FAQs About Womancare Birth & Breastfeeding Center

What is your training and experience?

Compiling information for this section

Who will attend me at my birth?

One or two midwives and a trained birth assistant who is often also a student training to be a licensed midwife. Although it is rare, if there are two women in labor at the same time we have other midwives willing to help.

Do you work with doulas?

Yes, doulas are a welcome addition to any birth. You are welcome to hire a doula but it is not required.  Women find they receive a lot of extra attention and loving-kindness from both doulas and midwives during a very important transition of becoming a mother.

How involved are fathers or other family members allowed to be at the pregnancy and birth?

We encourage fathers or the family member(s) of your choice to attend prenatal visits, and birth and breastfeeding classes with you. During the birth fathers are welcome to help receive the baby, and cut the umbilical cord if both parents are comfortable with this. Mothers may have the person or persons of their choice attend their birth. Children are always welcome. You are in control and there is no limit.

Care During Pregnancy

How much time do you spend with your clients at prenatal visits.

Studies show that Obstetricians spend on average 7 minutes per prenatal visit and an initial visit can be about 20 to 45 minutes although not all of that time is spent with the doctor. You will find midwifery care much different. The pace of the visits is relaxed and inviting. There will always be time for a cup of tea, and to have all your questions and concerns addressed. The first visit is a free consultation and we spend about one hour answering any questions and discussing our practice and protocols. Then we do an initial work-up, and we spend about two, to two and a half hours going over your medical history, talking about how to have an optimum pregnancy, and doing a complete physical examination including all desired lab work.  After that, we spend about 45 minutes to an hour at every prenatal visit. Visits are monthly until the 7th month, then every two weeks until the beginning of the 9th month, and then weekly after that. This extra time allows us to know one another on a more intimate level as we all prepare for the day of your birth. We find this helps build a deeper level of trust and understanding which allows us to deliver the ultimate prenatal care to each of our clients.

What ways do I, or my family get to actively participate in my prenatal care?

Lots of ways! We encourage your questions and comments at every visit.
We give you the reasons for all prenatal testing and let you make the decisions about which ones you want. We encourage fathers to come to visits, listen to baby’s heartbeat and be as involved in your care as you and he feel comfortable. We encourage you to evaluate your own eating habits and make healthy choices. We discuss all recommended supplements, health foods, and healthy home remedies for particular conditions. We listen and ask your opinions about the choices that are available for your care. Older children are encouraged to be the midwife’s helpers at the visits and can help feel mom’s belly for fetal position, measure her tummy for growth and development, hold the Doppler in place as we listen to baby’s heartbeat. We show pictures of baby’s development at each stage of the prenatal journey.

Do you recommend herbal preparations, essential oils, or homeopathics in your practice?

We have seen our clients use a number of nutritive herbs and occasionally some medicinal herbs for various reasons in pregnancy, with excellent results. We have herb books available to loan you and we are glad to talk to you about what we know regarding herbs, including which herbs to avoid during pregnancy and breastfeeding.

Many clients use and love essential oils in pregnancy, labor& delivery and postpartum. While internal use is discouraged in pregnancy, some topical use and aromatherapy can be very helpful to some mothers. We have a diffuser for your use during labor and delivery when using our birthing facility with any oils you wish to bring.

We routinely use a variety of homeopathics in our practice.

Can I get an ultrasound or non stress test if I want one?

Although we do not offer ultrasounds in our office, we do refer to several phyicians’ offices that provide ultrasounds here and in the Phoenix area.

We now offer non stress tests which are read by our Certified Nurse Midwife.

What tests do you routinely perform? Can they be refused?

We offer pregnancy testing. We routinely draw labs for what is known as an OB panel which tests your complete blood count (CBC), checks your blood type and Rh factor, immunity to Rubella, Red cell Antibody screen, RPR screen, Hepititis B screen. We also take a urine sample and send that to the lab for a urinalysis and urine culture. We are happy to offer you a PAP smear either during or after pregnancy and also offer full STI screening as requested. We offer cell free DNA testing for anomalies of the fetus in early pregnancy, and can send referrals for further genetic testing as requested. In mid pregnancy we repeat the CBC and do a Glucose tolerance screen. At 36 weeks we do a swab to check for overgrowth of Group b strep.  We also offer extra Antibody testing for mothers who are Rh negative and cord blood testing /Rhogam injections as needed. Many of these may be refused, but we find them helpful to monitor your health and baby’s health. The state of Arizona has certain requirements that could preclude you from using an AZ licensed midwife if you do not wish to do prenatal testing but they are minimal. No matter who your health care provider is or what setting you are in, you have the right to refuse treatment or testing.

Do you recommend that I read certain books during pregnancy? What about prenatal or breastfeeding classes?

We have a list of recommended books that I would love every mother to read, but they are not required. Many are available in our lending library.

We encourage every mother to take the childbirth class of her choice during her pregnancy to prepare for labor. We are happy to recommend Kristen Pearson who teaches the Bradley method childbirth method; and Mary Ann Baul ICBLC who teaches a breastfeeding class at Womancare Birth Center.

Care for Birth and Afterwards

How much time do you spend with your clients during labor and postpartum?

During labor, we come to support the woman whenever she wants us there. It might be hours or more than a day! We stay for at least four hours after the birth, and come back 24 hours later to make sure everything is fine with both mother and baby. We see the mother and baby again at their home 3 days postpartum (after the birth), and then in our office at one week, two weeks and six weeks postpartum. Other visits are available if needed to monitor weight gain in the baby, lactation support, or other problems that may arise.

How many of your clients give birth without medications of any kind?

In all these years, there have only been a handful of women who chose to go into the hospital for pain medication when they were experiencing normal labors. Sometimes, during an especially long, complicated labor, women get tired and if they are transported to the hospital they opt to have something for pain. We always honor their request if that is what they wish as an epidural or other methods can be a mercy.  At home, we use warm baths, showers, massage, walking, changing positions and many other comfort measures to help women give birth naturally. We have a labor pool for rent for those wishing to use warm water immersion.

Can I eat and drink during labor? Can I labor in any position I want?

Yes, and yes! Women often want to eat small amounts of nutritious food and keep drinking juices or other nutritious liquids during labor. There is no reason not to eat, and we actually encourage women to keep up their fluids. Women can labor in whatever position they want to, but we might encourage different positions in order to help the baby move down and get the labor progressing, or we might encourage rest at other times. We are there to help facilitate a normal, natural labor and birth.

What do I need to prepare?

We will provide a list of common household items to prepare for a home birth, as well as a few things to buy. If you are having a Birth Center birth we will provide a list of things to bring including chargers, food, articles of clothing, etc. In either case we will also provide a birth kit of disposable medical supplies that will be used during the birth. In addition we ask that you prepare a bag for the hospital in case of transport.

Can my other children attend the birth?

Yes, if they want to attend. We recommend that they have someone present to care just for them and attend to their special needs. They can talk to the midwives ahead of time if they wish and have any questions answered. We encourage you to seek out information, birth films, or books to help prepare them ahead of time.

Care for Complications

What happens if I have to go to the hospital, or have special tests done?

We currently work closely with the OB’s and the certified nurse midwies at North Country Health Care for any complications that may arise during pregnancy or birth. They are respectful of our clients and supportive of our presence. We also have a good rapport with Flagstaff OB. We have a good relationship with the hospital staff at Flagstaff Medical Center as well, and have found in general that our clients are pleased with FMC’s care whenever it is needed.  If you do desire a test that we don’t provide here in our office we can refer you to an OB here in Flagstaff or in the Phoenix area.

At what point am I considered overdue enough to warrant concern?

At one to two weeks overdue. As licensed midwives, our regulations by the State Dept. of Health Services require that we consult with a physician and seek their care when a pregnancy goes two weeks beyond the due date, but women are almost always induced earlier if they are under the care of a physician. We will begin discussing options for your care at one week beyond your due date. There are times when induction is recommended for the safety of the baby. We work with women before that time to encourage labor, with natural methods such as walking, making love, and other natural alternatives.

What would make my pregnancy high risk? Do you handle any of these complications?

There are many things that would make a pregnancy high risk, more than we can answer here. However, most of these conditions are rare, and most of them can be prevented with good care, especially taking good care of yourself! Some of the ones that you might have heard of are: high blood pressure, diabetes, heart disease, pre-term labor, breech baby or twins. We stress healthy lifestyle and good diet in pregnancy to achieve an optimum pregnancy, and educate women and families about ways to prevent complications. We also perform all the necessary screening for these complications at every prenatal visit.

Do you deliver VBACS?

In some cases Vaginal Birth after Cesarean is allowed in our scope of practice by the Arizona Department of Health Services. You may be considered as a candidate if you have had only 1 previous cesarean and if the surgeon’s notes are available stating that your previous incision was low transverse in both layers. If addition if you had a particular condition that caused you to need surgery that is still present you may not be able to birth vaginally. You will need to be carefully screened if we are to proceed. You will be required to seek medical consult and in some cases you may need dual care with a physician.

What is your transport rate? For what reasons do you transport? Where do you transport to?

Our overall transport rate during labor or after the birth averages about 13% over the past 20 years. That means that out of 100 women starting labor at home, 87 of them give birth successfully at home without requiring any additional medical care for themselves or the newborn. We transport to Flagstaff Medical Center in case of complications or emergencies when in the Flagstaff area. If you are delivering in Sedona or surrounding areas then we transport to Verde Valley Medical Center if there is no time to go to FMC.  The most common reasons for transport are prolonged labors (where the mother is getting exhausted and dehydrated) or signs that the baby is not tolerating labor well. It is extremely rare for us to transport in an emergency situation, where time is of the essence. Most transports are calmly accomplished by going in the car with the midwife to the hospital. Very rarely, we will call an ambulance for assistance and transport. Our birth center is only about 3 minutes from FMC.

What happens if an emergency cesarean is needed?

If there is an emergency requiring a cesarean section, we call the hospital and doctor on the way and let them know we are coming, so that they can organize their staff and prepare to take care of the mother immediately. We may call an ambulance for transport, and we accompany the mother to the hospital. We do everything we possibly can to assure a safe and smooth transition from home to hospital under the circumstances.

What is your cesarean rate?

Our cesarean rate is very low at just over 5%. The national average for cesarean section is 29 %. The World Health Organization recommends the rate of cesarean sections remain below 15%. For the women we transport to the hospital for complications, 70% of them still give birth vaginally. We keep careful statistics through the Midwives Alliance of North America Statistics project (with the permission of our clients), they are available to anyone who may be interested.

What is your episiotomy rate?

Our episiotomy rate at home is less than 1%. For the women who transport to the hospital in labor, 95% of them do not receive episiotomies either. Episiotomies are rarely needed and are no longer standard practice for the doctors.

What medical care is available at home for complications?

We carry oxygen, newborn resuscitation and suctioning equipment, and all of us are certified in Neonatal Life Support. We carry medications to stop bleeding. We carry equipment to monitor the mother and baby for complications, as well as equipment and medications for suturing. We offer IV therapy for certain conditions if needed. We offer erythromycin treatment for newborns eyes, or vitamin K injections. We have an extensive list of all the equipment and medical supplies that we carry for anyone who is interested.

Do you offer newborn screening?

Yes, we offer the same newborn initial exam, PKUs (Heel stick tests), Congenital heart defects screening, and hearing screen that your baby would receive from other practices or at the hospital.

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