FAQs

Is this a safe way to have my baby?

So far, the largest and most complete study on the comparison of hospital birth outcomes to that of homebirth outcomes was done by Dr. Lewis Mehl and associates in 1976. In the study, 1046 homebirths were compared with 1046 hospital births of equivalent populations in the United States. For each home-birth patient, a hospital-birth patient was matched for age, length of gestation, parity (number of pregnancies), risk factor score, education and socio-economic status, race, presentation of the baby and individual major risk factors. The homebirth population also had trained attendants and prenatal care.

The results of this study showed a three times greater likelihood of cesarean operation if a woman gave birth in a hospital instead of at home with the hospital standing by. The hospital population revealed twenty times more use of forceps, twice as much use of oxytocin to accelerate or induce labor, greater incidence of episiotomy (while at the same time having more severe tears in need of major repair). The hospital group showed six times more infant distress in labor, five times more cases of maternal high blood pressure, and three times greater incidence of postpartum hemorrhage. There was four times more infection among the newborn; three times more babies that needed help to begin breathing. While the hospital group had thirty cases of birth injuries, including skull fractures, facial nerve palsies, brachial nerve injuries and severe cephalohematomas, there were no such injuries at home.

The infant death rate of the study was low in both cases and essentially the same. There were no maternal deaths for either home or hospital. The main differences were in the significant improvement of the mother’s and baby’s health if the couple planned a homebirth, and this was true despite the fact that the homebirth statistics of the study included those who began labor at home but ultimately needed to be transferred to the hospital.

Dr. Lewis Mehl, “Home Birth Versus Hospital Birth: Comparisons of Outcomes of Matched Populations.” Presented on October 20, 1976 before the 104th annual meeting of the American Public Health Association. For further information contact the Institute for Childbirth and Family Research, 2522 Dana St., Suite 201, Berkeley, CA 94704

Do you do waterbirths?

We are frequently asked if we will do a birth in the water. In fact, it turns out that a lot of our birthing moms choose to give birth in the water.

See our page on waterbirths.

How much will it cost?

CDM services are among the most affordable professional services available for Alaska’s childbearing families and are covered by medical insurance. Because Cesarean section rates are extremely low with Alaskan CDMs and the mothers and babies are so healthy, there are many long-term savings as well for this model of maternity care. Please contact us for exact fee information.

Will my insurance cover this?

Most likely, YES. Licensed midwives are covered by all Alaska- based insurance companies. Many out of state policies also provide coverage for midwifery services. There are, however, numerous plans within each company, so it’s always best to call and check. For clients that are not insured we are happy to set up payment plans to suit your needs. If you are not insured and would like some tips on what insurance plans cover maternity care and midwives, give us a call or contact us via email. (*Note: You can acquire medical insurance once you are pregnant and still have the pregnancy covered).

We accept Denali Kid Care.

What if I am “high risk?” How is that determined?

Midwives will do an initial risk screening at your first consultation, and continue throughout your prenatal appointments. If there is any indication of a risk factor, they will refer you to a physician for evaluation. The midwives together with the physician will determine whether you can stay in Midwifery care or transfer to another care provider.

This is my first baby, so am I at risk for out-of-hospital delivery? What if the baby won’t fit through my pelvis?

Many first time mothers choose to have out of hospital delivery and are not considered a risk. Very rarely will a baby grow to big for the mother’s pelvis. No one can tell for sure if a baby can fit through the pelvis until there has been given an cide quafe trial of labor. Many a woman has been told her pelvis is too small, only to give birth vaginally. If you were told early in pregnancy that your pelvis is too small or “borderline”, rest assured that in the last weeks of pregnancy a hormone called relaxin will go to work, softening the joints and ligaments, making your pelvis roomier. For this reason, midwives will often postpone pelvimetry, (the internal measuring of the pelvis) until late in pregnancy.

Can my children be present for the birth?

Midwives encourage family-centered birth. Many families wish to have siblings involved in the prenatal care and plan to have them present for the birth. Others desire their children to be supervised close by and to be brought in immediately following delivery. Education is a priority in midwifery care, and your midwives can help facilitate preparation of siblings; offering classes, videos and books, and recommendations for appropriate age involvement.

I had toxemia with my first baby. What if I get it again?

Midwives believe toxemia to be a result of nutritional deficiency. Our approach is one of nutritional counseling, guidance, prevention and prenatal screening. We are vigilant with our care to be sure you stay under low risk parameters. Toxemia is less prevalent with subsequent pregnancies. If you do become high risk, appropriate medical consultation or referral will be arranged.

Do Midwives have backup arrangements with a doctor?

Midwives are independent practitioners and are not required to have formal back up. Midwives do all of your prenatal care, delivery and postpartum care, including lab work. ordering prenatal garments and ultrasounds. However, we do have access to doctors. If your midwives refer you to a doctor, or if you would like to see a doctor during your pregnancy, midwives can make the arrangements for a doctor to see you.

What if I need a cesarean section or have to go to the hospital?

The genuine need for a cesarean section is lower, statistically, than you may realize, especially in the population of low risk mothers who qualify for out of hospital delivery. However, if you fail to progress in labor, develop complications, or if your baby shows any signs of fetal distress you may need hospital assistance, intervention or surgical birth, not available in a birth center or home setting. In this case, your midwife will accompany you to the hospital with your records.

What do midwives carry for emergencies?

Midwives carry an array of equipment and supplies. The following is a list of the emergency items available for out of hospital delivery: medical oxygen (2 tanks minimum), infant and adult resuscitation equipment, IV equipment. Antihemorrhagic medications (in the case of postpartum hemorrhage), mucous traps for suctioning the newborn and suturing equipment.

What if I have twins?

If your midwife discovers twins, you will be referred to a physician for a hospital delivery, as twins are considered a higher risk. Twins are usually diagnosed early in pregnancy.

What if my baby is breech?

It is quite common for babies to be breech during pregnancy. They usually settle into a head down position by 32-36 weeks. If your baby is breech, your midwife will recommend several exercise techniques to facilitate the baby into a head down position. Persistent breeches are referred to an obstetrician who can usually turn the baby by performing a “version” under ultrasound. If all attempts to turn the breech fails, a hospital birth is indicated and your midwives will work with to make the appropriate transfer-of-care arrangements.

How can you tell if the baby is in the correct position?

Midwives have been trained to use their hands in order to feel for the baby’s position. This is an acquired art that has been all but lost to modern technology. If there is any question to the position of the baby late in pregnancy, an ultrasound will be ordered.

What if the cord is around the baby’s neck?

One-third of all babies have the cord around their neck at birth. The midwife does one of the following:

a. allows it to remain, as long as it isn’t too tight b. slips the cord over the baby’s head c. clamps the cord in two places and cuts between the clamps to release the tightly wound cord.

The average cord length is twenty inches or longer, and is often wrapped around the baby. This is rarely a problem. The midwife will be listening to the baby’s heart with a doppler or fetascope to be sure the baby’s condition remains stable.

I am concerned about blood loss.

Midwives carry antihemorrhagic medications and medical oxygen and are trained to handle emergencies. Prevention and vigilance are the midwives approach. Many carry an array of herbs and homeopathic remedies for use in pregnancy and in labor and delivery.

What can you give me for pain?

Midwives do not carry pain-relieving medication other than natural remedies. Education about the birth process and coping techniques are taught prenatally. The fact that midwives remain with their clients throughout labor and delivery, offering emotional support and minimizing fear, helps alleviate pain. Also, midwives are very skilled in offering alternatives such as positioning, massage, showers and warm baths, (see waterbirth ) to name a few.

What if I need an episiotomy or stitches?

Midwives are trained to perform episiotomy when necessary. More desirable is the assistance of a midwife to prevent episiotomy or tearing. Midwives are skilled in suturing, and carry appropriate equipment and local anesthetic for repair of episiotomy or tear.

What about after I have my baby?

Midwifery care includes close follow up care for mothers and their babies through six weeks postpartum, including a home visit when the baby is 24 hours old, and a 3 day mother and baby checkup. At that time, an appropriate schedule is developed to meet the needs of mother and baby.