Womancare Midwifery FAQs

Flagstaff midwife Mary Ann Baul responds to some frequently asked questions...

ABOUT OUR PRACTICE
CARE DURING PREGNANCY
CARE FOR BIRTH & AFTERWARDS
CARE FOR COMPLICATIONS


About Our Practice ~


How many births have you attended?

Between the three of us, we have attended close to 2000 births.

Who will be at the birth?

Generally, two midwives attend each birth, and a trained birth assistant. The midwives will take turns seeing you during your prenatal visits.When we have students studying midwifery with us, we will ask your permission to have themparticipate in some of your care and possibly come to your birth as well. We believe that having two midwives and a trained assistant or student creates a great team to serve you and your baby safely during the birth process. Although it is rare, if there are two women in labor at the same time we have other midwives willing to help.

Have you worked with a doula before? Why or why not?

A doula is a labor support person who is at the birth to physically and emotionally support the laboring mother, and to help with postpartum needs. We encourage our clients to hire a doula if they would like, but we don’t require it. 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 the fathers or other family members allowed to be in the pregnancy and birth?

We encourage any members of your family to participate in your pregnancy and birth as much as you desire. They are welcome to accompany you to all of your prenatal visits, help receive the baby and cut the umbilical cord if both parents are comfortable with this.

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Care During Pregnancy ~


How much time do you spend with your clients prenatally?

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 an hour and a half, 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.

In what ways do I 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 listen and ask your opinions about the choices that are available for your care.

Do you recommend herbal preparations 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.

Can I get an ultrasound if I want one?

Although we don’t perform ultrasounds here in our office, we do refer to several physicians’ offices that provide ultrasounds here and in the Phoenix area.

Can I turn down any tests I don't want?

You have the right to refuse prenatal testing. We will thoroughly explain the reasons for any tests, and you can participate in the decision-making.

What insurance do you take? Do you have payment plans?

Most private insurance companies, such as Mutual of Omaha, Blue Cross, Aetna, Cigna and others, will reimburse our clients for home birth care with us though we are always considered out-of-network providers. Managed care organizations that require a contract with a provider usually do not reimburse for our care. AHCCCS does not currently cover the cost of our care although they will cover some labs. Each situation is different, and we will help you determine whether your insurance company will cover for our care. We have payment plans and are willing to work with each family so that the fees can be paid in a reasonable manner.  We also accept VISA and Mastercard for your convenience.

Are there books you recommend I read during pregnancy? What about recommended classes?

We have a list of books that we recommend. We also recommend classes, especially for first-time parents. We find that knowledge helps to prevent complications and helps people know what to expect.

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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 three 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.

How many of your clients give birth without medication 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, want to have something for pain. We always honor their request if that is what they wish. 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.

Do you allow women to eat during labor? Can I labor in whatever 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 have prepared for the birth?

We will provide a list of common household items to prepare for the birth, as well as a few things to buy. We will also provide a birth kit of disposable medical supplies that will be used during the birth. It’s pretty simple to prepare.

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.

Do you do water births?

Yes, we have done both planned and unplanned water births. We have books and films about this and will discuss this with you at any time. We highly recommend immersion in warm water for labor. It is one of the most relaxing things a woman in labor can do! We have a labor pool/birth tub available for rent.

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Care for Complications ~


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

We currently work closely with the 5 OB’s and the certified nurse midwife 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 have a good relationship with the hospital staff at FlagstaffMedicalCenter 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 ofyourself! 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.

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 FlagstaffMedicalCenter in case of complications or emergencies. 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.

What happens when 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 at all times. 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 26.1%. 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? Can you use oxygen? Do you use any IVs or medications to stop bleeding?

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 have an extensive list of all the equipment and medical supplies that we carry for anyone who is interested.

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