Frequently Asked Questions For Midwives
When we meet with couples exploring birthing options we cover the most frequently asked questions. This entails the style of care we offer and scope of practice we provide. We’ve compiled a list of questions to ask a midwife, with answers, to help parents find the best fit for their care!
Why birth with a midwife?
We midwives know that you’ll always remember the day that you gave birth to your baby. Understandably it’s an innate and integral part of your life, and your baby’s life. It’s the first time you will feel their tiny feet cupped in your hand, and first time you cuddle your baby’s soft head and look into his eyes.
Next, we feel the birth of your baby is an experience unlike any other. Not to be hurried, or stressed with intervention. Midwives value the spiritual, & human aspect of birth so that you don’t have to sacrifice the special moments or safety. Lastly, you choose a midwife to help you have the birth you envision, with those you feel most comfortable.
Who are good candidates for home birth?
The good news is that the majority of women are good candidates for home birth! Midwives care for low-risk women, who are living a healthy lifestyle, free of chronic health conditions. Our focus is on the prevention of problems through nutritional support, exercise, while utilizing both natural and allopathic resources. Statistically when women receive holistic care that begins with the first visit, and continues throughout pregnancy -with one on one care, they have healthier outcomes. We offer a consultation screening, to help ensure that this would be a safe option for you and your baby.
What happens if I become high risk?
Sometimes a woman can start out pregnancy as low risk, and then develop a condition that would make for a referral or transfer of care. In addition, this warrants necessity to see a physician. The following conditions tend to be rare, but hold necessity; placenta previa (placenta covering cervical opening), uncontrolled gestational diabetes, to much or to little amniotic fluid, or IUGR (Intrauterine Growth Restriction) lack of fetal growth. Also genetic anomalies detected with baby, Pre-eclampsia or Pregnancy Induced Hypertension(PIH), or Intrahepatic Cholestasis of Pregnancy(ICP). Moreover, when conditions like this occur the safest option would be to deliver in the hospital under physician care.
Do you attend vaginal birth after cesarean (VBAC), Breech, and Twin birth?
Yes we do, however you must be a good candidate, healthy, with a thorough assessment of your medical history. With each situation we go through and evaluate the inherent risks. In addition we discuss the need of ongoing assessments and required referrals needed to move forward. We agree to a care plan, as well as provide informed consent covering possible risks. My experience with each situation is vast, and Im happy to set up a consultation to answer any questions that you may have regarding your care in particular.
VBAC –We do offer midwifery care, and informed choice of vbac birth, with prior low-transverse cesarean section. For VBAC education & research go to the following links:
-Fraternal Twins
- Another helpful source https://vbacfacts.com/
- Also, you can benefit by signing up for online classes on vbac.
Breech Birth –We do offer midwifery care, and informed choice of breech birth. First this is with frank and complete breech presentation. For more information and research on outcomes of out-of-hospital breech birth go to Breech birth at home: a new study of safety outcomes.
Twins –We do offer midwifery care, and informed choice of vaginal twins. We encourage you to explore your options, gather information, education- research on natural twin birth, https://www.twinstuff.com/natural-twin-birth/
or read further information at this link; https://indiebirth.org/case-vaginal-twin-home-birth-cassie-snyder/
You have questions on breech or twin birth: Call Direct 469-961-9933
Do you have a high hospital transport rate?
This is our thoughts about transport: If during the course of labor, you or your babies health is at risk, and it’s more intervention than we can offer, then it’s off to the hospital where you need to be for a safe birth.
According to a study the most common indication for transfer was labour dystocia, occurring in 5.1% to 9.8% of all women planning for home births. Transfer for fetal distress varied from 1.0% to 3.6%, postpartum hemorrhage from 0% to 0.2% and infant respiratory problems 0.3% to 1.4%.
You see midwives are the guardians of the natural process, and when something is not right they have a duty to look out for you. This is not a failure on anyones part, midwifery or yours, rather it’s just us dealing with circumstance. Sometimes a transport is necessary even when we as a team have done everything in our power to get you closer to your goal of giving birth. Our commitment is to support you through this process either by your side advising or helping you by tele-health.
You know what they say about the power of suggestion, you can follow it with a positive result, or maybe not. On average when mothers commit to a healthy lifestyle in pregnancy, and doing what it takes to have an out of hospital birth by following care recommendations, and instruction that we offer then more have positive home birth experiences. More often it’s having evidence based practice, wisdom shared, tricks of the trade, but remember we can’t want this natural birth more than you!
What are some reasons for transfer?
Maternal exhaustion is big, and can cause a mothers birth plans to change. A study found that labor fatigue is a frequent cause of physical and mental discomfort, increasing the likelihood of medical interventions such as instrumental delivery and cesarean section. This is why we advise through the process, giving suggestions to conserve energy to gain progress. If we see you not handling labor well, and your body is not getting closer to giving birth, it may be in your best interest to explore options for pain relief. This may warrant a trip to the hospital. It’s always in your best interest to explore coping techniques and natural relief options first, but not suffering in vein.
We midwives know normal, and the difference, and want you to have fond memories. A study found that labor fatigue is a frequent cause of physical and mental discomfort, increasing the likelihood of medical interventions such as instrumental delivery and cesarean section. If needed, I hear from experience, the hospital of choice for non emergency transports is Baylor University Medical Center in Dallas. However when it’s emergent -transports go by ambulance to the nearest hospital with a labor and delivery department..
Is having a birthing center birth safer than a home birth?
To have an out-of-hospital birth, in your own home is as safe as, or safer than, a hospital birth for the majority of women. A study on maternal outcomes with birth interventions https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext
It’s a common misconception that birthing centers are safer than home births. A place of birth can change proximity to a hospital, as with home versus a birthing center. Currently Texas law requires birth centers to be within a max of 30 minutes from the nearest hospital that has a labor and delivery department. In addition most home births fall into that same distance category, unless you live further. Birth equipment, medications are the same, making home birth a viable option. I have prior experience where I co-directed a family birthing center. For home birth, our team has safety equipment and medications that we would have had access to at a birth center.
- Oxygen, resuscitation equipment- Current CPR, Neonatal Resuscitation-NRP
- IV fluids fluid for hemorrhage- antibiotics for Group B strep
- Postpartum hemorrhage medication
- Suture equipment & supplies-numbing agent
- Herbal, homeopathic medicine, essential oils
How long can I go past my estimated due date?
On average, most labors will start spontaneously before 41.3, or 10 days past due date. In our experience over the years, pregnancies rarely went past 42 weeks. If you have prior birth history of longer gestation, there are natural options that we suggest after 36 weeks. Importantly they often help bring labor and baby closer to 41 weeks. If we are nearing 42.0 weeks, we discuss options and you can choose the path forward.
The licensing laws that govern our scope of practice recently changed in 2019 to say that after 42.0 weeks a client must have appropriate prenatal testing to ensure a healthy pregnancy, in order to continue forward. Keep in mind checking in on baby is for safety. To meet this requirement you would need an ultrasound called a Bio Physical Profile (BPP), or a Non Stress Test(NST). Both we can order for you to be seen, or you can be transferred for labor induction.
What is required of practicing midwives with continuing education?
The Texas State license renewal requires 20 CEU hours per cycle. Typically we accrue around 40+ hours of continuing education hours each term. This is similar to the 25 hours needed for national certification as well. Each may be achieved with, in-person classes, workshops, and online courses. Continuing education is important for midwives, with records kept for each renewal. We are evidence based providers and to do so, we follow current research, with CEU courses.
Charlotte believes in taking workshops where hands on skills are practiced regularly, such as CPR, Neonatal Resuscitation, fetal heart auscultation. In fact given her years of practice achieved, teaching breech skill workshops, this helps to instill necessary maneuvers -for when they are needed. Even after 30 years of managing complications in out of hospital settings, her continuing education is still ongoing!
Attending peer review regularly keeps a balance with accountability, and adds value to our profession, yes we attend regularly. This is a requirement for national certification, but not for state licensure. Midwives are encouraged to review difficult cases, and fetal loss with peers. Again this is to evaluate assessments and decision making skills, and determine if they were appropriate.
Can I decline having lab work or sonograms?
As midwives we feel every woman should have choice, however to determine a mother to be low risk you will need assessments, and this is for your maternal and fetal wellbeing and safety. I like to keep lab work and ultrasound to the minimum, unless otherwise warranted with a condition to look into. The use of sonogram can be tricky, for some just figuring out the estimated due date during the first trimester, or a concern of spot bleeding we can order a sonogram.
We require a sonogram at 20 weeks called an anatomy scan, to determine everything is well. This detailed scan will assess fetal growth matching size for dates, placenta placement, amniotic fluid level, and checking development as normal. Some labs we have informed choice consent/refusal where you have a choice on how to perform the test, such as gestational diabetes screening, and Group B strep screening. As a licensed midwives we practice safely and within the scope of law, and this state requires specific testing, such as HIV, Syphilis and Hep B in the first and third trimester, or at the onset of labor.
Will you be at my birth?
Labor can be tricky, and on rare occasion you may have a precipitous fast birth. If your labor is picking up, be assured we are on our way. Or if we know you live in close proximity to another midwife we may call her to head your way, as we are en route. Yes we make every effort to have your birth attended!
In practice, we can limit the number of births we have each month, but we can not predict when each mother goes into labor. In the case of two overlapping mothers in labor, as well as unexpected emergencies, or illnesses we will send another midwife with a similar style of practice. It’s common for us to work well together, as we typically assist at each others births. Our midwifery community is more of a sisterhood, who are willing to back each other when needed.
How much are your fee’s, and will insurance cover it?
A breakdown of fees, payment plan schedules, and insurance reimbursement questions are covered during consultation, not posted online. You will be expected to prepay your birth fee, upfront -during pregnancy. After full dates of service, with insurance you can opt for a billing service with self fee, or we can provide you with a coded receipt at postpartum completion. Patient reimbursement comes directly to you, not the midwife attendant.
What is included in your fee?
- Routine Labs
- Regular prenatal/postpartum appointments.
- Medications for hemorrhage- suture supply/oxygen.
- Labor & birth with immediate – postpartum care.
- Payment of second midwife- birth assistant w/vertex singleton.
- Heated water birth tubs for loan- based upon availability(5)
What is not included in the fee?
- Non routine labs
- Ultrasound/BPP
- Prescriptive medication
- RhoGam (Rh- mothers)
- Visits to other provider
- Hospital bills/transfer fee
- Prenatal Genetic Screening- they direct bill insurance
- Payment of second midwife- as assistant w/breech, twins
- Custom birth supply kits, florals, personal essential oil kits
- Non disposable supply-towels, sheets- waterproof mattress protector
- Private doula support services.
Questions For A Midwife
Call Midwife Charlotte Sanchez To Have Your Questions Answered. She Currently Serves Families Near DFW Metroplex: Dallas, Allen, Frisco, Plano, McKinney, Little Elm, Lewisville, Addison, Farmers Branch, Carrollton, Richardson, The Colony and More!