Midwifery Care

It is my honor to accompany women and families on the amazing journey of  childbirth. Midwives view birth as a sacred and beautiful life event.  We view women as strong and capable, and we view pregnancy as a sign of vitality and good health.  Midwives work in the model of holistic health care.  We view birth as a whole life experience, as it affects, influences, and is influenced by your whole life.  Our time together is focused on you as a whole, a physical, mental, emotional, and spiritual being. In the office, you will find laughter, tears, baby cries, toddler squeals, prayer, meditation, and full expression of joy, sadness, fear, and triumph.

In addition, midwives view the relationship as “client/midwife” as opposed to “patient/doctor.” As your midwife, I do not pretend that there is something wrong with you that needs fixing, and that I have what you need to fix it.  Instead, I honor the fact that you are the expert of your own body, and I offer experience, knowledge, and ideas. While we do the clinical assessment that assures us that all is well, such as blood pressure checks, weight checks, listening to the baby’s heart beat, checking the baby’s growth, urinalysis, and all applicable diagnostic testing in pregnancy, I believe my main job is to empower you with information, support, and acceptance. I can give you recommendations for certain exercises, herbs, dietary modifications, relaxation and stress-reduction strategies, statistics, pros and cons, risks and benefits, and I offer my intuition, as well. I can tell you when it seems as though something is awry, and when it seems as though things are moving ahead perfectly.  As we sail together through your pregnancy, birth, and postpartum period, I view myself as the “lookout.”  I can let you know if there are choppy seas ahead, and recommend that we steer in a different direction.  However, YOU are the captain. You decide what is ultimately right for you and your family, and I will respect that.

 

Call today, to set up your free consultation with Jen!  It’s free, easygoing, and enjoyable.  Ask all your questions, and discover the possibilities!  Papa bears are welcomed too, along with any and all questions regarding safety. A midwife’s office is a place where open communication is celebrated! 480.239.2912

 

Below, you will find a description of what a midwife does, and doesn’t do.  Although every midwife is a little different, we all abide by the rules of licensure set forth by the state of Arizona.

 

 

 

Click here to find out what sets our practice apart, including FREE monthly meditation groups, birth story groups, and mama groups!

The midwife is specially trained in the support of normal pregnancy, birth and postpartum care, and views birth as a natural and sacred event.  She provides individualized holistic healthcare during the prenatal period, during labor and birth, as well as the postpartum period.  She provides medical, informational, emotional, and physical support to women and families.  Each midwifery visit is typically one hour in length.  The midwife continually monitors the mama and baby to ensure that each phase of the birth journey remains healthy and normal.  She will refer to higher-level healthcare providers, should the need arise.  Every effort is made to keep the process of pregnancy and birth joyous and empowering.  She may recommend homeopathic, herbal or therapeutic remedies.  Midwives are not obstetricians nor pediatricians.  The midwife is independent and self-employed.

In Arizona, midwives practice under the ARIZONA ADMINISTRATIVE CODE, TITLE 9. HEALTH SERVICES, CHAPTER 16. DEPARTMENT OF HEALTH SERVICES OCCUPATIONAL LICENSING Supp. 05-2, ARTICLE 1. LICENSING OF MIDWIFERY.

You can find these rules and regulations online at: http://apps.azsos.gov/public_services/Title_09/9-16.pdf

or by contacting the Arizona Department of Health Services.

Clinical procedures and holistic healthcare performed by the Midwife:

Clinical monitoring at prenatal visits (once per month until 28 weeks, twice per month, until 36 weeks, once per week until birth)

This includes taking blood pressure, pulse, respirations, measuring fundal height, determining baby’s position, checking fetal heart tones, etc.

Holistic care at prenatal visits (once per month until 28 weeks, twice per month, until 36 weeks, once per week until birth)

Diet and exercise will be discussed at each visit, to ensure that the mama has energy and is feeling healthy.  We will discuss how she is feeling emotionally and how she is connecting with the current phase of pregnancy.  The midwife will provide resources  to ensure that the mama has a sense of community and a good support system.  As pregnancy progresses, we talk more about preparations for the birth, both physically and emotionally.

Labwork

At specific weeks of gestation, during the pregnancy, labwork is done.  Arizona State Law requires midwives to encourage all standardized testing. The midwife will obtain the labs, as necessary, in the office or in your home. This may include drawing blood, urinalysis, cultures, etc.

Required tests (excerpted from Arizona Department Of Health Services):

  1. Blood type, including ABO and Rh, with antibody screen
  2. Urinalysis
  3.  Hematocrit, hemoglobin, or complete blood count, initially and rechecked at 28 to 36 weeks of the pregnancy
  4. Syphilis, gonorrhea, and chlamydia testing, unless a written refusal for gonorrhea or chlamydia testing is obtained from the Client
  5. Rubella titer
  6. One-hour blood glucose screening test for diabetes, between 24 to 28 weeks of the pregnancy.
  7. PKU heel prick test for the newborn, within 72 hours of the birth

Holistic care with testing

All tests offered by an obstetrician’s office are offered by homebirth midwives.  The difference is that midwives provide informed consent for each test.  The midwife will explain each test thoroughly and provide risk/benefit information,  encouraging the Client to research and choose carefully, so that the Client can make an informed decision about what is right for her and her family.

Clinical monitoring during labor

This includes taking blood pressure, pulse, respirations, determining baby’s position, checking fetal heart tones, vaginal exams, administration of oxygen as necessary, etc.

Holistic care during labor

The midwife accompanies the couple, when her presence is requested.  She, along with her assistant/s, will provide encouragement, massage, aromatherapy, herbal, homeopathic or other remedies.  She can assist the mother with positioning and relaxation techniques. She will help keep the mother nourished and will remind her that she already knows how to birth.   She will help the mother to feel safe and free to labor and birth in the way that she chooses.

Clinical procedures during the birth

The midwife will perform hand maneuvers to support the baby’s head, as it emerges.  Midwives do not cut episiotomies except as a last resort.

Holistic care during the birth

The midwife makes every effort to protect the Client’s perineum by using massage, oils, warm compresses, counter pressure and relaxed guidance, during the birth.  The Client’s partner or any other special person is welcomed to assist with the delivery, to their comfort level.

Clinical procedures immediately following the birth

The midwife will assist with the cutting of the umbilical cord.  She will obtain cord blood, if the parents have arranged to bank it.  She will assist with delivery of the placenta, to the Client’s comfort level.  She will perform repair of the perineum, if necessary, and will use a local anesthetic. If necessary, the midwife may use pitocin or oxygen. Vital signs of the mother and the new baby are taken every 15 minutes, for the first hour, and every 30 minutes during the second hour.  A full, head-to-toe newborn exam will be performed within the first two hours of birth.  The midwife will administer eye ointment and Vitamin K drops or injection to the baby, if the parents wish.  She will also do the baby’s footprints.

Holistic care immediately following the birth

Once the mother is settled in, the midwife will assist with breastfeeding, if desired.  At some point, she will assist the mama to the bathroom and/or to the shower or bath.  The midwife or her assistant/s will bring the mother some food and drink and ensure that she is warm and cozy.  The midwife will adore the baby.

Clinical procedures during the postpartum period (24-hour visit, 72-hour visit, two-week visit, six-week visit)

The midwife will check vital signs for mother and baby, including monitoring for signs of infection.  We will provide you with a birth certificate worksheet to fill out by the 72-hour visit, and will submit this to the State for the baby’s birth certificate as well as social security card, typically arriving by mail  within 3-6 weeks after the birth.

Holistic care during the postpartum period (24-hour visit, 72-hour visit, two-week visit, six-week visit)

Breastfeeding is discussed at each visit, to ensure that the process is runnng smoothly.  Emotional well-being is also discussed, and the midwife will encourage the mama to attend postpartum support groups, such as breastfeeding groups and new-mama groups.  The midwife will provide the mother with information, concerning family-planning, at the 6-week visit.

Procedures that are NOT performed by the Midwife:

Making decisions for the mom or partner

The midwife understands that she is a servant of the Client, and not an authority figure.  While the midwife may provide the map, the Client is the navigator.  This is HER birth.  Midwifery Clients understand that with great freedom comes great responsibility.  The midwife is not liable for undesired clinical outcomes.

Ultrasound or high-level genetic testing

The midwife will refer you to a specialty provider for ultrasound and/or genetic testing.

Utilization of obstetrical medical equipment or interventions

Midwives do not use vacuums, forceps, routinely cut episiotomies or perform cesarean sections. There will not be an obstetrician at your birth, at home.  If we must transfer to a hospital, all clinical procedures would be performed by hospital staff.  It is important to note that, Arizona State Law requires midwives to terminate care with a Client who refuses to transport to the hospital upon the midwife’s recommendation or in the event of an emergency.  Also, the midwife does not treat any emergencies, prior to the Client going into labor (i.e. asthma, car accident, etc).  If an emergency occurs, during pregnancy, please call 9-1-1 and then let the midwife know as soon as possible.

Insurance billing

Homebirth midwives do not contract with insurance companies.  This is due to the fact that insurance companies require all medical providers to carry malpractice insurance.  The cost of an obstetric malpractice insurance policy is approximately four times a homebirth midwife’s annual salary.  These insurance policies are one reason why obstetricians have so many patients and have such short office visits.  Homebirth midwives have few Clients and long office visits.   Consequently, we operate on a basis of trust and informed consent with our Clients.  Should you have a PPO, they will oftentimes reimburse you for your midwifery expenses, at an “out of network” provider level.  This is usually a split, such as 60/40, or 80/20.  The midwife will provide you with an invoice, and you are welcomed to submit it to your insurance company, after the birth.

Doula care

Doulas and midwives are not the same.  A midwife can do many of the same tasks that a doula does.  However, the scope of practice is different.  Doulas can safely stay up all night with a Client, rubbing her back, and be awake enough to witness the beautiful birth, without safety being compromised.  A midwife cannot.  She must be sharp and on-point during the delivery, as she is responsible for the safety of the birth.  Doula care is invaluable.

Circumcision

The midwife does not circumcise.  It’s hard enough poking those cute babies in the heel or giving them a quick shot in the thigh.  The midwife has a list of providers who perform circumcision.

Visits Outside the Normal Prenatal Schedule

Interview:

An initial meeting will take place between the midwife and potential Client in order to discuss the Client’s ideal birth as well as the midwife’s role.  The midwife will share her experiences and educational background as well as her philosophy about birth.  This is an opportunity for the Client and the midwife to share in the excitement of the upcoming birth and discuss how the midwife can best serve her Client.  It is also an opportunity to discuss the various services and fees.

Initial Visit:

The initial visit is an opportunity to discuss your medical history and birth history.  We will perform a physical exam, which does not normally include a breast exam or vaginal exam.  We usually do some baseline labwork, such as a urinalysis and a blood-draw.  A risk-assesment is performed at this visit, to ensure that you are healthy and a good candidate for home birth.  This initial visit usually lasts about 1.5 hours, and this is normally our longest visit together.

 Assistants:

The midwife has two assistants who attend each birth with her.  These are professionals, trained in normal, healthy birth and also trained in dealing with emergencies at birth, utilizing neonatal resuscitation.  Assistants perform various duties, such as taking vital signs, charting, cleaning, and assisting in the event of an emergency situation.  You will have an opportunity to meet the assistants at a minimum of one prenatal visit, prior to the birth, and also at the group prenatal.  The assistants may arrive at your birth first, to do baseline vitals and set up equipment, etc.  They typically stay a little longer than the midwife, after the birth, to assist with tidying up and performing final rounds, before leaving to let you snuggle in and sleep while your new baby sleeps.  Assistants also may perform postpartum visits.

Availability:

Prior to the Client’s 36th week of pregnancy, and between visits, the midwife is available by phone or e-mail and will return messages within 24 hours.  Subsequent to the Client’s 36th week of pregnancy, and prior to the Client’s birth, the midwife is on call 24 hours a day.  The midwife is also available by phone for questions before and after the birth.

Not-In-Labor Questions (returned within 24 hours)

Midwife’s Phone: (480) 239-2912 (feel free to text!)

Midwife’s E-mail: azlovingbirth@gmail.com

Urgent Medical Question or In Labor (returned within 15 minutes)

Midwife’s Phone: (480) 239-2912 (please do NOT text!)

Medical Emergency (can’t breathe, bleeding profusely, car accident, etc.)

Call 9-1-1, and then call the midwife asap. (480) 239-2912

When Labor Begins:

When the Client believes labor has begun, the midwife respectfully requests that she be contacted as soon as possible, even if the Client is not ready for the midwife to arrive just yet.  This is so the midwife may begin making arrangements for attending the birth.

Once the Client has requested the presence of the midwife, she will make every effort to arrive at the Client’s home within 1 hour.

After the Birth:

The midwife will remain with the Client at least two hours after the birth, to monitor vital signs and ensure that breastfeeding is off to a good start as well as to clean the birth space.  The midwife’s assistants may stay up to four hours after the birth.

Postpartum Visits:

The midwife and/or her assistant/s will travel to the Client’s home at 24-hours, 72-hours, and one week after the birth to ensure that the mother remains healthy as she heals, and to ensure that the baby is growing and nursing well.  The client will return to the office for postpartum visits at 3 weeks and 6 weeks.

Failure of the midwife to provide service:

The midwife will make every effort to provide the services described herein.

In the event of a personal emergency, the midwife has two back-up midwives.

Amenities:

A comprehensive and individualized educational booklet, concerning the best ways to prepare the body for labor and childbirth, etc. as well as a listing of local resources are provided to the Client.

The Client will receive unlimited access to the Lending Library, from the first prenatal visit through the postpartum visits, and possibly beyond, dependent upon demand for particular books.

The Client will have access to an inflatable labor tub and water pump.

The midwife also provides the birthing kit, all of the disposable supplies for the birth.

 

Contact Your Midwife
As your midwife, I am on call 24/7 for YOU!
Phone: (480) 239-2912 (feel free to text!)
E-mail: jennifer@moxiemidwifery.com