Is homebirth safe?

This depends on the person and the pregnancy. Several published studied have confirmed that for low-risk people it is just as safe to birth at home with a trained midwife as it is to birth in the hospital. In fact, the research found that low-risk people who birth at home were less likely to experience an episiotomy, vacuum extraction, induction, or an instrument assisted delivery (Cheney, et al). Homebirth may not be a safe option for people with some pre-existing conditions or for people who develop complications in pregnancy.

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 placenta previa.) 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. You should contact your insurance company directly to see if they will cover the services of a licensed Certified Professional Midwife. I do not bill insurance companies directly, but can provide you with a coded receipt so you can request reimbursement from your insurance company. I provide clients with information to guide them through contacting their insurance company to verify anticipated coverage.

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, like an ultrasound, I will arrange for you to have the test done in an appropriate facility.

Are you licensed?

I am licensed by the state of Maine as a Certified Professional Midwife. Currently the Board of Complementary Healthcare Providers made up of CPMs and other health professionals is working to put in place the rules that will govern the license. In the meantime, I continue to practice under a bill passed in 2008 that allows Certified Professional Midwives to acquire and administer five medications necessary for safe practice:  oxytocin to control hemorrhage, lidocaine for suturing, oxygen, and antibiotic eye ointment and vitamin K for the newborn.

What if you are at another birth when I go into labor?

I limit my number of clients to two to three 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 your 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. Any previous trauma to the uterus, including the incision made to birth a baby during a cesarean section, slightly increases the chances that the uterus may rupture during a subsequent labor. For this reason, VBAC has become a controversy in the childbirth community. As a licensed CPM the law currently prohibits me from attending VBAC births as the primary care giver. This prohibition will expire when rules for licensed CPMs are approved. Please contact me for more information on out-of-hospital VBACs or referrals to supportive hospital-based providers.

What is the cost of homebirth midwifery care?

The base cost for complete midwifery care is $4,800. 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.

What is an IBCLC?

An IBCLC (International Board Certified Lactation Consultant) is a healthcare provider that specializes in the clinical management and support of breastfeeding. I work with clients expecting babies to address potential breastfeeding issues like history of breast surgery and inverted nipples. I also work with babies and their nursing parents to address issues like poor latch, breast infection or plugged ducts, sore nipples, low- or over-milk supply, poor weight gain, supplementation, returning to work, and weening. Sometimes a parents would like to nurse a child, but is not pregnant either because they are planning adoption, surrogacy, or their partner is carrying the pregnancy. I work with people in these situations to create a plan to induce lactation. While IBCLCs support breastfeeding, my most important work is to support clients in identifying and achieving their infant feeding goals. For some that is exclusive, long-term breast-feeding. For some that is tandem nursing. For others that includes supplementation and partial breastfeeding.

What training is required to be a lactation consultant?

There are many different credentials related to lactation care. I have chosen to be an International Board Certified Lactation Consultant, or IBCLC. The IBCLC is the most extensive lactation credential available and requires didactic and clinical training in lactation as well as a certifying exam. More information about the IBCLC credential is available here.

Can you do lactation care by phone?

Yes. Depending up on the nature of the issues, it may be possible to do lactation consultations by phone or video conference. Some issues require physical assessment and are not effectively assessed or managed remotely. Please call or email for more information.

What is the cost of lactation care?

Lactation care is including in the cost of midwifery care for the first 12 weeks. Those desiring lactation care beyond 12 weeks, or those that received maternity care from a different provider and desire lactation care are charged per visit. Health insurance policies that comply with he Affordable Care Act (ACA) typically cover lactation services at no cost to the insured. I am an out-of-network provider and do not submit claims directly to insurance companies, but will provide you with a coded claim form that you can submit to your insurer to request reimbursement.

Initial lactation consultations are 90-minutes long and include a physical assessment and evaluation of feeding mechanics. The cost of an initial consultation is $120 for office visits and $165 for home visits within one-hour of the office. Visits beyond one-hour may be available for an additional fee.

Follow-up lactation visits are 60-minutes long, and are $90 for office visits and $135 for in-home visits.

Are payment plans available?

Creative payment plans are available for midwifery clients. Most people make measured payments though the pregnancy. I request a $300 down payment and that the balance be paid in full by the 36th 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.