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FAQs: Prenatal and Home Birth Care

Q: Where should I give birth?

A: Environment plays a crucial role in having a safe and satisfying labor and birth experience. At Birth & Beyond we consider your individual history and health status, your desires, and the potential for complications. Together, we will help you determine what will be the most comfortable and safe setting for your labor and birth. The Birth & Beyond midwives attend planned home births.

lizzie with mom in hosp #2

Q: What happens if I have a complication, or need to go to the hospital during labor?

A: If at any time a woman needs care beyond the midwifery scope of care, the Birth & Beyond midwives assist in accessing and implementing the appropriate level of care for the client’s particular needs.

If a serious medical condition develops which requires care by specialists in complicated pregnancy, we will coordinate the transfer of your care. We will remain a resource for information and support through your pregnancy and the post-partum period.

Urgent situations rarely develop in the course of planned home birth. In this event, the midwives initiate emergency transport to the closest medical facility through EMS. Our goal is to keep mother and baby stable, facilitate communication, and provide on-going support to you, your family, and the rest of the medical team. All Birth & Beyond caregivers are BLS (Basic Life Saving) and NALS (Neonatal Advanced Life Support) certified.

Q: What can I expect for my initial prenatal visit?

A:  The initial prenatal visit is a good time to learn more about our practice, and for the midwives to get to know you. A midwife will talk with you about your plans for birth, the schedule of prenatal care, and options for genetic screening, ultrasounds, and blood work. She will take a thorough history about you and your family, including the father of the baby. This visit is also a good time to discuss common goals to help you improve your health and the health of your developing baby: changes in diet, exercise habits, medications, stress reduction, and lifestyle. At this visit you will also have a physical exam, which may include a Pap smear if you have not had one recently.

At any time, feel free to ask any questions that you have! The midwives at Birth & Beyond are open and knowledgeable, and can help you find the resources you need to have an optimal birth experience.

Q: What can I expect for subsequent routine prenatal visits?

A: After the initial visit, appointments are 30-60 minutes long. The routine course of prenatal visits is typically once a month until 28 weeks, then every two weeks until 35 weeks, and then weekly until 40 weeks.

When you arrive, you will be welcomed and encouraged to use the rest room. While in the rest room, you can step on the scale to weigh yourself. During your exam, a midwife will check your blood pressure, measure your abdomen, feel the position of the baby, and listen to the baby’s heartbeat. This is a fun task in which older siblings can get involved and help the midwife. The midwife will also review current lab or ultrasound results with you.

There is ample time for questions and discussion. At any time, you can feel free to express thoughts or feelings that have come up. We want to make sure your emotional and educational needs are met just as well as your physical needs.

Q: What tests will be done during my pregnancy? Are they required?

A: If you are considering home birth, it is important to make sure that your pregnancy is low risk and continues to be low risk throughout the pregnancy. In the first trimester, initial blood work is done to assess for anemia, immunity to Rubella, and for exposure to Syphilis, Hepatitis B, or HIV. We will also determine your blood type.

At 28 weeks, the beginning of the seventh month, we will re-check for anemia and assess how your body is managing glucose metabolism in pregnancy. In our office, we perform the “glucose tolerance test” with organic grape juice rather than the neon-orange glucose drink usually used in labs.

At approximately 35 weeks, a GBS culture is performed to check for the presence of the bacteria Group B Strep.

Genetic testing of you or your baby is completely optional, and you can discuss with a midwife whether or not you desire it. If so, we can order tests such as cffDNA, first trimester screening, AFP testing, CVS, and amniocentesis.

Ultrasounds are also optional. They may be used to assess gestational age, how well the baby is growing, the position of the baby, or fluid checks. These are done by referral to a facility of your choice.

Luca Birth Story

Q: Can I have a water birth?

A: Birth & Beyond has a limited number of birth tubs available for rent for our clients. Water birth is a great option for relaxation and relieving discomfort during labor and birth. Warm water can help lower blood pressure, dilate the cervix, and ease strain on the perineum, which may help reduce tearing.

Q: What pain management options are available to me?

A: There are many options to make your labor and birth more comfortable and empowering. Clients may choose to use water in a tub, as well as warm or cold compresses, massage, strategic position changes, eating and drinking freely, wearing your own comfortable clothes, aromatherapy, and other environmental changes such as dimming the lights or playing soft music. These strategies and more, as well as having emotional support, all help to make pain more manageable.

Q: What if I need antibiotics for Group B Strep?

A: You can still have a home birth if you are positive for GBS. If you test positive for GBS, the Birth & Beyond midwives can administer the IV antibiotics in labor recommended by the Center for Disease Control (CDC) guidelines.

Q: If I have risk factors, can I still choose to have midwifery care?

A: Most risk factors will not prevent you from choosing midwifery care, but we do have strict guidelines for what conditions present too high of a risk for home birth care. These include twins, breech presentation, labor before 37 weeks gestation, labor after 42 weeks gestation, a prior c-section, and certain medical conditions. We feel that these circumstances are best cared for in a hospital setting, with collaboration between midwives and physicians. Risk factors may also come up during labor that necessitate transferring to a hospital setting.

If you have any questions, we are happy to discuss your personal circumstances at any visit.

Q: How is the baby’s heartbeat monitored during labor?

A: The baby’s heartbeat is monitored throughout labor using a hand-held ultrasound device called a doppler. A midwife will listen intermittently, depending on what stage of the labor you are in and how the baby is tolerating labor. The doppler can be used underwater during water births. We follow the national guidelines on the intervals for listening to the heartbeat that are proven to be safe. If at any time we hear a heart rate that is non-reassuring and may indicate a higher risk, we transfer to the hospital for continuous fetal monitoring.

Q: Who examines my baby after birth?

A: The Birth & Beyond midwives will provide care for healthy newborns for the first two weeks of life. At the birth, your midwife will perform a complete newborn exam, and there will also be baby exams during your two follow-up home visits (postpartum day 1 and day 3).  At two weeks, we provide a mother and baby exam in the office. After that visit, information from the newborn exams as well as labor and birth will be sent to your pediatric office. If the newborn exam reveals any abnormalities or if your baby needs additional medical care or support, we will contact your pediatrician and facilitate a transfer of care.

Q: Are there tests for my baby after birth?

A: Soon after birth, your baby will have a physical examination in your presence. We will weigh and measure your baby at this time. At your first or third day home visit, we perform the cystic fibrosis and “PKU” metabolic screening tests. At the two week office visit, the midwife will perform a hearing screening test. The results from this test and the PKU test are recorded with the state as well as being available to you and your pediatrician.

Q: What if I want my son circumcised?

A: If you elect to circumcise your son, we will refer you to a certified professional who can perform the circumcision in your home.

Q: Can I transfer into your practice if I am far along in my pregnancy?

A: While we appreciate being able to get to know you and your family throughout your pregnancy, it is possible to transfer to our care in the third trimester as long as you have had regular, routine, low risk prenatal care. You must supply us with a copy of your complete prenatal records, including lab work and ultrasound reports.

Q: Can my children attend my appointments and the birth?

A: Children are welcome at your prenatal visits, and during your birth! We have toys and books to entertain children, and there are fun opportunities for children to be helpers during belly checks in the exam room. We can also help you to prepare your older children for the birth and being an older sibling.

Q: How do I obtain the birth certificate and social security number for my baby?

A: After the birth, the midwives will assist you to complete the forms required for the birth certificate. Once your forms are completed Birth & Beyond will submit the paperwork to the town clerk for processing. After you receive the baby’s Social Security card you will need to go to your Town Hall and to obtain the birth certificate. There is a small fee associated with the birth certificate, payable to the town clerk when you pick it up.

If you are not married to your partner, you will need to fill our paternity papers or civil union documents if you are in a same-sex relationship.