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 believed I needed to gain experience as a midwife in a setting where I could learn from and depend upon more experienced midwives and doctors before providing care to women in their homes without the support a hospital provides. I was also sidetracked by family obligations. Finally, 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. When I had hospital admitting privileges as part of my practice in Denver, Colorado, my care was philosophically the same as when I attended home births while adhering to hospital policies.
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 assisting in the birth of babies with women resting on their sides, first on the delivery table and then in their labor beds.
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; a pulse oximeter; 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?
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 provide my clients with a supply list. The cost is about $25.00. It contains items such as Chux pads (urinary incontinence) and a box of vinyl gloves. I provide all medical supplies.
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 earlier 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.
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. How do you care for women during labor and birth?
I am present when my client calls me. I support and guide her through her labor and birth, offering suggestions for comfort and to enhance labor progress. I pay particular attention to a well positioned baby to enhance labor progress. I listen to the baby’s heartbeat regularly to know that the baby is well. I encourage her to give birth in whatever position works best for her.
12. Can I eat and drink in labor?
Yes, I encourage women to drink fluids and eat food for energy during labor.
13. What about interventions in labor, such as breaking the bag of waters and cervical exams?
I rarely suggest breaking the bag of waters in labor. I perform as few cervical checks as possible in labor. I always discuss any interventions with the laboring woman and only intervene with her permission.
14. Can I give birth in the position I choose?
Yes. 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.
15. Do you leave the cord intact until it stops pulsating?
Yes. In fact, I typically wait for the placenta to deliver before offering to clamp it. The person of your choosing cuts the cord.
16. Do you pull on the cord and/or massage the uterus to deliver the placenta?
I observe for signs of placental separation from the wall of the uterus and then encourage the mother to push to birth the placenta. I can utilize what is known as controlled cord traction to assist her as necessary.
17. Do you give Pitocin after the birth?
I give an injection of Pitocin after the birth only if the mother is at risk for hemorrhage and/or if she is bleeding excessively after the birth of the placenta. I always discuss this with the mother and give the medication with her permission.
18. What medications do you bring to the birth?
I bring medication to prevent and/or control hemorrhage after the birth, including Pitocin, methergine, and misoprostol. These are the same medications that are used in the hospital. I bring IV fluid. I can start an IV if the mother is bleeding excessively after the birth or the mother is dehydrated from excessive vomiting during labor. I bring Zofran to treat excessive vomiting in labor if needed. I bring antibiotics to treat a mother who is GBS positive if she chooses to be treated. I bring injectable newborn vitamin K and erythromycin eye ointment if the parents to choose to give either or both of these medications to their newborn. I bring lidocaine local anesthetic for use when I repair a
19. Do you place the baby immediately on the mother’s chest following birth?
Yes and I encourage women to reach down and assist the baby up onto their abdomen/chest as baby is born.
20. Do you suction the baby?
I do not suction well newborns.
21. What if the baby needs help breathing when s/he is born?
Before the birth I set up all of the equipment and medication I might need including including oxygen, a newborn pulse oximeter, and an “ambu bag” used to assist a newborn with breathing. I am certified in newborn resuscitation as are my birth assistants. We are experienced in assessing and caring for newborns who require resuscitation at birth.
22. If I tear when I give birth, can you repair it?
Yes, I can repair vaginal tears. I am very experienced in doing this.
23. Are you comfortable with siblings being present for the birth?
Yes. I pioneered that change in a suburban hospital I practiced in over 25 years ago. I request that young children have a care provider present for them separate from the laboring partners.
24. Are you comfortable with water birth?
Yes. 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.
25. 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).
26. 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.
27. Isn't home birth messy?
No. The birth assistant and I keep the birth place quite tidy and clean up after ourselves.
28. 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) and I perform the newborn cardiac screen. The results are sent to the baby's care provider. Finally, I see the mother 6 weeks postpartum for a follow up exam.
29. 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. If these newborns require treatment it can often be provided at home with what is known as a bili blanket by the newborn care provider.
30. How is a birth certificate obtained?
I file the paper work with the State of New York to obtain a birth certificate for the newborn.
31. When do I first begin to see you and how often do I see you?
Prenatal care usually begins between 8 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.
32. Where do I see you for prenatal visits and how long are the visits? Who can be present for my visits?
I see my clients for prenatal care in my office. 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. You may bring who you wish to your appointments.
33. 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. I accept transfers of care through 36 weeks of pregnancy.
34. Do you accept women seeking a VBAC (vaginal birth after cesarean)?
Please contact me to discuss this on a case-by-case basis.
35. Do you care for women seeking a breech vaginal delivery or delivery of twins at home?
I do not care for women seeking a breech vaginal delivery or women with a twin pregnancy at home.
36. 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 genetic screening testing, that decision ultimately being the client’s. I recommend ultrasound evaluation in early pregnancy if the date of your last menstrual period is unknown or uncertain, your periods are irregular, or if there is a medical indication for an ultrasound such as unexplained
vaginal bleeding in pregnancy. I do require that a client has a screening/anatomy ultrasound at 20 weeks gestation. I do require gestational diabetes screening. If a client prefers not to drink the lab glucola I recommend other means for screening.
37. 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 her or him regarding your care. Most of the time a telephone consultation is all that is needed. The physician provides medical guidance regarding the problem. Occasionally the client will go to see the physician for further evaluation of the medical problem.
38. 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.
39. 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.
40. 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. I encourage all of my clients to get regular exercise. We discuss exercise in pregnancy as it affects each individual client’s needs. 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.
41. Do your clients attend childbirth education classes?
Yes. I request that all first time mothers and partners complete an online prenatal education class to prepare for labor and birth.
42. What happens if I need to go to the hospital during labor?
I always travel to a home birth with directions and telephone number to the closest hospital and/or 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
43. How many transfers have you had?
Approximately 10% of first time mothers are transferred in labor. I have never transferred a mother or newborn who was medically unstable and/or requiring emergency care.
44. What are the most common reasons for transfer?
Slow progression in labor and request for pain relief.
45. 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 common gynecological complaints such as vaginal and urinary tract infections and provide contraception. I also provide care for menopausal and postmenopausal women. I have diagnosed many medical conditions including cardiac abnormalities, thyroid disease, PCOS, melanoma,
breast cancer, vulvar cancer, and ovarian cancer amongst others over the years. I consult with and refer to medical providers when necessary.
46. Can you provide me with references from former clients?
Yes! My former clients are happy to communicate with you by email and/or telephone.
47. Do you carry medical malpractice insurance?
No, I do not carry medical malpractice insurance.
48. What made you leave Colorado for New York?
I wished to return to the State of my birth and to enjoy the benefits of the law I helped to
pass in 1991 which established a Board of Midwifery, the only such Board in the U.S.