Frequently Asked Questions

What is a Florida Licensed Midwife?

• Professional practitioner providing expert prenatal, labor, delivery, and postpartum services to women having normal, healthy
  pregnancies.
  
• Graduate of a 3-year academic and clinical midwifery education program.
  
• License requirements meet established national and international professional standards
  

Through Licensed Midwifery, Florida shows leadership in health policy innovation. Florida’s statute is seen as a standard for direct-entry midwifery programs by many other states. Continued support by the Florida Legislature gives all Florida families access to this choice of time-honored, quality maternity care. Florida has been licensing midwives since 1931. The Midwifery Practice Act (FS 467) was updated in 1982 and 1992, based on World Health Organization standards and successful European direct-entry midwifery programs. To become licensed, an applicant completes a three-year program of academic and clinical education and must pass the North American Registry of Midwives national certification examination. Licensed Midwives are autonomous maternity care providers for women experiencing normal, healthy pregnancies. Midwives also work collaboratively with the physicians, if medical concerns arise. Licensed Midwives offer childbirth services in clients’ homes, birth centers, clinics and hospitals, and they are eligible for reimbursement by private insurance and Medicaid.

Midwives deliver over 70% of the babies born in countries which have fewer infant and maternal deaths, lower cesarean rates, and lower health care costs that the United States.

• The United States ranks 26th, worldwide, in infant survival.
  
• Florida’s rate of low birth weight babies is twice as high as in Sweden or Finland, where midwifery services are standard care for women with normal, healthy pregnancies (8% vs. 4% low birth weight)
  
• Women under the care of a midwife have significantly fewer costly cesarean births, when comparing similar pregnancy profiles.
• Florida’s 22.2% cesarean rate ranks 39th within the U.S., with cesarean birth costing twice as much as vaginal births.
  
  

Is birth at home safe?

Birth at home is a very safe option for the majority of women. Today, many people recognize the benefits and safety of out-of-hospital birth with midwifery care and choose a midwife for their primary care during pregnancy. Birth at home or in a birth center with a Midwife has been proven to be as safe as birthing in the hospital, but with fewer interventions and more satisfying experiences.

Countless studies have been done throughout the world that have proven the safety of home birth. In 1998 the Department of Obstetrics and Gynecology at Columbia University concluded a study that found homebirth can be accomplished with good outcomes as long as there is a qualified practitioner (including midwives) at attend the birth and with a system in place for transporting the mother if she needs to go to the hospital. (1)

The World Health Organization recognizes homebirth with a trained attendant (midwife) and hospital back-up as a good option for low risk women. (2)

June 18, 2005 a study was released that compared the outcomes of 5,000 women planning homebirth with a midwife to low-risk hospital births and found that the outcomes of planned homebirth were as good as hospital outcomes, but with fewer interventions and greater
satisfaction. (3)

Normally, birth is uncomplicated and does not require any intervention. The national rate of transfer from a planned homebirth to the hospital is less than 15%. This means that 85%-90% of planned homebirths occur at home without complications. The national cesarean
rate for Certified Professional Midwives is about 5%. The health of the mother, comprehensive prenatal visits, risk screening, referral and/or transfer to the hospital when appropriate, continuous support and care during labor and birth is what makes birthing at home safe.
(visit our "Links" page for more resources on birth safety)

(1) "Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study." By Murphy PA, Fullerton J. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA. pam15@columbia.edu
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=9721790&dopt=Abstract  

(2) World Health Organization's Care in Normal Birth: GENERAL ASPECTS OF CARE IN LABOUR WHO/FRH/MSM/96.24
http://www.who.int/reproductivehealth/publications/MSM_96_24/MSM_96_24_Chapter2Part1.en.html

(3) "Outcomes of planned home births with certified professional midwives: large prospective study in North America." Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager. BMJ  2005;330:1416 (18 June).The BMJ has published the paper on-line.
http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416?ehom

What if something happens?

Midwives are prepared for obstetrical emergencies, just like paramedics are prepared for out of hospital emergencies. Emergencies during labor rarely occur at home or in a birth center. With a midwife in attendance she is able to detect early signs of a possible problem and either prevent the problem from occurring or transfer the mother to the hospital before it happens. True emergencies are rare. Most transfers that occur from a birth center or homebirth are NOT emergencies. Usually a decision is made that it is better to be at the hospital and the mother, her family, and midwife all drive to the hospital. In an emergency, 911 is initiated and the nearest hospital is notified to be prepared upon arrival. At our Birth Center, our nearest paramedics are less than 2 miles away and our transferring hospital, Sarasota Memorial Hospital, is only xx miles away.

All the essentials for routine birth as well as emergencies are at our Birth Center or are brought to the home by the midwife. These include but are not limited to:

• Doppler and fetoscope for assessing the baby’s heart rate
  
• Herbs and homeopathics
  
• Birth balls
  
• Medications and herbs to control hemorrhage
  
• Oxygen and resuscitation equipment, bulb and delee suction
  
• Sterile instruments: scissors, hemostats, needle holders
  
• Suturing equipment and medication to numb the area when tears occur
  
• Blood pressure cuff, stethoscope
  
• Baby scale and tape measure (to weigh & measure they baby)
  
• Neonatal eye ointment and Vitamin K (given to baby with consent)
  
• IV equipment, fluids, antibiotics (if needed)
  
• Other misc.. supplies, sterile gloves, cord clamps, urinary catheter, amnicot (to break water if needed), betadine, gauze, sub-pump
  to drain birth tub
  

If you have any questions about specific complications the midwife will be happy to answer your questions.

Do you offer pain medication?

All medications increase the risks of complications for you and your baby, therefore, we believe that pain medication is best received in the hospital setting.

How do you help with pain?

First, it has been proven that stress increases pain. Being in a relaxed setting with people you know and trust helps to decrease stress and pain. We strongly encourage you to take a childbirth class, especially if this is your first baby or first baby not born in the hospital. While
we offer the Bradley Method, any method you prefer is fine, and you are not required to take a class in order to give birth with us.

During labor we encourage you to eat and drink, change positions, listen to music, use the birth ball, shower, or birthing tub. We do not routinely use IV's, but they are available if you need one. We do use natural pain relief methods stemming from complimentary therapies, such as massage, healing touch therapy, acupressure, homeopathy, herbal remedies,and aromatherapy. You may give birth in any position you choose, side-lying, standing, squatting, hands and knees, or in the water. A doula added to your support team can be a great benefit as well.

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

This is a common occurrence (30%), and a common concern, but it doesn’t normally cause a problem. Once the head is born the midwife can feel the baby for a cord, if it’s around the neck she can free simply by slipping it over the head or shoulder. If the cord is very tight she can clamp and cut it, but that’s usually not necessary.

What if there is too much bleeding (hemorrhage)?

Although it is rare, some mothers will hemorrhage at after birth. Licensed Midwives have many procedures and carry herbs and medications (same ones as used in the hospital) to stop hemorrhage. IV fluids are available and can be given as well. In severe cases, a mother will be transferred if the Midwife feels that it is necessary.

Who will clean up after the birth?

The Midwife and birth assistant will clean up after the birth. There are things you can do ahead of time to prepare your home for birth, the midwife will provide you with a list of supplies and things to do before the birth. Usually within an hour of the birth the home is tidied and no one can tell you just had your baby there.

What about a birth certificate and social security card?

The Midwife will complete the birth certificate application which also requests the social security card. You will automatically receive the social security card in the mail in 4-8 weeks. In order to receive a copy of the birth certificate you will have to contact vital records and pay a fee with your request.

Do I need a Pediatrician?

Your Midwife will perform a complete physical exam on your baby shortly after birth. She’ll also weigh and measure your baby. You will be instructed on how to listen to your baby’s heart rate and breathing so that you can check this between visits. Your midwife will see you and your baby again the day after your birth and a couple days later. It is recommended that you choose a Pediatrician during your pregnancy and plan to have your baby seen within the first couple days after the birth. Vaccines are not recommended by the American Academy of Pediatrics under 2 months of age.

What about payment?

BirthWays offers high quality care at an affordable price. Several payment options are available to meet individual needs. Insurance, Medicaid, and credit cards are accepted. Payment plans are also available. We accept Medicaid. To discuss your specific situation call our office at 941-366-BABY(2229) or send an email to SarasotaMidwife@yahoo.com.

Florida Law Mandates that all insurance companies that provide maternity care, MUST cover the services of a Licensed Midwife, Homebirth, and Birth Center. If you have maternity coverage, services with Birthways will be covered.

While Midwifery Care is covered by insurance, not all insurance companies will cover doula services.  Payment for doula services must be made in advance and BirthWays will bill for reimbursement.