Frequently Asked Questions
Often it is hard to know what questions to ask a home birth midwife when you are inquiring about services offered. Following is a list of frequently asked questions with answers specific to my practice. Feel free to also use this as a guide when interviewing other home birth midwives!
What does prenatal care look like? Schedule? Location?
I have an office in Southampton on the East End of the South Fork of Long Island. I predominantly work in Eastern Suffolk but have travelled further. I see clients in the office setting throughout the pregnancy but also include one in-home visit at or around 36 weeks with your chosen team (partner, doula, family members who you plan to have present in your birthing time). My assistant Noelle comes to this appointment so that you are able to meet her prior to your birth.
A typical schedule of care follows the standards of what is provided in any obstetrical setting but also I will tailor a schedule to accommodate an individual client’s needs. The typical schedule is monthly visits in the first and second trimester, followed by two week intervals starting at 26-28 weeks until 36 weeks, when I will see you weekly until delivery.
What screening/testing/ultrasounds do you offer?
I perform all labs in my office including blood work (routine labs, genetic screening and all indicated labs based upon your clinical story) and swabs. I do not perform ultrasounds in my office. Ultrasounds are obtained via referral (I provide the referral and subsequently receive a faxed report) to a location of your choosing, however I prefer that clients obtain their ultrasounds at Stony Brook locations (Hampton Bays, Bohemia, Commack and Setauket).
How do you do gestational diabetes screening?
I utilize the one hour glucose challenge test and do not require my clients to utilize the Glucola for screening as I understand clients may not prefer to use this beverage. If further testing is indicated we will discuss.
What conditions can risk me out of home birth?
*Hypertension whether previously diagnosed, gestational hypertension or caused by pre-eclampsia
*Pre-eclampsia
*Gestational Diabetes requiring medication management
*Cardiac or neurological conditions that can lead to dangerous outcomes related to the birthing process
*Other conditions may arise that change your status from low-risk to intermediate or high risk based upon further data collection. If risk status changes I will refer you for a consult with obstetricians and maternal fetal medicine physicians to evaluate your risk level. Dependent upon the recommendations from these providers we will determine if home birth remains a safe option for you and your baby.
How do you screen/monitor for these conditions?
Routine prenatal care is an ongoing assessment and evaluation of your risk strata. Any yellow or red flags will be addressed through shared decision making.
Do you support VBAC in the home?
Yes on a case by case basis. Your unique story and birth history allow me to determine my comfort level with supporting your home VBAC.
Do you recommend childbirth education?
YES! Education is invaluable as you prepare for your birth regardless of location. However I firmly believe it is an absolute necessity when preparing for a home birth.
Do you require me to hire a doula?
I do not presume upon the financial resources of any client. That being said I strongly (and I mean STRONGLY) recommend doula support for home birth in general but even more so for first time birthing people and first time home birthers.
Do you support water birth?
Absolutely! I do not provide a birth tub. They can be purchased, borrowed or rented. I do carry a sump pump and will empty the birth tub, wipe it down and pack it up on your behalf.
Do you do routine cervical checks prenatally and/or in labor?
Prenatal cervical exams are not a routine part of my care. Cervical exams in labor are a snapshot in time and can be helpful to you and me for different reasons. It is always a conversation when a cervical exam is requested by you or by me.
When do you come to my home in my labor?
Ideally I come to you when you have reached an active labor stage. That being said, when you explicitly request midwifery support I will come, regardless of what your stage of labor may be. When in labor we will be communicating frequently so we can collaborate on when you would like me to be in attendance.
What equipment do you bring?
My training and skills as a Certified Nurse Midwife.
My assistant Noelle Beutler, also well trained and certified in neonatal resucitation and hemorrhage protocols/management.
My bags with everything needed to support your low-risk birth. This includes but is not limited to doppler to auscultate fetal heart tones in labor, IV supplies and fluids, antibiotics, hemorrhagic agents, herbs, essential oils and homeopathy to support your process, oxygen and equipment to monitor oxygenation, heart rate and respiratory rate for you and baby if indicated. Furthermore, I have suture equipment and local anesthetics if a laceration occurs and a repair is needed.
Do you have an assistant?
Yes, as mentioned above, Noelle Beutler is my assist and her bio is on my website. Please take a look to read more about her.
How long do you stay after I give birth?
I am typically present for 2-3 hours postpartum if you and baby are stable, eating, drinking and you have voided. If more time is needed for this, I stay of course.
What does postpartum care entail, how many visits?
As discussed in the previous question, I remain in the home after your birth until you and baby are stable and tucked into bed. I come back to your home on day one and day three for routine follow up. On our day 3 visit I complete all indicated screenings for your baby, as well as complete birth certificate and social security paperwork. I follow up in the home at 2 weeks to evaluate you physically and further screen for postpartum mood disorders. We complete the care for your pregnancy at 6 weeks in my office. I remain accessible to you for up to one year postpartum for any breastfeeding complications, pelvic floor dysfunction and mood disorder challenges.
How late into my pregnancy are you comfortable waiting for spontaneous labor?
That is unique to each pregnant person. In your third trimester (or at any visit you desire this conversation to occur) we will have a more detailed discussion regarding the evidence and statistics related to late term pregnancies to allow for informed choice and shared decision making. In my practice should you enter your 41st week of pregnancy I would like you to obtain a biophysical profile to evaluate fetal well-being between 41.3 and 41.5 weeks gestational age. This is a sonogram that evaluates breathing movements, fetal muscle tone, fetal movement and amniotic fluid volume. The results of which will lead to clinical recommendations for your unique plan of care in a late term pregnancy. You will be provided with a handout with options to support cervical ripening and reduce the incidence of induction of labor when you enter care. (At minimum eat your 6 dates a day!!)
Do you induce labor, if yes, how?
I am willing to consider induction of labor with a shared decision making model for a term, low-risk pregnancy. I have recommendations for homeopathics, herbs and essential oils that can promote spontaneous labor in the form of a handout (mentioned above). Induction can be attempted with herbs in homeopathic and tincture form. Furthermore I do utilize cervical foley balloons if indicated and consented to. Castor oil is NOT my go to!
Do you file the birth certificate and submit necessary informnation to obtain a social security card for my child?
Yes
Do you perform the metabolic screen?
Yes
Do you perform the CCHD (congenital cardiac heart defect) screening?
Yes
When do I have to see my pediatrician after birth?
I recommend seeing your pediatrician within the first week or so of life. I am licensed to care for a typical healthy newborn for up to 28 days of life and will provide an evaluation at the two week visit, including a weight check, however my preference remains that you establish care prior to two weeks.
Do you have referrals for doulas and lactation support?
Yes, I have multiple doulas and lactation consultants including IBCLC’s. I like to tailor my recommendations to the specific client, attempting to make a good match and minimize your need to interview a multitude of providers. Click here for a link to doulas and lactation providers I commonly refer to.
What does all this cost?
I have an initial retainer fee of $2500 divided into two payments. The first payment ($1250) is due when you initiate care with me and the second ($1250) is due when you enter your third trimester (prior to 36 weeks). This is an out of pocket cost and reserves a spot for your due time in my practice. My global fee for care will be quoted during a meet and greet.
Do you work with insurance companies?
Yes, I am an out of network provider but I work with a highly competent (home birth specializing) biller who will work with your specific insurance company (Medicaid included) to cover the remainder of my global fee. If insurance does not completely cover the remainder of my global fee you will be responsible for the difference, which is to be paid in full by your 6 week visit. Payment plans will be considered on a case by case basis.