Homebirth Midwifery
Birch Moon Midwifery & Lactation Care provides comprehensive midwifery care from conception to postpartum including:
Consultation while deciding on care plan (at no charge)
Routine prenatal care
Laboratory testing
Support and monitoring during labor and birth
Immediate postpartum care of parent and newborn
Filing of birth certificate
Routine screening and preventative treatment of the newborn as desired
Routine postpartum care until 12 weeks including pap if needed
Routine newborn care until 8 weeks
Lactation support for up to 12 weeks
Is home birth safe?
This depends on the person and the pregnancy. Adverse outcomes in states with well-established and integrated community midwifery, like Maine, are overall low and comparable to hospital-based outcomes for low-risk pregnancies. Published research suggests that low-risk people that give birth at home are less likely to birth by cesarean, be induced, or experience instrument-assisted births. Home birth may not be a safe option for people with some pre-existing conditions or for people who develop complications in pregnancy. You can read more about research on home birth outcomes in the following articles: “Birth Outcomes for Planned Home and Licensed Birth Center Births in Washington State” and “Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009.”
What if something goes wrong?
The majority of the time healthy, low-risk people have healthy, low-risk pregnancies and births. This is not always the case though. That is why it is important to receive thorough prenatal care from someone trained to detect variations from normal and to respond to them promptly. If a complication arises prenatally additional testing, medical consultation, or transfer of care may be necessary. If a complication presents in labor that is beyond my scope of practice, a transport to the hospital would be necessary. I am trained to recognize potential complications, to manage many of them (such as hemorrhage, newborn resuscitation, and perineal tears,) and to stabilize and transport a person who develops a complication that can not safely be managed at home (such as cord prolapse or retained placenta.) In case of a transport I would remain with a client in a support role.
Will my insurance cover homebirth midwifery care?
Location of the birth is often not an issue for insurance companies, but provider is. Each insurance company has several different programs with varying coverage. It is hard to say with certainty if your insurer will cover your care until a verification of benefits is done. I work with a midwifery biller that can do a verification of benefits and submit claims directly to your insurance company. I am not contracted with any insurance companies. In some cases it may be possible to apply for a ‘gap exception’ to have your care covered at the same rate as an in-network provider. The biller can help with that, too.
Can I still have an ultrasound or other tests?
Absolutely. You can choose to have every test available or no testing, or something in between. As you approach the time in pregnancy when a test is usually done I will give you information and resources so you can gather the information you need to decide which tests you would like. Tests involving blood draws or cultures can be done in office, or in your home. If you desire a test that can not be done at home, I will arrange for you to have the test done in an appropriate facility. I have an in-office ultrasound machine that can be useful in determining fetal position or assessing viability, but I do not do diagnostic ultrasounds in-office.
Are you licensed?
Yes. Since 2020 Maine has required that CPMs be licensed to practice in the state. The Board of Complementary Health Care Providers oversees licenses for CPMs in Maine. Details about the laws and rules that govern CPMs are available on the Board’s website.
What if you are at another birth when I go into labor?
I limit my number of clients to two to four in a month (based on geography) in order to minimize the chances of having two people in labor at one time. I always attend births with another CPM. In the unlikely event that your labor coincides with another labor the midwives split up so that each laboring person has a familiar midwife present. Additional CPMs would be called in to assist.
What training do you need to be a CPM in Maine?
The CPM credential is administered by the North American Registry of Midwives (NARM.) NARM, in accordance with their accrediting agency, set the standards for the CPM credential. In order to be eligible to take the CPM examination a midwife must meet one of two requirements. They must have either graduated from an accredited midwifery school or they must show extensive documentation of self-study and apprenticeship. In both cases they must also show evidence of attendance at and participation in a specified number of births (typically 60-100). More information about the specifics of the NARM process and the CPM credential is available at NARM.org. In order to practice in Maine a CPM must be licensed by the state.
What is the difference between a Certified Nurse Midwife (CNM) and a Certified Professional Midwife (CPM)?
Certified Nurse Midwives (CNM) are licensed in all fifty states to provide midwifery care, typically under the supervision of a doctor. Most CNMs work in hospital-based practices. CNMs are advance practice nurses. They are nurses that did additional training in midwifery.
Certified Professional Midwives (CPM) are practicing in all fifty states and are licensed by 33 as independent providers. CPMs are direct-entry midwives meaning they came directly to their midwifery training and did not necessarily come to midwifery through nursing. Most CPMs work in out-of-hospital birth settings.
Do I need to see a doctor if I am seeing you?
Midwifery care is comprehensive and there is no need to see a doctor as well, providing everything is normal. If a person has non-pregnancy related conditions that need monitoring during pregnancy, like thyroid irregularities, that condition may need to be followed by a doctor. If a condition develops during pregnancy that is beyond my scope of care, we will work together to find appropriate complementary care.
When should I start seeing a midwife?
Most people contact a midwife between six and 12 weeks. It is important to take your time finding the right caregiver for you. However, there are some time sensitive testing options in pregnancy. There is not necessarily a time you must start seeing a midwife, but if you begin care beyond 12 weeks you may miss some optional tests.
I have birthed a baby by cesarean section. Can I still have a homebirth?
A person who gives birth vaginally after having a previous cesarean section is said to have had a VBAC or vaginal birth after cesarean. Maine rules allow CPMs to attend VBAC births at home or in birth centers if the client has had only one previous cesarean, the estimated due date is at least 18-months from the previous birth, and the cesarean incision was low-transverse. Maine rules related to VBAC births at home with CPMs are available here (Chapter 6-C). Please contact me for more specific details about VBAC care and birth.
What is the cost of homebirth midwifery care?
The base cost for complete midwifery care is $5,600. The fee includes prenatal, birth, and postpartum care and lactation support until 12 weeks following the birth. The fee also includes access to a birth tub, in-office testing and all routine newborn care, testing, and treatment, as desired. Laboratory testing, ultrasounds, and some treatment options are additional. There is no charge for an initial, one-hour consultation visit to learn more about midwifery and the care I offer. A $400 early pay discount is offered to clients that pay in full by 28 weeks.
Are payment plans available?
Creative payment plans are available for midwifery clients. Most people make measured payments though the pregnancy. I request a $400 down payment at the start of care and that the balance be paid in full by the 38th week of pregnancy. In some situations a longer payment plan may be possible.
Where is your office and how far will you travel?
My office is located at 1518 Castine Road in Penobscot on the Blue Hill Peninsula. Drive time is approximately 10 minutes to Route One and Bucksport, 15 minutes to Blue Hill, 35 minutes to Belfast, one hour to Camden, 45 minutes to Bangor, 25 minutes to Ellsworth, and 50 minutes to Mount Desert Island. Generally, I provide home-based care within a one-hour drive of my office.