What is a midwife?
The word midwife is an Old English word which literally means “with woman.” In times past, a midwife typically cared for not only those in labor but the community wellness as a whole. Modern midwives in America care for low risk, pregnant women throughout their childbearing cycle.
A Certified Professional Midwife has studied and trained exclusively in out-of-hospital settings. This certification is obtained through NARM- the North American Registry of Midwives. Currently, in the US, 35 states license and regulate midwives with legislation being drafted in several more. South Carolina has been licensing and regulating midwives since 1976, and was, in fact, the first state to have regulations for licensure. Visit "The Big Push for Midwives" to read more about this.
In other countries around the world, midwife is a commonly heard and used term as midwives are standard of care in those countries such as the Netherlands, Guatemala, Japan, Hong Kong, United Kingdom, Canada and Australia. A midwife can be either a woman or a man. Learn more here.
What hospital or group do you work with?
As a South Carolina Licensed Midwife and nationally Certified Professional Midwife, I am an autonomous, independent midwife. I am trained exclusively in low risk maternity care, out-of-hospital birth and postpartum care. My credentials do not require me to work under the direct supervision of a doctor, and I do not have clinical privileges in a hospital. I maintain relationships with doctors, certified nurse midwives and other medical professionals to facilitate collaboration when needed.
Do I need to see a doctor before hiring a midwife?
No, it is not necessary to see a doctor prior to your initial appointment with me. I can obtain lab work, complete a physical and assess you and the baby. Pursuant to SCDHEC regulations, however, all moms will need to see an outside medical provider (obstetrician, certified nurse midwife, family practice or general practice doctor, etc) twice during the pregnancy. The first of these two visits will need to take place within the first two trimesters and the second one will need to be within the last six weeks of pregnancy.
Do you do ultrasounds, or will I need to have an ultrasound?
No, I do not perform ultrasounds, and no, an ultrasound is not required for a low risk pregnancy. Should the mom desire an ultrasound, I can send in a referral for a diagnostic ultrasound or she may go to a freestanding ultrasound office for a non-diagnostic ultrasound. In the case where the mother does not know the date of her last normal menstrual period or when she may have conceived, it would be beneficial to have an ultrasound- either diagnostic or non-diagnostic for dating purposes, though not a requirement. If at any time during the pregnancy, I feel that there is a medical need for an ultrasound, I will refer the mom to a diagnostic ultrasound clinic.
Who can be at my birth?
Labor and birth are very intimate and private times, second to making the baby! Your birth team will need to be 100% supportive of your decision to have a normal, natural birth, therefore anyone other than your partner, your midwife and her assistant must be fully aware that this is your well informed decision. Siblings who have been prepared for what birth is and means are welcome to be a part of this incredible experience. In fact, pets can be part of the process, too!
What will the midwife do with the baby once the is born?
Immediately after the baby has been born, he goes directly onto his mama’s chest. My assistant midwife and I will put warm blankets on the baby, then observe for reflexes, breathing, heart rate, color, and muscle tone. This is continuously assessed even as the mother and baby are bonding. The Apgar score is assigned one minute and five minutes after the birth. Learn more about the Apgar score here.
Once the cord has finished pulsing and the baby has received all of his blood, the cord will be clamped and cut (mom, her partner or an older sibling can do this!).
After “The Golden Hour,” which may actually be a little longer than an hour, I will perform a complete head-to-toe newborn exam on the bed right beside mama. Then the baby will be returned to snuggle and nurse.
Sometime between 24 and 36 hours after the birth, I will return to your home to conduct a postpartum exam for you and the baby. At this visit, I will weigh the baby, observe and assist with breastfeeding, assess the baby’s respiratory efforts, color and heart rate. I will also obtain a blood sample from the baby for the Newborn Metabolic Screening.
What if I have to go to a hospital during labor?
During labor, my assistant and I will be with you observing you, keeping you hydrated and fed, intermittently listening to the baby’s heart rate, providing comfort measures, and assisting you in the normal physiological process of birth. Should labor slow and not pick back up, or you become extremely exhausted, a non-emergency transport to the hospital of your choice will be recommended.
If at any point, there is an emergency with mama or baby, an ambulance will be called and transport to the closest hospital will be required. In either scenario, I will follow you to the hospital with your records and stay with you throughout the remainder of labor, or until the emergency has been resolved and you and baby are stable.
The assistant will remain at the home to clean up so that when you return, you can snuggle right into bed with your baby. I will continue care by being on call for you and conducting postpartum visits for you and the baby. This is discussed at the initial visit and an emergency care plan document is completed by the mother and kept in the file.
Will my baby breathe in water if she is born in the water?
No, babies are already in an aqueous environment, so being born into water may actually be a gentler transition for the baby. If a mother stays in the tub or birth pool to give birth, the baby will not take her first breath until she is brought up out of the water. The baby does not stay in the tub after birth for more than a few seconds as she is being given to her mama. Read more here.
I am older than 35, am I high risk?
NO! Age alone does not make someone high risk. If you are a healthy woman, and intend to proceed with a healthy pregnancy, then you can have a normal, natural birth without the stigma of “high risk due to advanced maternal age.”
Will my insurance cover your services?
Whether or not your private insurance covers midwifery and home birth services is as individual as each mother that I serve. In order to get an idea of what your plan covers, I recommend that you have your benefits verified by my biller. She charges a nominal fee for her time and that is paid by you directly to her. This can be completed prior to hiring me as your midwife. Once that has been taken care of, the biller will also proceed with anything such as initiating an in network exception or obtaining a prior authorization if required by your insurance.
Throughout your pregnancy, you will be responsible to pay me for my services and can do so with a payment plan or all at one time according to our financial agreement.
Once the baby has been born, and you wish to have claims submitted to your insurance company, I will send a super bill to the biller to initiate the process. This will cost $50.00 and, again, is your responsibility to pay the biller directly for this service. After the insurance company has processed all of the claims, I will be able to determine if there is a refund of any amount due to you based on your deductible and co-insurance. This process could take a few months after the birth, however, we have had success with some private insurance companies in the past.
For SC Medicaid recipients, currently there are only two MCO. that will pay for services. Clients must be on First Choice by Select Health or Absolute Total Care MCO and will be responsible for paying a fee for services not covered by the plan or Medicaid. If you are currently on SC Medicaid, but not on Select Health or Absolute Total Care, you will need to switch to that plan. If you do not want to switch or have questions have questions regarding the 2 MCO plans, please contact me for more information here.
To initiate your VOB with the Biller: click here
Can you be my midwife if I am pregnant with twins or if my baby is breech?
SCDHEC regulation 61-24 Licensed Midwives states that we "must obtain medical consultation or refer for medical care" a woman who is suspected to be carrying twins or if the baby is in a breech position. In consultation with a medical provider, we can design a birth plan for your situation. Should you desire, I can be hired as your doula for that birth. However, I am trained, and participate in continuing education workshops geared towards refreshing that training, in the rare surprise situation when a second baby hasn’t been detected, or if the baby has done a big flip since the last prenatal visit prior to labor, should there not be enough time to transport.