What is a midwife?
A midwife is a highly trained and licensed professional who helps you deliver your baby in the comfort of your home. Midwifery care offers an alternative to mainstream obstetrical care for pregnant people with the aim to optimize health outcomes and client satisfaction. Midwifery care emphasizes the trusting relationship between the client and the midwife, encouraging the family’s active participation in their pregnancy care and minimizing unnecessary and potentially harmful intervention.
Why do people choose to birth at home?
Homebirth is on the rise! The U.S. is facing a shortage of hospital providers that causes labor and delivery nurses, nurse midwives, and OB/GYNs to have ever-larger caseloads. At the same time, insurance and hospital policies encourage shortening the amount of time hospital providers spend with their patients. It’s no surprise that people report worsening experiences with standard obstetrical care.
Birth is one of life’s most intimate and sacred events. As the saying goes, “home is where the heart is,” so what better place for it than in the comfort of your own home surrounded by your chosen support team! Choosing to birth at home lets you set the stage to welcome your baby.
There are many reasons people choose a homebirth including:
- Privacy and comfort
- Desire for a medication-free natural birth
- Family participation
- Not having to travel after the baby’s birth
- Significantly lower cost
Homebirth is a safe and empowering choice for people with a low-risk, healthy pregnancy. Giving birth in a familiar and comforting environment surrounded by the people you love helps you to fully relax and trust the birth process, which facilitates a healthy labor and birth for you and your baby. My goal is to aid you in discovering the power and fulfillment of birthing naturally, in the familiar comfort of home. And don’t worry, we handle the clean up afterwards!
Can I have a waterbirth?
Water birth is a safe and natural way to give birth. Did you know that water has natural analgesic properties that help to ease the intensity of labor? Resting in the water eases the discomfort of the birth process and allows your body to relax. As your labor progresses, the water calms and soothes you and naturally relieves your pain. Water birthed babies are often calmer because they are born from water into water.
I provide a comfortable heated birth tub to my clients. They are easy to set up in any room of your home and can be taken down quickly after the birth.
Here are some good articles to read relating to waterbirth from Evidence Based Birth® & a study on the safety of waterbirth:
Real life stories of waterbirth
Outcomes following waterbirth study
What happens when I’m in labor?
We will talk about labor and birth a lot in your prenatal appointments, including when to call me and what things might feel like. When you think you might be in labor, we’ll be in touch a lot by phone to decide when I should come to you. I may come and go a few times in your early labor to check on you and your baby. When things get going or you want my presence full time, I’ll stay with you.
When you get closer to having your baby, I will call an assistant midwife to come and be with us. Because there will be two of you who need care after your baby is born, I like to have another trained person there just in case we need anything!
What supplies and equipment do midwives bring to a homebirth?
Along with our medical expertise and emotional support to you, we carry all the same emergency birth equipment available at a birth center: oxygen, anti-hemorrhagic medication, IV fluids, and infant resuscitation equipment. We monitor your baby’s heart rate in labor (the best indicator of wellbeing) as well as your vital signs in order to give you both a safe and comfortable birth.
Do you have a diversity policy?
ABSOLUTELY! I’m committed to providing inclusive, culturally sensitive care to my clients. I strive to practice in a way that helps you feel safe, powerful, and in charge of your own care. I am committed to continually educating myself about cultural inclusivity and forms of oppression, and to evaluating the ways privilege and oppression manifest in my own life. If you have questions or concerns at any point during our time together, I am open to — and absolutely encourage — feedback so that I can improve my care.
What is the Midwifery Model of Care©?
The Midwifery Model of Care© focuses on the holistic, family-centered ways parents can prepare their bodies and minds for the work of growing, birthing, and feeding healthy babies.
Midwives acknowledge that the process of bringing a baby into the world is not just a physiological process; it happens within a social, emotional, and spiritual context. The Midwifery Model of Care© focuses on preventive care, promoting health, shared decision-making, and clinical checkpoints to ensure that you and your baby thrive. Midwives serve as guardians of healthy pregnancy and are trained to identify conditions which fall outside of the normal spectrum of childbearing so we can refer you to higher level obstetrical care when necessary.
Midwifery care asks for your full participation to promote the health of your pregnancy. To this end, we provide extensive education and resources to guide you. Education is woven into every visit we have so that you are fully equipped to play a central role in your own care and feel empowered in your health.
Is homebirth safe?
The largest study of homebirths attended by Certified Professional Midwives, as published in the British Medical Journal, has found that homebirth is safe for low risk pregnancies and involves far fewer interventions than similar births in hospitals.
New Hampshire Certified Midwives are highly skilled; all midwives must be current in their Neonatal Resuscitation Program (NRP) and Basic Life Support (BLS) certifications, complete on-going education and are otherwise prepared for a variety of scenarios.
Studies show that planned home births with trained providers are safe for low risk pregnancies.
“Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009,” Melissa Cheyney PhD, et al. JMWH, 2014.
“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson, senior epidemiologist, Betty-Anne Davis, project manager. BMJ 2005;330:1416 (18 June)
These are large well-designed studies that have examined the safety of planned out-of-hospital birth. The results are conclusive; for low-risk pregnant people, out-of-hospital birth attended by a skilled provider and hospital birth of similar groups have equivalent safety outcomes. There are inherent risks regardless of where a person is giving birth and having trained providers with medical intervention available, if needed, increases safety. I prioritize safety in the out-of-hospital birth setting and we will transfer to a hospital if a higher level of care is needed at any time during care.
For a deep dive into the studies that show the safety of homebirth for low risk pregnancies, please see this NACPM page.
Every Mother Counts publishes a good fact sheet called Midwifery = High Value Maternity Care.
How are emergencies handled? What if something happens during labor?
Sometimes events in labor necessitate a change of plans and a transport to a hospital is recommended. Transports can occur during labor or in the hours immediately following a birth. In almost all cases, there are warning signs that occur before a problem develops. Careful attention to these signs allows for a non-urgent transfer (i.e. in your own car) to a hospital for higher-level care. Possible reasons include exhaustion, request for pain medication, or improper cervical dilation. The first two are the most common reasons people having their first babies transfer to the hospital.
Very rarely, a problem occurs without warning which requires immediate care that is unavailable at home. In this small number of cases, a call to 911 is made to initiate urgent transport by ambulance. Families choosing home or birth center birth must be aware of and willing to accept this risk. We will discuss possible emergency scenarios during your care and answer any questions you may have.
Do you do Vaginal Birth After Cesarean (VBAC)?
YES! In New Hampshire, Certified Midwives attend VBAC births, there are a few criteria if you live in New Hampshire: You must have had only one previous cesarean, it has been at least 18 months since your last cesarean, you have had no other uterine surgeries and we can verify from your medical records that they type of incision you had was a lower uterine segment transverse incision. If you live in Maine or Massachusetts, these regulations are not in place, contact me to discuss your unique situation.
What happens after my baby comes?
I’ll stay with you for several hours postpartum to ensure that you and your baby are in stable condition. Your family will be encouraged to rest and get to know your new little one. If you’re choosing to breast/chestfeed, we’ll get your baby latched on and eating. Before I go, I’ll tuck you into bed and we’ll talk about when you should call me if something looks abnormal. You can expect to see me frequently in the first couple of weeks after you give birth. I believe the postpartum period is a crucial time for new families, so it’s very important to me that you receive a lot of care and nurturing!
I want a midwife, but I need or want to have my baby in the hospital, how does that work?
Doula or Monitrice (co-care) are great options for people who plan to birth in the hospital. Depending on the type of support you want, we may meet regularly for full prenatal and postpartum care. For your birth, I may meet you at the hospital when the time is right or come to your house as your labor support in early labor then transfer to the hospital at an appropriate time for you to have your baby there. There are lots of options!
Please see the Doula and Monitrice Care section of the Services page.
How often will we meet?
The first step is an informal meeting where you can ask all your questions (about me, about homebirth, about insurance, about your cat being at the birth — whatever you feel is important!) and we’ll see if we’re a good match.
If you decide that you want a homebirth with me as your midwife, I’ll send you some paperwork and we’ll schedule your first prenatal visit. Visits last about an hour, during which we focus on your questions and your needs, discuss issues that might be arising in the pregnancy, and check the well-being of you and your baby.
We’ll meet once a month up to 28 weeks, twice a month from 28 to 36 weeks, and weekly or more often until you give birth. I’m on call for you 24/7 to answer questions, talk through situations, and of course attend your birth! In the postpartum time, I will visit you on days 1, 3, 7, at two weeks, and at six weeks after the birth (and more often if needed).
What do you charge for midwifery care? What is included in your fee?
My fee is $5,500. I believe in transparency, so I’m very upfront about what I charge and what you can expect in return:
- Midwife’s 24/7 availability by phone, text, or email
- The midwife assistant fee (most providers charge an extra $500 for this fee)
- Comprehensive prenatal care, starting as early in your pregnancy as you’d like, including nutritional counseling and ongoing childbirth education
- Labor, birth, and immediate postpartum care for you and baby, including support of an experienced assistant midwife
- Complementary use of our cushy birth tubs for families choosing water birth
- Six weeks of postpartum care for the birthing person and baby, including infant feeding support and family planning counseling
- Newborn metabolic screening and critical congenital heart defect screening
- Referral for newborn hearing screening
- Referrals to complementary health care providers and community resources
What is not included in your fee?
- Lab work (for an additional fee, I will draw labs and order analysis of samples that is billed directly to your insurance by the lab)
- Diagnostic tests, such as ultrasounds and non-stress tests (I will provide a referral for you)
- Childbirth preparation classes
- “Problem visits” (a visit for an IUI or additional monitoring for the baby, for example)
- Non-routine labor and birth supplies
- Required visit(s) with consulting obstetrician
- Special medications, including Rho(D) Immune Globulin (RhoGam) and antibiotics to treat Group B Strep (GBS)
- Placenta encapsulation (please see the Placenta Encapsulation section of the Services page)
How do you set your fee?
A hallmark of midwifery care is a commitment to personal and individualized care. Midwives know that this attention to relationship is the key to our excellent health outcomes and client satisfaction.
Over the course of your care, it’s likely that we’ll spend easily 30 to 60 face-to-face hours together, plus more time in phone/text/email communication. I’ll also spend a significant amount of time between our visits charting, researching resources for you, calling other providers to consult or arrange referrals, preparing for our next visit, stocking supplies, driving to and from your house, etc.
As a licensed healthcare provider, I have a continuing education commitment that requires me to supplement my education with additional courses, professional conference sessions, and access to the latest medical literature — all of which come with a steep price tag. Add to that the overhead of running a business: phone and internet service, website maintenance, medical supplies, and much more.
I hope this breakdown of the time and money invested in your care helps to explain why midwives charge what they do. When you consider that standard obstetrical care — which offers significantly less time and individualized attention — is billed to insurance for a minimum of $30,000 (and much more if there are complications during your birth), it’s easy to see that midwives in the U.S. are drastically underpaid.
My fee ensures the financial sustainability of the excellent care I provide to the families I serve. It covers the cost of important components of your care, which goes above and beyond the standard obstetrical model, including:
- Time and attention dedicated solely to you, your health, and your needs
- Continuity of care ensured by 24/7 availability of your midwife
- Significantly longer appointment times
- Additional prenatal and postpartum visits as needed
- Continuous labor, birth, and immediate postpartum support
- Expanded postpartum care through six weeks postpartum
What if I can’t afford your fee? Do you have payment plans?
Yes! I have a standard payment plan that spreads my fee over the course your pregnancy until 36 weeks. If this plan doesn’t work for you, we can work together to find one that does. I also offer a 10% discount to military families and cash-pay clients who pay in full at the start of care. This discount reduces the cost of your care to $3,420. (The fee that goes to the assistant midwife is still included in this lowered price!)
If this doesn’t work for you, we can discuss other options as noted below such as bartering.
How do people pay for midwifery care?
There are a variety of ways people raise money to pay for their care, including asking for donations instead of baby shower gifts, creating personal fundraising websites (using GoFundMe or YouCaring, for example), taking out low-cost loans from a local credit union, making and selling things online or to friends, and bartering.
Will my insurance cover a homebirth?
Some PPO insurance plans do cover homebirth! I am not contracted with any insurer, so the care I provide is considered “out-of-network”. My billing service, Cohosh, can verify your insurance benefits to help us choose the best payment plan for your family. If your plan covers homebirth, Cohosh Billing can file an insurance claim for your care after your last postpartum visit.
