Many people are surprised at the difference in our midwifery care
when compared to the typical obstetrical care when preparing for a
The difference begins at the free initial interview meeting - we will
schedule a meeting so that we can get to know each other, answer
questions, and find out if we are a good match for each other.
This meeting can be as quick as you'd like it to be, but typically
we will spend an hour getting to know each other.
Once you've chosen to hire us to assist you, we will begin seeing each
other every 4 weeks until you are 28 weeks pregnant. Once you are 28
weeks pregnant, visits become once every 2 weeks until you are 36 weeks
pregnant. For the 36 weeks appointment we will come out to your home
so that we are certain we can find your home, you can show us around
and get comfortable with our presence in your home, review your birthing
supplies, etc. After the home visit will see each other weekly in our
office until the baby is born. Every appointment is 30-60 minutes long.
We will take our time to get to know you and your family on a personal
level, as well as have plenty of time to ask (and answer) all of the
important medical questions.
It is extremely rare that you have to wait at all for your appointment.
We believe that your time is just as valuable as our own - as much as we
don't want to wait for an appointment, we don't want you to have to wait!
At each visit we will begin by simply talking - discussing nutrition,
concerns or questions you may have, finding out how you are feeling and
how you have been since our last appointment. After that, you will do
a urine check and weigh yourself. We will finish up by checking on your
baby (feeling for baby's position once the baby is big enough, listening
to the baby's heartbeat), measuring your uterus, and taking your blood
We STRONGLY believe in informed consent - that means that while we are
required by the Arizona Department of Health Services to offer a great
number of tests and procedures, we will discuss everything with you
beforehand and customize your care, performing only those procedures that
you have chosen and feel are best for you. The tests and procedures we
offer you are as follows:
- Blood typing
- Antibody Screen
- Complete Blood Count (CBC)
- Syphilis Screen
- Rubella Titer
- Hepatitis B
- HIV Screen
- Genetic Screen
- Gonorrhea and Chlamydia Cultures
- Group B Strep Culture
- Glucose Screen between 24-28 weeks
- Repeat Hemoglobin and Hematocrit at 28 weeks
- Rhogam for unsensitized Rh negative mothers at 28 weeks and 72 hours after birth
- Antibiotic Ointment to newborn eyes
- Vitamin K shot to the newborn
- Newborn Metabolic Blood Screening
When you feel that labor may be beginning, we will keep in contact with you by phone until
labor is established and you are ready for our assistance. We will monitor you and your baby
throughout the labor and delivery to ensure that everything is going smoothly.
We always come as a team - there are always at least two people at the labor and birth to
assist you. We know that once the baby is born we have two people whose safety and health
are counting on us, and we feel that it's very important to have two people there so that
(if necessary) one team member can attend to the medical needs of each person.
There is always at least one licensed midwife at the birth. The second person is usually
a student - but may be another midwife or an assistant. Every person who attends the birth
is certified in Neonatal Rescusitation and is fully ready to assist the midwife with whatever
she needs. (see our page
"The Birth Team")
Occasionally, there may even be three members of the birth team - and that is your choice!
You do not have to welcome anybody into your home that you do not desire to be there!
We strive to make your birth experience the best it can possibly be - that is our goal!
Every care provider has their own routines or things that they do with most births
when things are occurring in a normal, healthy manner.
Our routine labor/delivery care
- You are free to move throughout labor, walk around, choose a position of
- You are encouraged to eat/drink throughout labor
- You can choose to have as few or as many people as you desire at your birth.
We enjoy working with doulas, and believe that in many cases children
(older siblings of the baby) are a beautiful and welcome addition to
- You will push in whatever position you choose - squatting, hands and knees,
semi-sitting, standing - it's your choice.
- No episiotomy - if we perform an episiotomy, it means that we feel that
someone is at risk or that you have requested one. Usually our clients
don't tear at all - but studies have shown that tears heal faster and
hurt less than an episiotomy. If you do tear, we are prepared to repair
- Dad is as involved as he would like to be! If he wants to catch his baby,
we will help talk him through that!
- Baby is placed immediately on mom's belly - moms body is perfect for keeping
her baby warm and feeling safe, and makes her available for breastfeeding
whenever they feel ready for it.
- Breastfeeding is always encouraged
- The umbilical cord is only clamped once there is a reason to clamp it -
delayed cord clamping is the norm (this means waiting until the cord has
stopped pulsing and delivering blood/oxygen to the baby, or until the
placenta is born). Some reasons for clamping and cutting the umbilical
cord would be:
- cord blood collection: this requires immediate clamping/cutting
of the cord to try to get as much cord blood as possible as
there is a minimum amount required to be collected in order
for them to store your baby's stem cells.
- mom and dad want the freedom that comes with having baby's cord
cut, so that dad can hold baby across the room or other
family members may hold baby.
- Placenta is allowed to deliver when it's ready - we don't yank or pull on the
cord to rush it.
- Baby is not taken from mom and dad for at LEAST an hour - and then is only placed
next to them while we perform an exam on the baby.
In the immediate postpartum period (the first couple of hours after the birth), we will
continue to monitor you and the baby to make sure that everyone remains healthy - but
do our best to be as unobtrusive as possible to allow your family some quiet time to get
to know the newest member! You will be encouraged to get up and urinate in the first
couple of hours, and to shower if you desire. Once you have gone to the bathroom and
are back in bed, we will weigh the baby and perform a "newborn exam" - this simply means
we check the baby over from head to toe to make sure that he or she is perfect and healthy!
We will clean up quite a bit after the birth, usually starting a load of laundry, cleaning
up all of our supplies, wiping anything that got soiled down.
Once everyone is stable and healthy and things are cleaned up, we will leave - this is
usually about 2-3 hours after the birth.
We will be back to your home to check on you and your baby a day after the birth, then
again three days after the birth. At the 1-day visit we will review and have you sign the
birth certificate which we will submit for you. The baby's social security card request
is part of the birth certificate and will be sent to you automatically if you've requested
it on the birth certificate. We will weigh the baby, assist with breastfeeding if you
need it, and make sure that you and the baby are well.
After that, we will see you in our office at one week and the final visit at five weeks.
Your baby will be offered the "Newborn Screen" (formerly "PKU" test) to check for
metabolic disorders. At all of these visits we will answer any questions, make sure that
baby is gaining weight and breastfeeding is going well, make sure that you are healing
appropriately, answer family planning questions, and have closure to this intimate
relationship we have built over the past many months. The Arizona Department of Health
Services forbids Arizona licensed midwives from providing services after you reach six
weeks postpartum, therefore we always want to see you for your final visit when your
baby is five weeks old.
In those rare occasions that interference is needed, we do come with many tools and the
knowledge ready to deal with some of the issues that may come up. The largest issues that
need immediate attention would be if baby needs help after the birth, or if mom bleeds too
much after the birth. We bring oxygen to the birth and everyone that attends is certified
in Neonatal Resuscitation in case baby needs help. If mom is bleeding too much, we carry
Pitocin - a drug that causes the uterus to contract that almost always causes the bleeding
to stop and become normal once more.
If something happens which requires more assistance that we can provide, that is when we
will head to a hospital. The midwives will go to the hospital with you and continue to
provide emotional support throughout the birth as well as advocate for you.