Frequently Asked Questions
What is a midwife?
Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. Many midwives also provide preconception care and routine well-body reproductive care throughout the life cycle.
The Midwifery Model of Care is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Our model of care includes:
Monitoring the physical, psychological and social well-being of the birthing parent throughout the childbearing cycle
Providing the birth parent and family with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
Minimizing technological interventions and
Ientifying and referring individuals who require obstetrical attention.
Is homebirth safe?
Homebirth is a safe option for pregnant people whose pregnancies are without complications and are full-term at the start of labor when monitored and attended by professional midwives. For some babies and parents who are at higher risk for complications, a hospital birth is a safer option. To learn more about the safety of home birth, check out these studies:
How does two midwife practice work?
In our practice, families get to know each of us equally by alternating prenatal visits. We both see clients at our West Philly offices, and join you in your home together at 36 weeks so we can all prepare together for your big day. We attend most births together, but will sometimes work with another community midwife so that we each have time off-call. This ensures that our clients always have someone they’ve come to know and trust at their births. We will also switch out at 24 hours of labor support so you have a well resourced midwife supporting you in labor.
We divide postpartum care as we do prenatal care, so every client has the opportunity to process their experience with each midwife.
Can I have a water birth?
Yes! Waterbirth is a lovely option for those who desire it. Many families choose to have birth tubs for comfort in labor, regardless of whether the family plans to have the baby in or out of the water.
Can I have a VBAC (Vaginal Birth After Cesarean)?
Most likely. Trying for a home VBAC has a high success rate - up to 87% - but there are some additional risk during labor, and some people are better candidates for home VBAC than others. Cesarean birth or other uterine surgeries leave a scar on the uterus, leaving some of the tissue weaker and slightly more prone to separating during labor. This is known as uterine rupture. The risk of uterine rupture is 0.2% if you have had one prior c-section, wait at least one year for your uterus to heal before becoming pregnant, have a low transverse incision, and your reason for the c-section does not necessitate another - like breech or failed labor induction. Additional c-sections, infections during healing, smoking, and possible anatomical reasons for c-section (ex: contracted pelvis) can increase your risk of uterine rupture.
We can discuss your prior birth experience and desire for VBAC during a free consultation. Unfortunately due to New Jersey midwifery laws, we are only able to offer home VBAC in Pennsylvania.
What do you do after the baby is born?
While every birth is a little different (depending on if you, your partner, your child, or your midwife catches your baby), at a typical birth we will wait for you to take your baby and bring them onto your stomach or chest, and we will keep a close eye on your bleeding and your baby's adjustment to life outside the womb. After the placenta is born and the baby's cord is done pulsing, we ask you if you are ready to cut the cord and who is going to be the one to do it, and we help clamp and cut the cord. Then we give you some space for family time, staying close by with an ear out for your needs and checking on you periodically. Whenever your baby is interested in nursing, we offer help with positioning and latch if you would like it. After a thorough newborn exam when your family is feeling comfortable and ready for a nap and we’re satisfied that you and baby are healthy and stable, we leave. Then one of your midwives will return in about 24-36 hours for your first postpartum visit.
What happens if something goes wrong?
Midwives are trained to handle certain complications at home and to know when a transport to the hospital may be necessary. One of the most common complications we handle at home is excessive bleeding from the uterus immediately after the baby is born, and we carry the same medications used in hospitals to stop the bleeding. The second most common complication in a homebirth is a baby who needs some help to take his or her first breaths. Every midwife at your birth is certified in neonatal resuscitation. Again, in this scenario, we follow the same standards as the hospital. Our most common reason for transporting a pregnant person to the hospital happens during a very long labor where the birth parent nears clinical exhaustion. In this case, the hospital can provide epidural and pitocin, which are the best tools to support sleep and enable a safe delivery.
Do I need to see a doctor for my prenatal care?
No, unless you would like to. Midwives provide the same clinical components as doctors during prenatal care, such as listening to the baby and taking your blood pressure. We get to know you and your health, and address all your questions. While it is not necessary to also receive prenatal care with a doctor, some families may feel more comfortable establishing a relationship with an obstetrician in addition to their midwife for backup or better insurance coverage of lab work and ultrasounds. There are also some instances when your midwife requests you follow up with a physician, such as antibiotic treatment of a UTI.
How much does it cost?
Our fee for complete midwifery care services is $7,000 and usually includes prenatal care, attendance at the birth, postpartum and newborn care for the first 6 weeks. We offer discounts for cash pay and medicaid clients. This fee does not include your birth kit, lab work or ultrasounds, newborn metabolic screen, or a birth tub.
What are the benefits of homebirth?
The latest research on planned home birth, released in 2014 by the Midwives Alliance of North America (MANA), found that among 17,000 families:
Better outcomes for babies: 97% of babies were carried to full-term, and weighed an average of eight pounds at birth. Only 1% of babies were transferred to the hospital after birth, most for non-urgent conditions.
Low rates of intervention: Only 4.5% of the 17,000 study participants required oxytocin augmentation and/or epidural analgesia. This is much lower than average for the United States, where 26% have oxytocin augmentation and 67% have epidurals.
Low rates of cesarean birth: The 2014 MANA study also found that of the 17,000 planned home births, only 5.7% ended up birthing their babies via cesarean. This is compared to the national average of approximately 31% for full-term pregnancies.
High VBAC success rate: For low-risk individuals, the chance of having a vaginal birth after cesarean ranges from 68-87% when birthing outside the hospital.
Other benefits of choosing home birth with midwives:
Individualized care: All decisions about your care are made together with you. We will have thorough conversation about your needs, preferences, and values, your individual health, and the evidence regarding the options available to you. We respect you as the expert of your own body and your baby's primary care provider.
Continuity of care: Your midwife will follow you throughout the course of your prenatal, birth, and postpartum care. At every point in your parenting journey, you will see the familiar, comfortable, friendly face of your very own midwife.
Evidence-based care: We stay current on the research around pregnancy, birth, postpartum, and breastfeeding so that we can provide up-to-date information to assist you in your decision-making.
Your own environment: For many families, the comfort and security of your own home cannot be matched. You choose who attends your birth and who cares for you. You choose what to eat and drink. Walk, dance or sleep uninterrupted - it's your birth!
Incredible postpartum care: From the first minutes of your baby's life to your six week postpartum checkup, Refuge Midwifery provides attentive, personal support and education necessary for your baby's growth, help your family bond with your newborn, develop long-lasting breastfeeding or chestfeeding relationships, and heal your body in the postpartum.
Who will attend my birth?
During the beginning of your labor, you will be with one of your midwives and anyone you invite to your birth. If your midwife is at your home for longer than 24 hours, we will switch out so you have a fresh, well rested midwife attending to you. As you get closer to birthing your baby, we will call in your other midwife to assist at the birth and transition to postpartum. A student midwife may be present during your care and birth. We value and respect your desire to know who will be at your birth and strive to make sure you have a chance to meet your entire birth team before labor time.
Can I have friends and family at my birth?
Yes! We truly appreciate the presence of loved ones who bring positivity and their love for you into your birthing space. We can also offer support for setting boundaries when you desire privacy.
What equipment do you bring with you to births?
Midwives in New Jersey are legally licensed to carry equipment and medications to safely manage normal deliveries at home, and we bring the same equipment to home births in Pennsylvania. Some of the equipment we bring includes:
Monitoring equipment for you and your baby, including a doppler, blood pressure cuff and stethoscope, thermometer, and infant stethoscope.
Supplies for the newborn exam and any newborn procedures that you choose, including a scale, measuring tape, erythromycin ointment, and vitamin K.
Antihemorrhagic drugs to stop excessive postpartum bleeding.
Resuscitation equipment for baby and birth parent: a bag and mask resuscitator and oxygen.
Suturing equipment to do repairs if any tearing occurred, and lidocaine to numb for suturing.
What about the mess?
We aim to leave the house as clean as it was when we arrived! During your pregnancy I will give you a link to a website where you will order a "birth kit" which includes all the disposable supplies for your birth. Many of these supplies are meant to keep your house clean during the birth. While you have family bonding time with your new baby, we quietly tidy up.
What about ultrasounds and lab work?
We provide lab services: blood draws, urine tests, pap screening and infection swabs during regular appointments or in between if any concerns arise. We also provide referrals to medical imaging professionals in order to obtain ultrasounds as needed or desired. We are able to refer you to other professionals for additional testing if it becomes necessary. There are no tests available in obstetric care that we cannot provide you or help you access.
Does insurance cover midwifery care?
Possibly, but not well. Often, PPO insurance companies will reimburse for midwifery services at the out-of-network or sometimes the in-network rate. We work with an insurance biller to help you get the best reimbursement. Most people will have to pay out-of-pocket then be reimbursed. We offer the option to pay your expected out-of-pocket costs instead of the global fee.