1. What made you begin attending home births after so many years of working in the hospital setting?

It was my goal when I first attended midwifery school at the University of Miami to attend home births as a CNM.

I was sidetracked by family obligations. Also, I felt I was doing worthy work in the inner city settings where I provided midwifery care to impoverished, under served women.

2. Do you feel that you provide authentic home birth care in spite of your many years experience in the hospital setting?

Yes. In fact, philosophically it is the same care I attempted to provide in the hospital. In the hospital, whether it was in the inner city or later, a wealthy suburb, I always remained at the side of the laboring woman as much as possible to provide her with support and reassurance and to shield her from unnecessary interventions. Now in the home philosophy and care are truly one.

In the hospital (in many such institutions) I led efforts to change hospital policies so that women could choose intermittent auscultation of fetal heart tones (listening with the fetal doppler) and decline continuous electronic fetal monitoring, walk in labor, eat and drink, have a support person with them and then later their children, and birth in a birthing room first on a birthing bed and later however they chose, rather than in a delivery room on a delivery table. Before birthing beds were widely available I began catching babies with women resting on their sides, first on the delivery table and then in their labor beds. In fact, I was working as a nurse in labor and delivery at Rose Hospital in Denver in 1980 when I saw Rose's first CNM catch a baby in that way; something I had only read about until then.

3. What do you bring to a birth?

I bring many supplies, most of which I don't end up using. They include among other things, a fetal doppler to listen to fetal heart tones during labor; a blood pressure cuff and stethoscope; a newborn stethoscope and scale; an oxygen tank and equipment to resuscitate a newborn if necessary; medication to control postpartum bleeding including IV fluids; sterile instruments and gloves, local anesthetic, syringes and suture to repair a tear that is bleeding.

4. Can you administer IV antibiotics in labor if I am Group B Strep positive?

Yes.

5. Will I need special supplies for the birth?

Most supplies are items you already have (towels, washcloths) or can be easily and cheaply obtained locally. I do ask my clients to order a birth kit from a birthing supply company. The cost is about $50.00. It contains items such as a cord clamp and a box of vinyl gloves. You would order the kit about 6 weeks prior to your due date. You may delete any items from the kit that you already own or wish to purchase elsewhere.

6. When do you come to the birth?

I am on call 24 hours/7 days a week. I am always available by phone for questions and concerns. I come to your home when you and I agree that my presence is needed and wanted. With first time mothers this is typically early in labor while women who have had a baby before often have me arrive when labor is more active.

7. So if you are on call 24hours/7 days a week, do you ever take a vacation?

Yes. But I plan my vacations around my clients' due dates.

8. Do you have anyone assist you at the birth?

Yes. I always bring a birth assistant with me. This individual is certified in neonatal resuscitation. The birth assistant arrives after I call her. I call the birth assistant when the laboring woman is in active labor and I anticipate that the birth will occur relatively soon.

9. Do I need a doula if I have a home birth with a midwife?

A doula is always welcome. Her support will be an added benefit to your labor and birth experience wherever and with whomever you give birth.

10. Do you have any routines that you follow at a birth?

I routinely check the mother's vital signs (blood pressure, temperature, pulse and respirations), I routinely palpate the mother's abdomen (place my hands on the mother's belly) to check fetal position and I routinely listen to the fetal heart tones during labor. All other care is individualized to the woman and her labor.

11. Can I give birth in the position I choose?

Y es. Standing, squatting, side lying, bending over, semi-sitting, lying down, hands and knees, in the tub, on the birth stool, in the shower, in the pool, in the bed, on the floor, in a chair, on the toilet, hanging from a bar. It's your birth.

12. Do you clamp the cord immediately after birth?

No. I wait for the cord to stop pulsating and then clamp and cut the cord. The person of your choosing cuts the cord.

13. Do you pull on the cord to deliver the placenta or do you have the mother push the placenta out?

I observe for signs of placental separation from the wall of the uterus and then have the mother squat or sit on the toilet to push her placenta out. I assist the birth of the placenta with what is known as "controlled cord traction" only if the mother is unable to birth the placenta and/or there is an abnormal amount of bleeding. I always explain what is going on and what I wish to do with the mother and her partner.

14. Are you comfortable with siblings being present for the birth?

Yes. I pioneered that change in a suburban hospital I practiced in over 10 years ago. It's your birth.

15. Do you do water birth?

Yes. I love water births! I encourage all my clients to have a tub so that soaking in the tub can promote relaxation and comfort in labor and ease birth.

16. Do you assist with breastfeeding?

Yes. I am very experienced in assisting new mothers in correct positioning and latch on and trouble shooting breastfeeding concerns that may arise. In addition, I can evaluate and treat breast infections (mastitis).

17. How long do you stay after the birth?

I remain until mother and newborn are stable. That means that the mother's vital signs - blood pressure, temperature, pulse and respirations, are normal; the mother has been able to eat and drink and urinate; her vaginal bleeding is normal and her uterus is normally contracted; the newborn has had a normal physical exam, including normal temperature, pulse and respirations, and has breastfed successfully. This is typically 2 to 4 hours after the birth.

18. Isn't home birth messy?

No. The birth assistant and I keep the birth place quite tidy and clean up after ourselves, including doing the laundry associated with the birth.

19. Do you return after the birth?

Yes. I return to see mother and newborn on day 1 and day 3 following the birth. I examine both the mother and the newborn to assure they are both well and that breastfeeding is continuing without problems. I obtain the newborn metabolic screening test (PKU) on day 3. The results are sent to the baby's care provider.
Finally, I see the mother 6 weeks postpartum for a follow up exam.

20. Do you communicate with the baby's care provider?

Yes. I fax a summary of the pregnancy, labor and birth as well as the newborn exam to the newborn care provider after the day 3 exam. In addition, if I find anything of concern upon examining the newborn at birth or on day 1 or 3, I communicate directly with the newborn's care provider regarding this finding and plan for care. The most common finding has been greater than normal jaundice on the day 3 exam. These newborns were treated at home with what is known as a "bili blanket" by the newborn care provider.

21. How is a birth certificate obtained?

I file the paper work with the State of Colorado to obtain a birth certificate for the newborn.

22. When do I first begin to see you and how often do I see you?

Prenatal care usually begins between 6 and 12 weeks of pregnancy. We meet every 4 weeks until the 28th week of pregnancy, then every 2 weeks until the 36th week of pregnancy, and then weekly until the birth.

23. Where do I see you for prenatal visits and how long are the visits? Who can be present for my visits?

I travel to your home for the prenatal visits. A first visit is typically about 2 hours long and subsequent visits are typically 1 hour long. However, you receive as much time as you need. Whoever you wish to have present at your prenatal visit is welcome. This includes your children, spouse, partner, friends, pets. It's your birth.

24. Do you accept everyone who wishes to use your services?

I accept women into my care who are essentially healthy and whose pregnancies are normal.

25. Do you order laboratory tests and ultrasounds?

Yes. I order routine prenatal laboratory work for all my clients. We discuss whether or not you will choose tests such as 1st trimester nuchal translucency screening and/or the AFP or QUAD screen as well as 3rd trimester screening for gestational diabetes. I recommend ultrasound evaluation if the date of your last menstrual period is unknown or uncertain or if there is a medical indication for an ultrasound such as unexplained vaginal bleeding in pregnancy. Many clients choose to have a screening ultrasound at 20 weeks gestation.

26. What do you do if I have a medical problem during pregnancy that might have an effect on the health of my pregnancy?

I call a physician with expertise in that area of health care and consult with him or her regarding your care. Most of the time a telephone consultation is all that is needed. Occasionally the client will go to see the physician for further evaluation of the medical problem. If the problem is specifically related to the pregnancy I accompany you to the physician visit.

27. What about other providers of health care, such as chiropractic care, massage therapy, or acupuncture?

I encourage my clients to see a chiropractor, massage therapist, and/or acupuncturist as needed to treat common discomforts of pregnancy such as sciatica, back pain, or carpal tunnel syndrome.

28. Do you incorporate herbal remedies in your care of pregnant women?

Yes. For instance, I encourage my pregnant clients to drink a cup of red raspberry leaf tea daily throughout pregnancy. I also use remedies such as papaya for heartburn and ginger for nausea amongst many others. If there is a natural remedy with good evidence that it is safe and effective I will recommend its use.

29. What are your thoughts about nutrition and exercise in pregnancy?

Good nutrition is the cornerstone of a healthy pregnancy. I review nutrition at every visit, emphasizing healthy food choices. Many of my clients take Bradley Childbirth Education classes where nutrition is also emphasized.

I encourage all of my clients to get regular exercise, at a minimum a 30 minute walk 3 days a week and for those who can and wish to do more, a prenatal exercise class. I refer all my clients to a prenatal yoga class and for those who swim I encourage regular swimming.

I also teach my clients how to identify where the baby's back is positioned once she reaches the 3rd trimester and what exercises and positioning she herself can use to encourage optimal positioning of the baby for labor.

30. Do your clients attend childbirth education classes?

Yes. I request that all first time mothers and partners attend a childbirth education class. I refer to private classes (not hospital based) including, but not limited to, the Bradley method, Birthing From Within, and Hypnobirthing.

31. What happens if I need to go to the hospital during labor?

I always travel to a home birth with directions to the closest hospital and to the preferred hospital for transfer. I also bring a copy of your prenatal record to give to the hospital upon transfer. In an emergency I would call 911 and an ambulance would take you to the hospital. In a non emergency we would drive to the hospital together. Once at the hospital I would remain with you as your advocate and to support you.

32. How many transfers have you had?

In 2 years of home birth practice I have transferred one client in labor for a non emergent cause.

33. What are the most common reasons for transfer?

Slow progression in labor and request for pain relief.

34. Do you provide gynecological care?

Yes. I have many years experience performing annual physical exams including gynecological exams. In addition, I evaluate and treat women for vaginal and urinary tract infections and provide contraception. I also provide routine care for menopausal and postmenopausal women. I consult with and refer to medical providers when necessary.

35. Do you accept health insurance as payment?

I contract with a professional billing service that will bill your health insurance company for my services after the birth. I ask that you pay my fee in full by 34 weeks.

36. Can you provide me with references from former clients?

Yes! My former clients are happy to communicate with you by email and/or telephone.

37. What made you leave Minnesota for Colorado?

I fell in love with a resident of Colorado.