midwifelove.com
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  • Dec13

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    Midwife Love’s Informed Disclosure

    Questions you should consider when choosing your prenatal care and birth attendant. If someone doesn’t know their rates, they either do not want to divulge or don’t care about their outcome statistics. These statistics for Midwife Love reflect her 103 births from 2010-2013.  Previously she attended 544 births in Miami. Total births attended: 647

      • What is your c-section rate? What have been the reasons?

        My medically indicated c-section rate was only 8% and primary c/sec rate 8%, Reasons: maternal high blood pressure during labor, breech baby, transverse baby, failure to progress and non-reassuring fetal heart tones. My elective c/s rate was 1% or 1 client. At 42.5 weeks she chose a c/section and refused induction. Compare that to local hospitals who report close to 40% c/section rates.

          • How do you feel about episiotomies? When are they needed?

            I think they are unnecessary and lead to greater tearing. My episiotomy rate was 0%. I teach my clients perineal massage techniques and pushing methods to help avoid tearing. Natural tearing requires fewer stitches and heals quicker than episiotomies. Moms remaining completely intact, needing not even 1 stitch after birth, my rate is 51%.First time moms: intact rate: 44%.

              • How long should my pregnancy continue? When do you usually induce?

                Your baby and body will decide how long your pregnancy goes. Most first time moms go 7-10 days past their due date. At 2 weeks post due date, we can discuss natural labor induction techniques you can do for yourself, but it is your choice whether to use them. I can continue taking care of you for as long as you need.

                  • What is the normal postpartum visit schedule? Do you include the PKU test

                    I like to do a home visit around day 2 postpartum and offer you the PKU test for your baby then. I then see you and offer lactation support back in my office, 3 weeks, and 6 week and additionally if necessary.

                      • Are labs drawn on premises or do I go elsewhere?

                        Labs are drawn by me in my office for your convenience.

                          • What is your transfer to the hospital rate? What have been the reasons?

                            My intrapartum transfer rate was 11%. My pregnancy pre-labor transfer rate was 6%. Reasons included high blood pressure, failure to progress, 1 request for an epidural, non-reassuring fetal heart tones, and 2 breeches, 1 in which I arranged a referral to a doctor colleague of mine who does vaginal breech births. My postpartum transfer rate was 2%.

                              • How many births have you attended? How long have you been in practice? In what environments have you practiced?

                                In my 9 years as a midwife I have caught 647 babies, and attended many more births. In my 5 prior years as a nurse, I attended thousands of hospital births, and caught a couple of babies that came quicker than the docs. I worked at several large hospitals, including Jackson MemoriaI, a tertiary hospital with a lot of high risk patients, including an ICU for pregnant women. I practiced 5 years at a busy birth center in Miami, where we did 30-40 births a month. I have been attending home births on the Treasure Coast since 2010.

                                  • If I need a prescription drug during my pregnancy or birth, or birth control later, do you provide that?

                                    Yes. Nurse practitioners can prescribe medications. I do not offer epidurals or narcotics during labor. I have extensive training in contraception, IUD insertion, and gynecology when needed for your annual gyn exams & Paps for years to come.

                                      • How do you feel about waterbirth?

                                        Laboring in water helps relax muscles, minds, and ease discomforts. It allows for easy and gentle movements which facilitate labor. I recommend water to be available for comfort for all my clients. 72% of my clients have birthed in the water, which is a gentle transition for baby, and helps decrease perineal tears in mom.

                                          • What is your VBAC success rate? 92% have had a VBAC,73% at home, 1 had a transfer after 4 days of labor and needed some pitocin, 1 requested an epidural, 1 had a baby with transverse lie and had a repeat c/s.
                                          1. Dec17

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                                            I have been doing a lot of reading and thinking lately about the “sacred hour after birth”. I have had the privilege of seeing a baby born quietly, maybe with a final groan from momma bear. Momma catching her breath after doing some powerful work during labor, and baby slowly opening eyes to peek at this new world. I try to remain silent, observing this beautiful, instinctual dance of discovery between momma, baby, & poppa. Most of us lead hurried lives, full of technology, screens, beeps, chatter. These first moments with your baby are powerful and timeless. They should be respected, and not interrupted for routine procedures. The umbilical cord is still pumping oxygen rich blood to the baby, full of magical stem cells, iron, and minerals. Some cords pulsate for 20 minutes. I observe, but don’t do much during this time. The hat can wait….momma still needs to stroke that wet hair. The weight can weight, as can the facebook updates, and the calls to friends and families. This hour is sacred. Keeping baby skin to skin encourages breastfeeding reflexes. Momma instinctively touches baby, lightly stroking fingers, toes, hair. Baby nestles on mommas chest, listening to her familiar heartbeat and feeling her warmth. This is the best place to be.

                                          2. Apr24

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                                            I’ve had tons of people ask me similar questions, so I thought I’d address them here in the blog.

                                            Here are the Frequently Asked Questions (FAQs) I’ve been getting recently. Feel free to comment and dialogue with me about these issues.

                                            What are some benefits of waterbirth?

                                            Laboring in the tub helps most women relax. They love the warm water and floating with no gravity. Being in warm water helps the perineal tissues relax, so you are less likely to tear and need stitches. Water birth is also a gentle transition for the baby. The baby is in warm water in the uterus, and comes out into welcoming warm water- which is a smoother transition than the cold air in a hospital room and a smack on the bottom.

                                            What are the different kinds of midwives in Florida?

                                            There are 2 types of midwives in Florida. The licensed midwife studied for at least 3 years in an approved school, took a national certification exam, and practices midwifery mainly in birth centers and homebirths. They are well versed in natural herbs, vitamins, and homeopathics but cannot write prescriptions, do gynecology past 6 weeks postpartum, or deliver babies in hospitals.

                                            The certified nurse midwife in Florida is licensed as a nurse practitioner and does write prescriptions, do gynecology, and most nurse midwives work in hospitals. Almost 20% of the babies born in Florida are delivered by nurse-midwives. I graduated from the University of Miami as a nurse-midwife, but then worked among licensed midwives for 5 years at a busy birthing center in Miami, Florida. The licensed midwives taught me so much about herbs, homeopathics, and other natural remedies. I taught them a bit about conventional Western medicine and obstetrics.

                                            I feel I’ve got the best of both worlds: the knowledge about less invasive therapies and treatments perfected over millennium by ancient healers and an in-depth knowledge of advanced pharmacological drugs that usually work quickly and efficiently. I worked as an insider in hospitals for 5 years, and then outside of the hospital since 2004. I know and understand both systems and can help my clients navigate all options so they can determine what meets their needs the best.

                                            What is your philosophy of midwifery care for pregnancy and birth?

                                            I advocate for informed choice, shared decision-making, and the right to self-determination. Too often health care providers in many disciplines, not just obstetrics, seem to believe that there is only 1 right way to treat a condition. If all they see is a diagnosis, they tell a client what to do with little input from the client herself. I think this is the wrong approach. People have different backgrounds, cultural differences, spiritual beliefs, economic realities, and family support systems that influence their decisions.

                                            I try to respect every human being as the ultimate guardian of their own health. Some people may make health care decisions different than ones I would make, but that’s ok. Their path is different than mine, and I’m sure we are each learning different lessons. My job is to present options, realistic risks and benefits of the different options, answer questions, and then let the client choose what is best for her particular situation. I value the empowerment that women have when taking charge of their own health, pregnancy, and birth.

                                            I feel that pregnancy, birth, and menopause are normal, physiologic and developmental processes that can have a profound spiritual impact. Women who have felt powerless in their birth choices can feel traumatized, and this can lead to postpartum depression and poor maternal-child bonding. There are support groups for women who feel traumatized by their c-section or by uncaring providers in the hospital. On the bright side, many women report feeling incredibly powerful after birthing naturally and feel ready to conquer the world and achieve their dreams. I want to help women have the option of homebirth and waterbirth.

                                            I realize that some women have a lot of fear about birth and are terrified of birthing without drugs or birthing outside of a hospital. I respect them and hope they have good experiences that lessen their fears. If any of you feel this way about birth, I recommend “Birthing From Within” and some hypnosis sessions before you give birth, and finding a midwife in the hospital who is gentle and respects your wishes.

                                            But I also know that natural birth can be an orgasmic, primal, tender, gentle, noisy, silent, meditative process that teaches a woman a lot about herself, her partner, and the divine connection between all of us. I think women should have options available about where they can birth, how they can birth, and with whom can they birth.

                                            How much does home birth cost in Florida?

                                            Florida has great laws that state that women in Florida have the right to choose where they would like to give birth. All insurance companies in Florida must reimburse for homebirth, birthing center, or hospital birth. By law, they must pay midwives in Florida for their services. If you have insurance and are interested to know what your deductible or co-pay would be for a homebirth, call me for a free consultation at 772-766-LOVE (5683)

                                            A typical homebirth on the Treasure Coast or Space Coast may cost $5000 which usually includes lab work, prenatal checkups, the labor and birth, and postpartum care for 6 weeks after the birth. Most midwives are available 24/7 for telephone consults and usually enjoy long, leisurely prenatal visits where all concerns are addressed. Lactation support postpartum is provided and essential to getting a good start nursing. Most midwives offer to all clients a type of “concierge medicine” where clients are treated like VIPs and have their midwife’s cell phone number.

                                            Compare this to typical Ob/Gyn doctors who rush through appointments like Jiffy Lube to maximize profits or pay off expensive school loans. Typical pregnancy visits with doctors like that might be 15 minutes with the medical assistant who checks your belly and hears the baby’s heartbeat, and 5 minutes with a hurried doctor who tells you everything’s fine and rushes out before the questions can come. I’m not inventing this; ask your friends how long were most of their visits during pregnancy if you don’t believe me. I’m not trying to say all doctors are bad. There are the good and bad doctors just like there are good and bad midwives. But the way our profit-driven medical system is set up does not provide for long visits, preventative care, nutritional counseling, or discussions of your emotional or spiritual health. Most docs focus on treating problems if they arise, but do little to tell you how to prevent them.

                                            If you choose a hospital birth and have no insurance, you have to pay a fee to the doctor who cares for you during pregnancy and birth, a fee to the hospital, a fee to the pediatrician, a fee for the anesthesiologist, etc. The more interventions they do to you, the more money they can charge.

                                            Ricki Lake did a great documentary about profit-driven American obstetrics in her 2007 film “The Business of Being Born” in which she shows her homebirth in her bathtub.

                                            I’ve done some research of prices here in Central Florida, on the Treasure Coast, and the Space Coast regarding the cost of hospital birth. Typical vaginal births run around $10,000-16,000. Remember that most hospitals have a c-section rate of at least 35%, so your chances are 1 in 3 of getting a much higher bill of $20,000-30,000 for a c-section. Don’t worry though because you won’t have to pay it all upfront, but you will be paying for awhile or it can ruin your credit.

                                            Most homebirth midwives have a transfer rate of less than 15%, while my transfer rate was less than 8% last year. You increase your chances of having a significantly smaller bill by choosing to birth naturally instead of relying on expensive technology. Some people might say that cost shouldn’t be a factor when choosing how to birth, but I’m being realistic. Finances are a factor in our lives. It’s better to be upfront about potential financial hurdles. The United States pays almost double what other developed countries do for its maternity care because we’re doing so many interventions and c-sections. However, that doesn’t lead to better outcomes. In the latest study, we ranked 30th in infant mortality. So 29 countries in the world did better than us, including the Netherlands where midwives deliver most of the babies, and about 50% are born at home.