~ ~  General Questions  ~ ~

Q:  Is home birth safe?

A:  Several studies have researched the issue of the safety of home birth in various countries around the world.  The best research continues to show that home birth for women with low-risk healthy pregnancies, attended by a qualified birth attendant, is no more risky than birth in the hospital.  Not only that, but in the U.S., women choosing home birth with a midwife have far fewer interventions during their labor, birth and immediate postpartum period, contributing to easier healing, breastfeeding and bonding with their new babies.

Homebirth with midwives is quite common for low-risk women in many other industrialized countries (Canada, UK, Australia, New Zealand, most Scandinavian countries, the Netherlands, Japan, the list goes on), and the safety of homebirth with midwives is well-established and accepted.  In fact, in the UK there is a push to get low-risk women out of the hospital and have their babies at home or in birth centers with midwives because the obstetricians are recognized as specialists in high-risk pregnancies.  US obstetricians are trained as high-risk providers too, but our culture values high-risk specialists caring for low-risk women.  Midwives are trained much more extensively in normal pregnancy and birth than obstetricians are and are often considered to be the "experts" in normal birth.

An important study was published in June 2005 in the British Medical Journal regarding the safety of home birth with Certified Professional Midwives in the U.S. and Canada:

"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)

Conclusions:  Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

Click here for more research on the safety of home birth.

Q:  What is CranioSacral Therapy and why might my baby need or want it?

A: CranioSacral Therapy is a very gentle way of adjusting the bones and membranes that make up the head, spine and pelvis. Many, many babies can benefit greatly from CranioSacral Therapy. See this page on our website for more information.

Q:  What are the advantages of home birth over hospital birth?

A: Women choose to have their babies at home for various reasons, but some of the most common reasons we hear are the following:

• desire for a natural birth
  
• more control and choice in who is there, where to labor, what position to labor in, whether to eat and drink, etc.
  
• security and comfort of own home and belongings
  
• less anxiety and stress
  
• immediate close contact with the new baby
  
• not attached to machines and IV poles
  
• greater sense of being able to let labor to progress naturally
  
• fewer interventions like epidurals, episiotomies, forceps/ vacuums, and unnecessary IVs
  
• lower risk of having an unnecessary cesarean
  
• more family unity
  
• lower cost
  
• less exposure to hospital bacteria and other germs
  
• higher satisfaction level

Q:  What equipment do the midwives bring to my home for the birth?

A:  The contents of each midwife's birth bag may be very different, but most licensed midwives carry similar basic equipment to all births:

• sterile instruments for the birth and cutting the umbilical cord
  
• an oxygen tank and resuscitation bag/ masks for mother and newborn
  
• a suction device for removing mucus and other material from the baby's nose and mouth
  
• a stethoscope for listening to the baby's heart rate during labor and pushing
  
• drugs and/or herbs for preventing or stopping the mother from bleeding too much after the birth
  
• IV equipment and fluids for rehydration of the mother
  
• Vitamin K and eye ointment for the newborn

Your midwife may ask you to purchase some other supplies for the birth, such as disposable underpads, gloves, a newborn hat and receiving blankets.

Q:  What if something happens during labor?

A:  About 90% of the time, there are warning signs that occur before a problem develops that allow plenty of time for good decision-making and non-urgent transport to the hospital in your own car.  Midwives are extensively trained in recognizing the warning signs that tell us that labor has gone outside of what is normal.  Not every problem requires a trip to the hospital; sometimes, just a change in the mother's position or rehydration solves the problem.  Issues requiring a hospital transfer most often happen during labor, but can sometimes come up in the first few hours after the birth as well.  The most common reasons for going to the hospital during labor include:

• maternal exhaustion and/or request for pain relief (this is more common in first-time mothers with very long labors)
  
• the cervix isn't dilating properly (often due to the baby's head being turned in an uneven position)
  
• the baby's heartbeat is indicating that the baby is stressed for some reason

There is a small percentage of emergencies that require a call to 911 and urgent transport to the hospital.  In very rare cases, a serious problem can occur that has no warnings signs at all, such as a tear in a blood vessel in the baby's umbilical cord or a blood clot in the mother's lung.  In these extremely unusual situations, the mother or baby would need immediate care or equipment that would not be available in the home setting. Being in the hospital is no guarantee that the mother's or baby's life would be saved either - often there is nothing that can be done in these situations - but emergency personnel and equipment are more likely to be available there.  It is important for families considering home birth to be willing to accept these risks.

In the period right after the baby is born, there may be problems in either the mother or the baby that could require a trip to the hospital. A few mothers have trouble with too much bleeding or the placenta doesn't come out as it should.  Licensed midwives are generally able to administer various drugs at home that are meant to stop excessive bleeding.  Sometimes more extensive measures must be taken, and about 2% of mothers require a hospital transport.  These issues are more likely to be urgent transfers.  The most common problem with newborn babies is difficulty breathing correctly, and about 1.5% of babies need to go to the hospital within the first few hours after birth for evaluation by a pediatrician.

Q:  What are some reasons why I wouldn't be able to have a home birth?

A:  Most women with low-risk, healthy pregnancies can have a home birth.  Risk criteria vary from state to state, but in most places, a woman is no longer considered to be "low-risk" if any of the following occurrences happen in the prenatal period, during labor, or immediately postpartum:

• the mother has any abnormal bleeding
  
• the mother is Rh-negative and has become sensitized to Rh-positive antigens
  
• the mother has high blood pressure requiring medication
  
• the mother has pre-existing diabetes (this is different from "gestational diabetes")
  
• the mother has heart, kidney or lung disease
  
• the mother is a heavy alcohol or drug user (or anyone else in the home that may be considered a risk to the midwife or emergency personnel during labor, birth and the immediate postpartum)
  
• the mother develops pre-eclampsia
  
• labor begins before 36 weeks of pregnancy
  
• the pregnancy continues longer than 42 or 43 weeks
  
• the mother has severe anemia
  
• the baby's umbilical cord prolapses when the water breaks
  
• the baby's heartbeat indicates that it is distressed
  
• the mother has a postpartum hemorrhage
  
• the mother has a severe tear that requires additional instruments, skill, or anesthesia to repair properly
  
• the newborn has problems such as infection, respiratory distress, or severe hypoglycemia

This list may be different for the midwife that you choose and is not intended to be an exhaustive list of every reason.  If you have a question about whether you are a good candidate for a home birth, please contact us.

Q:  This is my first baby.  Is home birth right for me?

A: Sure!  If you are having a low-risk, healthy pregnancy, it doesn't matter whether you are having your first baby or your tenth.  If you meet the following criteria, then you are probably eligible for a home birth:

• Is in good physical and mental health
  
• Has good nutritional status
  
• Has adequate social support before, during and after birth
  
• Is socially mature and able to accept responsibility for birth outcome
  
• Has a positive emotional environment
  
• Has access to childbirth, home birth and breastfeeding education (books, classes)
  
• Has access to emergency transportation
  
• Has a clean home and birthing room, with electricity, running water and a working telephone
  
• Understands that technological intervention is used only when necessary
  
• Understands that pain medication will not be used during labor
  
• Agrees to transfer to the hospital during labor, birth or postpartum, if necessary

Many of our clients are first-time moms and have beautiful home births.  If you are interested in learning more, please contact us.

Q:  Is home birth messy?

A:  Not really.  Most midwives use the same blue plastic-backed pads that are used in the hospital, and we spread plenty of these around underneath you to catch any fluids.  We often recommend that you protect your pillows by covering them with plastic and put an old pillowcase over the top.  A really handy thing to make is a special throw that can be picked up, moved around and laid down on the sofa, floor, bed, or wherever you want to be laboring or pushing.  We suggest getting some old sheets and a quilt from a thrift store, something that you don't care about getting messy.  Layer a sheet, a thicker piece of plastic (like a shower curtain, not a trash bag), a quilt, and another sheet all together, then get your girlfriends all together and with tapestry needles and some colorful yarn, punch through all four layers from top to bottom, then back up about a quarter-inch away, and tie a knot to hold the layers together.  Space the knots about every 18 inches apart so that the layers don't slide around or bunch up.  You can event roll up the edges and baste them in place to catch any fluids that want to slide off.  After the birth, it can be rolled up, sealed in a trash bag and thrown away!
Our midwives do a great job of cleaning up after the birth and will often start a load of laundry for you before we leave.

Q:  Can we keep the placenta?

A:  Yes, of course.  Many families like to commemorate the birth of their child by burying the placenta and planting a tree over it.  The placenta will nourish the growth of the tree, much like it nourished your baby in the womb.  Let your midwife know if you would like to keep the placenta, and she can wrap it up for you in a couple of plastic bags and put it in your freezer until you are ready to use it.  If you prefer not to keep the placenta, your midwife can dispose of it for you.

Q:  Is waterbirth safe?

A:  There have been over 100,000 babies born in the water reported worldwide, and the research into the safety of waterbirth is still being done.  The main challenge in doing research on waterbirth is that women typically choose whether to labor and birth their babies in the water, just like women choose home birth, and it is often difficult to know if women who choose waterbirth are different from women who choose other methods of birth in ways that can affect the research outcomes (i.e., they may be in general older, having their second or third babies instead of their first, are better educated about birth, have better nutrition, fewer smokers, etc.).  These factors can overlap each other and make it difficult to see whether the outcomes are better or worse because of those things or because of the fact that they were in the water.  So researchers are still conducting studies to pin down whether there are any differences in outcomes between babies born in water and babies born on land.

Many of our clients choose to have a waterbirth at home.  Some mothers find that they just like to labor in the water because it seems to make the contractions much easier to handle.  The midwife can monitor the baby's heartbeat regularly in the water with a special waterproof stethoscope.  If you choose to have your baby in the water, the midwife will help you to bring your baby up out of the water and gently into your arms within a few seconds after s/he comes out.  Until babies come in contact with air, they receive all of their oxygen through the umbilical cord, just like they do throughout the entire pregnancy.  For a great explanation of how this amazing process works in the newborn and why they don't inhale water when they are born, see "What Prevents Baby From Breathing Underwater" by Barbara Harper, an amazing woman who we are proud to know and lucky to have as a resource here in Portland.

Q:  What is the difference between nurse-midwives and direct-entry midwives?

A:  A Certified Nurse-Midwife (CNM) is a person who has been educated both in the discipline of nursing and in the discipline of midwifery.  A CNM's education occurs in a university program accredited through the American College of Nurse-Midwives and the birth experience is primarily in a hospital setting.  They must pass a national exam in order to become certified and then are legal and eligible to become licensed in all 50 states.  Most CNMs work in hospitals or birth centers.

A direct-entry midwife is educated in the discipline of midwifery in a program or path that does not also require her to become educated as a nurse.  Direct-entry midwives learn midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing.  A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Under the umbrella of "direct-entry midwife" are several types of midwives:

• A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care.  The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.
  
  
• A Licensed Direct-Entry Midwife (LDM) is a midwife who is licensed to practice in Oregon.  Currently, licensure for direct-entry midwives is available in 24 states, including Oregon and Washington.
  
  
• The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife credential was available). Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

~  ~    About Us    ~  ~

Q:  Where are you located, and is there parking?

A: Our office is located at 2625 SE Hawthorne in beautiful SE Portland.  Click here for a map and directions.  Parking is readily available on Hawthorne right in front of the office or on the side of the building on 27th St.

Q:  Do you charge for a midwifery consultation?

A: No, we do not charge for a consultation visit to get to know the midwives and ask questions to help decide whether a homebirth with Vivante Midwifery is right for you.

Q:  Are you covered by my insurance?

A: Certified Nurse-Midwives are covered providers by most insurance companies.  Vivante Midwifery is in-network with Regence Blue Cross/ Blue Shield as well as PacificSource and Great West.   Some insurance companies do not cover a birth at home, but will cover prenatal and postpartum care in the office.  We will work with your insurance company to estimate how much is covered and what, if any, out-of-pocket expenses you might have to pay.  We do accept Oregon Health Plan open card as well. At this time, we are not able to bill your insurance for CranioSacral Therapy, and therefore work on a cash or check basis only.

Q:  Can you attend homebirths in Washington?

A: Yes, we are licensed midwives in Washington as well as in Oregon. We are happy to attend births within a reasonable radius of the Portland metro area.

Q:  What forms of payment do you accept?

A: We are happy to work with most insurance providers for your maternity care.  We receive an estimate from them about how much they are likely to pay for a homebirth, and the remainder can be paid by you in a lump sum or in monthly payments by cash, check, or credit card via Paypal.  For those clients who are paying the entire amount themselves, discounts may apply for early payment. For CranioSacral Therapy clients, check or cash are gladly accepted.

Q:  Are there any former clients I can contact about your services?

A: Absolutely!  We try to match up our references to each particular situation (first-time mom, interest in waterbirth, CranioSacral Therapy, etc.), so please contact us if you would like a list of references that are similar to you.