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.