"One of the main reasons women decide to use a midwife is to experience childbirth as naturally as possible. An additional benefit of having a midwife is their various payment options. Midwives often offer payment plans and sliding fees. According to the American College of Nurse-Midwives, benefits of receiving midwifery care include: - Decreased risk of needing a cesarean - Reduced rates of labor induction and augmentation - Reduced use of regional anesthesia - Decreased infant mortality rates - Decreased risk of preterm birth - Decreased third and fourth-degree perineal tears - Lower costs for both clients and insurers - Increased chances of having a positive start to breastfeeding - Increased satisfaction with the quality of care" Source: American Pregnancy Association

In a recent study on midwifery care and out-of-hospital birth, "results show that among low risk women who intend to give birth at home when labor starts there is no increase in perinatal and neonatal mortality or morbidity compared to similarly low risk women who intend to give birth in a hospital" [1]. Some other recent validations on the efficacy and safety of midwifery care include: - Among 16,924 women planning a home birth at the onset of labor, 94% had a vaginal birth, and fewer than 5% required oxytocin augmentation or epidural analgesia. - Nearly 1100 women attempted a vaginal birth after cesarean (VBAC) in this sample, with a total VBAC success rate of 87%. - Low risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes [2] You can read the full MANA study here: https://onlinelibrary.wiley.com/doi/full/10.1111/jmwh.12172 Sources: 1. The Lancet, 2019 2. MANA Statistics

Midwifery prenatal and postpartum care are available to anyone! However, home birth is safest for those who are considered low-risk. What does low-risk mean? In the state of California, midwifery laws say that someone is eligible for homebirth with a midwife if they give birth to a single baby (no twins or multiples), in the head-down position (not breech), between weeks 37 and 42 of pregnancy. Low-risk also means healthy. Some pre-existing health conditions that would risk someone out of having a homebirth include preexisting diabetes or hypertension, hyperthyroidism, chronic lung disease, chronic hypertension, severe asthma, epilepsy, some clotting disorders, congenital heart disease (grades 2-4), kidney disease, unresolved STDs and severe malnutrition. Outside of these pre-existing conditions, risk is assessed by the midwife and the client together through informed choice care, while taking into account community standard. Soemtimes, there are certain conditions that arise during pregnancy or labor that will risk someone out of having a homebirth - such as gestational diabetes that requires insulin or development of pre-eclampsia. These conditions make it safer for the birthing parent and baby to be under the care of an obstetrician in the hospital. If I have a client who is risked out of care during the course of their pregnancy/labor, I will transfer their care to their backup OBGYN. However, I will still remain present as labor support, advocate and continue with concurrent prenatal care (if applicable) and of course, postpartum care.

VBACs are my favorite and I'm a huge advocate and supporter of vaginal birth after cesarean! Current research says that VBAC is safest for those who have one or two low-transverse incisions on their uterus (VBAC or VBA2C). All other types of incisions or having had more than two cesareans are taken on a case by case basis after thorough review of medical records and surgical reports. If you'd like to have a VBAC at home, let's get in touch and discuss the options!

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When I arrive at your home for your labor and birth, I bring with me everything needed to safely care for mom and baby throughout labor, birth and immediate postpartum at home: - Tools for monitoring maternal and fetal vitals, including thermometer, stethoscope, blood pressure cuff and fetal doppler (to listen to baby's heartbeat in labor). - Newborn support including umbilical cord band, resuscitation equipment, including compressed room air, oxygen, pulse oximeter, bag valve mask, DeLee suction trap. - Maternal support including various herbal and homeopathic remedies, IVs, IV fluids, antibiotics for GBS, oxygen, anti-hemorrhagetic medications (herbs, pitocin, methergine, cytotec and TRX), urinary catheters, lidocaine for suturing and suturing equipment. - An assistant! Birth is safer with more than one midwife in attendance. An assistant will be called to your birth as you get closer to delivery to assist me in providing care to you and your baby.

You can expect to have your vitals and your baby's heartbeat monitored at regular intervals throughout labor. As you get closer to delivery, we will listen more closely to baby's heart rate to make sure that baby is handeling labor well. You can expect to be able to move freely throughout this time - we work around you and your comforts. There may be times when we ask you to change position if we are not able to listen closely enough to your baby - this is always discussed with you as the situation arises. In between times that we are caring for you from a medical standpoint, we can also provide you with comfort measures, encouragement and emotional support. This is your birth - we want you to birth your way! We discuss all of your preferences prenatally, so the team can do our absolute best to support you in birthing the way you desire. When it is time for your baby to be born, we are mindful to continue to work around your instincts and follow your lead. If you need guidance, we are here to help! As soon as baby is born, they go directly to your chest for immediate skin to skin. If baby needs help breathing after they're born, we assist the baby right there in your arms, so you can remain connected (quite literally) and close to your baby (this helps your baby initiate breathing!). We monitor your bleeding after birth and assist in the delivery of your placenta. Typically, we don't cut the umbilical cord until after the placenta has been delivered (long after it is done pulsing), but we can also cut the cord sooner if you prefer. Once the placenta is delivered and postpartum bleeding is at a minimum, we give you some time to take in your new little one and the experience, all while keeping a close eye on your vitals and your baby's vitals. We also support you in getting your baby latched onto the breast, eventually get you up to empty your bladder and rinse off in the shower. When you're ready to find out the stats on your little one (how much does baby weigh??), we perform a head to toe newborn exam right next to you, or walk you through examining your baby yourself! When you and your baby are both stable, we feed you and tuck your family into bed for your post-birth nap, finish cleaning up and show ourselves out. We resume the normal course of postpartum care and remain on-call for you for the first six weeks postpartum.

Water birth is definitely an option! While I cannot guarantee that your baby will come out under the water (raise your hand if you found out in labor that you actually prefer to be a land-birther 🙋🏻‍♀️), we can prepare for the opportunity to have a water birth. The birth tub is also an excellent comfort measure for labor, even if you don't want to give birth to your baby in the water. If you have a roomy/comfortable bathtub at home, we can use that for a water birth. Or I also provide an inflatable birth tub for clients to labor and birth in. The inflatable birth tub can fit in nearly any living space and comes with a brand new liner (to keep it sanitary) and hose. All you have to provide is your own adaptor to connect the hose to your preferred water source (we can talk more about this in-person).

This question gets asked more than you'd think - it's an important question! One of the great things about birthing at home is that we leave your house just as clean as it was when we arrived. As your birth team, we are responsible for keeping your space as free of splashes and drips as possible in labor. In the event that something like a little blood finds its way to a surface (occasionally it happens), hydrogen peroxide typically does the trick. Birth also requires the use of several linens - towels, sheets, etc. Right before we leave your home, we will start a load of birth linen laundry and contain all of the used disposable birth supplies in a trash bag for you to add to your can. Oh - and you're responsible for your placenta, which is double bagged and placed in your freezer, unless we're encapsulating it for you, then it comes home with us. We take pride in taking care of you and your space during the course of your labor and birth!

Midwives are trained and certified emergency responders. This means we have the ability to preform NRP (neonatal resuscitation) and BLS (basic life support). The two most common complications that arise in birth are a baby who becomes distressed in labor and excessive maternal bleeding after the birth. We also expect that around 10% of babies need some assistance in learning how to breathe after they're born. We carry all of the tools and medications necessary to help a baby breathe after birth (compressed room air, oxygen, bag & mask for PPV) and to help prevent and stop excessive maternal bleeding after birth (herbs, pitocin, methergine, cytotec, TRX). Midwives are also highly skilled at handling other urgent situations, like giving IV fluids for dehydration, resolving shoulder dystocia, etc. We work together with you as a synchronous team. For emergencies that arise that are out of our scope of practice or require more intensive medical support or intervention, we alert EMS and transfer to the closest hospital. For situations that arise that are not urgent, but require medicalized support, such as pitocin augmentation for a stalled labor or a therapeutic epidural for an exhausted laboring person to get some much needed rest, we always have a non-emergent backup transfer plan with a preferred backup provider. Our backup transfer plans are always discussed together prenatally, at the start of our care together. Parents choose their preferred transfer provider in the event of a non-emergent tranfer and their closest transfer provider in the event of an urgent/emergent transfer. Ignoring warning signs in labor and waiting for an emergency to happen at home before transferring is never the plan. We always communicate with you directly about how things are progressing and help you to make the informed choice that you feel most comfortable with. If the labor is starting to go outside of the range of normal and you feel safer transferring to the hospital (or for any reason), that is always an option availble to you.

The postpartum care provided to you and your baby is extensive and comprehensive. The course of care includes: - home visit at 24-48 hours after birth - 3 day home visit - 1 week home visit - 2 week home visit - 4 week home visit - 6 week in-office visit During these visits, you can expect to have your vitals and your baby's vitals taken each time. Your recovery will be monitored to ensure that you are healing well and thriving as a new parent. Your baby's weight gain will be closely tracked and you will receive extensive breastfeeding support, as needed. At the 24/48 hour visit, you can choose to have the California Newborn Screen done and/or the non-invasive Critical Congenital Heart Disease (CCHD) Screen. Closer to your six week postpartum visit, we will assess your core and pelvic floor health by checking your abdomenal muscles for any separation and your pelvic floor for overall function. You can also choose to have a PAP at six weeks (or later if you're not ready yet) if you're due for one. Other offerings during postpartum visits include postpartum belly binding, vaginal steam herb preparation and instructions, education on normal newborn growth, behavior and patterns, thorough screening for postpartum mood disorders, and so much more! You also have the option for extended postpartum care, which includes: - 3 month in-office visit - 6 month in-office visit - 9 month in-office visit - 12 month in-office visit There are so many things that come up over the first year postpartum that parents aren't sure about or need more support with - especially with fullterm breastfeeding, which continues to evolve as your baby ages, solids are introduced or you begin incorporating pumping in preparation to go back to work. In addition to baby topics, there's a lot of transition with your own body, like tracking your fertility to avoid (or encourage) another conception, hormone flucctuations over the first year, changes in intimacy with your partner, etc. These visits provide the space for you to get all your questions answered, gain some confidence and guidance, and continued care as needed (like a PAP or hormone testing!).

One of the tenants of midwifery care is that the skills and art of midwifery are passed down through generations by way of the apprenticeship model. Senior midwives are responsible for helping to raise the next generation of midwives. At this time, there are not currently students in this practice. However, there may be a student introduced in the future, if it's the right fit for this practice. You will always be asked for consent before a student joins your care.

All of your prenatal care, attendance during your labor & birth, full postpartum care through six weeks, and four additional postpartum visits over the first year postpartum. Also included in the global fee is the cost of your birth kit (disposable supplies for birth), birth tub rental (includes birth tub, tub liner and hose), and assistant midwife's fee. A non-refundable $500 retainer is due at your first visit. A minimum payment of $150 is due at each prenatal visit, and the entire balance is due in full by your 36th week of pregnancy.

Labs andultrasounds over the course of your care are not included in the global fee, though they may be covered by your insurance. The California Newborn Screen and RhoGAM shot (if your bloodtype is Rh negative) are also not included in the global fee. I will provide you with a price sheet for all labs and ultrasounds, so you know how much you will need to spend. If you are doing concurrent care with an OBGYN provider throughout your pregnancy, you can also choose to have labs and ultrasounds done with them if that is more cost effective (under insurance coverage), and then have your results sent to me. If you decide to use a birth tub at your birth, you will need to purchase a hose adaptor to connect the hose to your preferred water source (usually just a few dollars and can be found at your local hardware store). There are a few other inexpensive birth supplies that you will need to gather for the birth - most are items you likely already have around your house. A list will be provided.

As an autonomous Licensed Midwife, I am considered an out of network provider. This means many insurance plans do not cover my services automatically. However, with some plans you may be able to get reimbursed a portion of the fee after your care is complete. I work directly with a medical biller who can verify benefits before you start care so you know exactly what you're getting into financially, and who also advocates for reimbursement on your behlaf, so the process is as stress free as possible. While it's not a guarantee how much you'll get reimbursed, or if you'll get reimbursed at all, it's worth a shot to try! The medical biller doesn't get paid unless you get reimbursed, and her fee is 10% of your reimbursement. The most success with reimbirsement is through PPO and POS plans, and some success with HMO plans. Unfortunately Medi-Cal will not cover my service. If you qualify for and have Medi-Cal coverage, I offer a generous discount. Please get in touch so we can discuss.

There are lots of options to make midwifery care affordable and accessible to you! Every year, I am able to offer a steeply discounted rate to one to two clients per year (at about 50% of my fee) through my Midwifery Care Fund. Availability is limited, so get on the waitlist ASAP! I also offer a generous extended payment plan, outside options for extending payment plans even further and I sometimes accept barter/trade for care. If finances are THE thing standing in the way of your family receiveing midwifery care - please, reach out!! I'm always happy to discuss options specific to your family's needs. I also offer a generous discount for those who qualify for and are currently receiveing Medi-Cal benefits. Please get in touch to discuss. Check out the Community Give Back page to learn more about all the ways to make midwifery care more affordable and accessible for you!