines community.  I prefer to transfer to Iowa Methodist Medical Center - reflecting my comfort level after attending births for 12 years in that facility.   I can use different hospitals. Sometimes, depending on the circumstances, we will go to the nearest hospital and work with the obstetrician on call. Back to top

Q: What supplies and equipment do you bring? A: I bring :  · Doppler & fetuscope for monitoring the fetal heart rate.  · Blood pressure cuff.  · Oxygen for the mother or the baby.   · Resuscitation equipment for the baby.   · Medications to stop maternal hemorrhage.  · Suture material and numbing medication should you need stitches.  · IV equipment and IV antibiotics  · Herbal or homeopathic remedies Back to top

Q: What medications do you bring? A: Those needed to stop maternal hemorrhage. I do not bring pain relief medications such as those that are offered in a hospital because a baby needs to be continually (electronically) monitored while the mother is taking that medication. Continual external fetal monitoring is not offered at home. I do offer alternative methods of pain relief if possible such as hydro therapy, massage or position changes. Back to top

Q: What do we have to do to get ready? What supplies? A: You should either gather a list of supplies that we will give you or simply buy a birth kit with all of the supplies already enclosed. The cost is about $50. It can be purchased on line or by phone.  Back to top

Q: When do I start coming to you, & do you do prenatal care? A: I do prenatal care and you can come to us as soon as you learn you are pregnant. I also offer pre-pregnancy counseling as well as the full spectrum of well woman care, such as pap smears, family planning services. Back to top

Q: Do you recommend childbirth education classes? A: Yes, most people that attend childbirth education classes are less anxious when they have more information. Having a homebirth requires a commitment to be informed and good childbirth education is an important part of this, expecially for first time parents.  I highly recommend Amy Murphy's class, "Beforeandafterthebirth.org." Back to top

Q: How do feel about episiotomy and do you do them? A: Midwives like to help babies out with slow head deliveries, giving the skin time to stretch over baby's head. If an episiotomy is necessary to facilitate the birth, it may be done. Back to top

 

My typical midwifery prenatal schedule involves hour-long appointments at the following times

• Pre-conception, if possible
• As soon as you know you are pregnant --Plan to visit with us for a couple of hours at this visit
• Every 3 weeks until the 8th month
• Every 2 weeks during the 8th month
• Every week during the 9th month

Client Fees

My "global" midwifery fee covers prenatal care, care during labor and delivery, a home visit and a six week postpartum office visit. Although you won't find Midwife and Doula Services, LLC on your HMO or PPO's list of participating clinics, most major insurance companies cover midwifery services-- typically at a reduced "out-of-network provider" rate. Your lab charges, as well as physician charges, if needed, are additional and usually covered by insurance plans even if you choose an out-of-network provider. More information about insurance plans, managed care, and our approach to maternity services can be found here.

Midwifery care through Midwife and Doula Services, LLC is a relationship and experience well worth the investment. I can design a payment plan that best suits your needs.

Doula fees are separate and may be reimbursable through your medical flexible spending account. Please contact your plan administrator for details