GENERAL QUESTIONS 

Q:  Are birth center and home births safe?

A:  Several studies have researched the issue of the safety of out-of-hospital birth in various countries around the world.  The best research continues to show that out-of-hospital birth for women with low-risk healthy pregnancies, attended by a qualified birth attendant, is no more risky than birth in the hospital.  Not only that, but in the U.S., women choosing out-of-hospital birth with a midwife have far fewer interventions during their labor, birth and immediate postpartum period, contributing to easier healing, breastfeeding and bonding with their new babies.

Out-of-hospital birth with midwives is quite common for low-risk women in many other industrialized countries (Canada, UK, Australia, New Zealand, most Scandinavian countries, the Netherlands, Japan, the list goes on), and the safety of out-of-hospital birth with midwives is well established and accepted.  In fact, in the UK there is a push to get low-risk women out of the hospital and have their babies at home or in birth centers with midwives because the obstetricians are recognized as specialists in high-risk pregnancies.  US obstetricians are trained as high-risk providers too, but our culture values high-risk specialists caring for low-risk women.  Midwives are trained much more extensively in normal pregnancy and birth than obstetricians are and are often considered to be the "experts" in normal birth.

An important study was published in June 2005 in the British Medical Journal regarding the safety of out-of-hospital birth with Certified Professional Midwives in the U.S. and Canada:

"Outcomes of planned home births with certified professional midwives: large prospective study in North America"  Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager.  BMJ  2005;330:1416 (18 June)

Conclusions:  Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Click here for more research on the safety of home birth.

Q:  What are the advantages of birth center and home birth over hospital birth?

A: Women choose to have their babies at out-of-hospital for various reasons, but some of the most common reasons we hear are the following:

• desire for a natural birth
• more control and choice in who is there, where to labor, what position to labor in, whether to eat and drink, etc.
• security and comfort of birth center suite or own home
• less anxiety and stress
• immediate close contact with the new baby
• not attached to machines and IV poles
• greater sense of being able to let labor to progress naturally
• fewer interventions like epidurals, episiotomies, forceps/ vacuums, and unnecessary IVs
• lower risk of having an unnecessary cesarean
• more family unity
• lower cost
• less exposure to hospital bacteria and other germs
• higher satisfaction level

Q:  What equipment do the midwives have at the birth center or bring to my home for the birth?

A:  The equipment and supplies at every birth, whether at birth center or home, is listed below:

• sterile instruments for the birth and cutting the umbilical cord
• an oxygen tank and resuscitation bag/ masks for mother and newborn
• a suction device for removing mucus and other material from the baby's nose and mouth
• a Doppler for listening to the baby's heart rate during labor and pushing
• equipment to monitor mother’s vital signs during labor
• drugs for preventing or stopping the mother from bleeding too much after the birth
• IV equipment and fluids for rehydration of the mother, and if necessary, to administer antibiotics
• Vitamin K and eye ointment for the newborn
  
  
  

Q:  What if something happens during labor?

A:  About 90% of the time, there are warning signs that occur before a problem develops that allow plenty of time for good decision-making and non-urgent transport to the hospital in your own car.  Midwives are extensively trained in recognizing the warning signs that tell us that labor has gone outside of what is normal.  Not every problem requires a trip to the hospital; sometimes, just a change in the mother's position or rehydration solves the problem.  Issues requiring a hospital transfer most often happen during labor, but can sometimes come up in the first few hours after the birth as well.  The most common reasons for going to the hospital during labor include:

• maternal exhaustion and/or request for pain relief (this is more common in first-time mothers with very long labors)
• the cervix isn't dilating properly (often due to the baby's head being turned in an uneven position)
• the baby's heartbeat is indicating that the baby is stressed for some reason

There is a small percentage of emergencies that require a call to 911 and urgent transport to the hospital.  In very rare cases, a serious problem can occur that has no warnings signs at all, such as a tear in a blood vessel in the baby's umbilical cord or a blood clot in the mother's lung.  In these extremely unusual situations, the mother or baby would need immediate care or equipment that would not be available in the home setting. Being in the hospital is no guarantee that the mother's or baby's life would be saved either - often there is nothing that can be done in these situations - but emergency personnel and equipment are more likely to be available there.  It is important for families considering home birth to be willing to accept these risks.

In the period right after the baby is born, there may be problems in either the mother or the baby that could require a trip to the hospital. A few mothers have trouble with too much bleeding or the placenta doesn't come out as it should.  The midwives are able to administer various drugs that are meant to stop excessive bleeding.  Sometimes more extensive measures must be taken, and about 2% of mothers require a hospital transport.  These issues are more likely to be urgent transfers.  The most common problem with newborn babies is difficulty breathing correctly, and about 1.5% of babies need to go to the hospital within the first few hours after birth for evaluation by a pediatrician.

Q:  What are some reasons why I wouldn't be able to have a birth center or home birth?

A:  Most women with low-risk, healthy pregnancies can have a home birth.  Risk criteria vary from state to state, but in most places, a woman is no longer considered to be "low-risk" if any of the following occurrences happen in the prenatal period, during labor, or immediately postpartum:

• the mother has any abnormal bleeding
• the mother is Rh-negative and has become sensitized to Rh-positive antigens
• the mother has high blood pressure requiring medication
• the mother has pre-existing diabetes (this is different from "gestational diabetes")
• the mother has heart, kidney or lung disease
• the mother is a heavy alcohol or drug user (or anyone else in the home that may be considered a risk to the midwife or emergency personnel during labor, birth and the immediate postpartum)
• the mother develops pre-eclampsia
• labor begins before 36 weeks of pregnancy
• the pregnancy continues longer than 42 weeks
• the mother has severe anemia
• the baby's umbilical cord prolapses when the water breaks
• the baby's heartbeat indicates that it is distressed
• the mother has a postpartum hemorrhage
• the mother has a severe tear that requires additional instruments, skill, or anesthesia to repair properly
• the newborn has problems such as infection, respiratory distress, or severe hypoglycemia

If you have a question about whether you are a good candidate for a birth center or home birth, please contact us.

Q:  This is my first baby.  Is birth center or home birth right for me?

A: Sure!  If you are having a low-risk, healthy pregnancy, it doesn't matter whether you are having your first baby or your tenth.  If you meet the following criteria, then you are probably eligible for a home birth:

• Is in good physical and mental health
• Has good nutritional status
• Has adequate social support before, during and after birth
• Is socially mature and able to accept responsibility for birth outcome
• Has a positive emotional environment
• Has access to pregnancy, childbirth, and breastfeeding education (books, classes)
• Has access to emergency transportation
• (For home birth) Has a clean home and birthing room, with electricity, running water and a working telephone
• Understands that technological intervention is used only when necessary
• Understands that pain medication will not be used during labor
• Agrees to transfer to the hospital during labor, birth or postpartum, if necessary

There are many first-time moms having beautiful births with Wenatchee Midwife Service. If you are interested in learning more, please contact us.


Q:  Is waterbirth safe?

A:  There have been over 100,000 babies born in the water reported worldwide, and the research into the safety of waterbirth is still being done.  The main challenge in doing research on waterbirth is that women typically choose whether to labor and birth their babies in the water, just like women choose home birth, and it is often difficult to know if women who choose waterbirth are different from women who choose other methods of birth in ways that can affect the research outcomes (i.e., they may be in general older, having their second or third babies instead of their first, are better educated about birth, have better nutrition, fewer smokers, etc.).  These factors can overlap each other and make it difficult to see whether the outcomes are better or worse because of those things or because of the fact that they were in the water.  So researchers are still conducting studies to pin down whether there are any differences in outcomes between babies born in water and babies born on land.

Many clients choose to have a waterbirth.  Some mothers find that they just like to labor in the water because it seems to make the contractions much easier to handle.  The midwife can monitor the baby's heartbeat regularly in the water with a special waterproof Doppler.  If you choose to have your baby in the water, the midwife will help you to bring your baby up out of the water and gently into your arms within a few seconds after s/he comes out.  Until babies come in contact with air, they receive all of their oxygen through the umbilical cord, just like they do throughout the entire pregnancy.  For a great explanation of how this amazing process works in the newborn and why they don't inhale water when they are born, see "What Prevents Baby From Breathing Underwater" by Barbara Harper.

Q:  What is the difference between nurse-midwives and licensed midwives?

A:  A Certified Nurse-Midwife (CNM) is a person who has been educated both in the discipline of nursing and in the discipline of midwifery.  A CNM's education is accredited through the American College of Nurse-Midwives and the birth experience is primarily in a hospital setting.  They must pass a national exam in order to become certified and then are legal and eligible to become licensed in all 50 states.  Most CNMs work in hospitals.

A licensed midwife, or direct entry midwife, is educated in the discipline of midwifery in a program or path that does not also require her to become educated as a nurse.  Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing.  A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Under the umbrella of "direct-entry midwife" are several types of midwives:

• A Licensed Midwife (LM) is a midwife who is licensed to practice in Washington.  Currently, licensure for direct-entry midwives is available in 24 states, including Oregon and Washington.
• A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care.  The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.
• The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

Laurie Braunstein & Dzhan McCaslin are both Licensed Midwives (LM), trained at Seattle Midwifery School, licensed by Washington State, and certified by NARM as Certified Professional Midwives (CPM).

Q:  Where are you located, and is there parking?

A: The office is located at 310 S Mission Street, in Wenatchee, WA. If you enter the alley behind the office, there is a parking lot available for your convenience.  For more extensive directions, click on Map/Directions.

Q:  Do you charge for a midwifery consultation?

A: No. The consultation visit is free. The purpose is for you to get to know the midwives, have a tour of the birth center, and ask questions to help decide whether working with Wenatchee Midwife Service is right for you.

Q:  Are you covered by my insurance?

A: Most insurance companies, including Medicaid, cover the care provided by Wenatchee Midwife Service. The midwives are in-network providers with most insurance companies and can determine the specifics of your coverage by sending a copy of your insurance card to the billing company. If your coverage has a large deductible or does not cover some aspect of midwifery care, an estimation of your out-of-pocket expenses can be determined.  For clients choosing to pay out-of-pocket, discounts may apply for early payment. 

Feel free to contact the midwives with any further questions!