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Frequently Asked Questions What is a CNM? All of the Certified Nurse-Midwives at Inanna Birth and Women's Care also hold masters degrees in different areas of women's healthcare and have clinical experience caring for pregnant women after numerous years of hands-on experience. What is the difference between a nurse-midwife and a doctor? Nurse-midwives at Inanna Birth and Women's Care practice the midwifery model of care.
A physician's education and experience is typically focused on complications in pregnancy and delivery. We believe that pregnancy and birth are normal, natural events in a woman's life and that birth is least complicated with fewer interventions. Is it safe to have my baby outside of the hospital? Very few pregnant women are unable to have their baby with a midwife in the birth center or at home. Age is not a risk factor, neither is infertility, nor is a history of miscarriages as long as things are progressing normally. Women of any age who begin their pregnancy in a healthy state generally remain healthy and have a normal delivery. During regular pre-natal visits, we conduct thorough screening to ensure that you remain healthy and normal. We also use education, nutrition and exercise to prevent problems and can manage most of the common pregnancy complications that may arise. Texas Law regulating Birth Centers requires that women who plan to deliver out-of-hospital be medically low-risk and be expected to have an uncomplicated birth. Examples of conditions that may place a woman in the higher-risk category and need medical care and hospital birth may include risk factors such as uncontrolled high blood pressure, heart disease, kidney disease, current addiction to drugs or alcohol pre-existing Type II diabetes, bleeding or blood clotting disease. Please note that gestational diabetes in a prior pregnancy does not automatically exclude you from consideration for a birth center birth. Except for serious medical conditions, all pregnant women are eligible for care by the midwife at Inanna Birth and Women's Care. We suggest you call us to discuss your questions with the midwife, or schedule a free tour of the birth center and an interview with a midwife. Why would I want to have my baby in a birth center? There are many reasons why women choose to give birth at a birth center. Some of them include: Freedom- You are encouraged to walk around, eat and drink during labor. You can have your baby in whatever position seems most natural to you and are never confined to a bed or strapped to monitors. The midwife uses a doppler to intermittently monitor your baby throughout labor so you are not restricted in your movement. Studies have clearly shown that labor is Privacy- You and your family will have complete privacy and will never be cared for by strangers. You will get to know our small staff during your pregnancy and by the end we usually all feel like family. You can have as many friends and family members with you to welcome the new baby. Personalized care- During your pregnancy, we get to know what is important to you and your family, so that we can accommodate your wishes. Would you like to avoid an episiotomy? Would you like to avoid unnecessary labs Breastfeeding support-We will encourage and assist you to nurse your baby soon after birth. We do not routinely offer sugar water or pacifiers to babies and your baby will never leave your side. Should you require assistance with breastfeeding in the days and weeks following your birth, a few of our staff are certified breastfeeding educators. Our birth assistants are also excellent in providing breastfeeding assistance. Safety- Research has proven that out-of-hospital birth leads to fewer interventions and complications for both the mother and the baby. The caesarean rate for women receiving care from Inanna Birth and Women's Care is only 3-4%. Your baby will not be subject to unneeded injections and examinations. Your body and your choices will be respected. A study comparing out of hospital birth to in hospital birth showed that for first time mothers, out of hospital birth was as safe as in hospital birth, and for mothers who have already had one baby, out of hospital births are safer than in-hospital births The National Birth Center Study What if something goes wrong? First of all, the chances of you having a problem are very small. Unlike the stories one hears or the dramas on television, birth is generally a straightforward and safe process. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time and we can calmly plan for, prevent or manage a problem. The more interventions performed during the birth process, the greater the likelihood for the development of problems. We do not handle high-risk pregnancies and you must be full term and essentially healthy to have your baby in the birth center. If problems arise with you or your baby, we have emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and pain medication), and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation). If you or your baby need to transfer to the hospital, we will accompany you. Our back-up physician, Dr. Fred Cummings has privileges at Presbyterian Hospital of Denton. Nationally, about 10% of women who plan to have their baby out-of-hospital end up transferring to physician care and have their baby in the hospital. About half of these transfers happen during pregnancy, for conditions such as gestational diabetes and high blood pressure. During labor, the single most common reason for hospital transfer is actually not an emergency; most of our hospital transfers are due to stalled labor. Inanna Birth and Women's Care has an even lower rate of labor transfer of only 8%. If you need to be cared for in the hospital, the midwife will accompany you to the hospital to provide support and assistance. You can then transfer back to us immediately after discharge for post-partum care (including a 3 day visit visit, breastfeeding support, etc). How much does it cost and will my insurance pay for it? Because we contract with some insurance companies, we cannot quote an exact price, but complete care at Inanna Birth and Women's Care costs about 1/2 to 1/3 of a typical delivery in a hospital. We have very affordable self-pay rates and payment plans can be arranged to meet almost any budget. Please call us to schedule a tour and interview so we can discuss your specific situation. We are in-network providers for the following Insurance Companies:
Do not be discouraged if your insurance company is not on this list. Considering the high cost of using a hospital for delivery, our out-of-network rates can sometimes mean fewer out-of-pocket costs for you. Even if it turns out that having your baby with us costs you a few dollars more, we are certain that you will find the personalized, family-centered care you receive is well worth a small additional expense. What happens when I go into labor? When your labor starts, you will page or call your midwife, who will meet you at the center. We expect you to labor at home until your labor is active. When you arrive with your family at the center, you will get settled in your choice of private birth suite. We ask you to bring nutritious snacks and energy drinks. Not only are you allowed to eat and drink during labor, you are encouraged to do so. Most hospitals have rules against laboring women having anything but ice chips, We will closely monitor your labor and the baby's health during labor, but we do so in such a way as not to interfere with your mobility. We have a variety of tools to help you with labor - cold and hot packs, birth balls, massage, hydrotherapy and the constant support and supervision of a skilled midwife. We encourage you to consider a water birth. Laboring in water shortens During labor and birth, we don't tell you what to do; instead, we guide you to the best way for you to get through the hard work of having your baby. You can be in any position you like for the birth. Basically, you will find the right way through labor and we will be there to support you. How long can I stay at the birth center after I have my baby? After your baby is born, you must stay for a minimum of 2 hours, according to Texas regulating birthing centers. The maximum stay is 24 hours. Before you leave, the midwife does a thorough check of the mother and newborn to ensure that you are both safe and healthy for discharge. Can't imagine going home so soon after having the baby? Most of our clients feel great after their unmedicated labor and birth and are ready and anxious to get back to their own bed and their own home. It is amazing how much energy you have after accomplishing your goal. Newborn Screening Tests are performed on the baby's blood sample at
the 3 day visit and again at the two week visit. Your baby should be examined by your choice of pediatrician at the time the pediatrician Can my family be present for the birth? You can have as many people with you during labor and birth as you like. Some clients have multiple friends and family, others prefer the privacy of being alone with their partner. We have a separate family room where people can be close by without actually witnessing the birth, allowing you privacy while still having the important people nearby. What about children attending the birth? Some people worry about having their young children present during the birth. Our experience with hundreds of siblings and cousins has been overwhelmingly positive. The only way to make the experience negative is to not allow the child to dictate his or her level of participation. Very few children under three are interested in actually seeing the baby born, but they are often anxious to be the first to hold their new sibling. Little ones need their own support person (not daddy, because he will be busy with mommy). They are usually content to play or nap and check in on mommy periodically. With basic age-appropriate preparation, children of any age can participate fully in the experience. Older children, especially girls, are often fascinated by the process and want very much to be a part of the experience. Having your other children present for the birth can be an important part of their bonding experience and acceptance of the newest family member. Natural Labor sounds like a good idea, but what if I want pain medication? Some women, especially those having their first baby, are frightened by the idea that they will be forced to labor without the option of pain medication. None of us knows ahead of time what labor will be like or how we will cope. Many women tell us that they have a low pain tolerance. That may be true for certain things, but labor is unlike any other experience of pain that you will have in your life. You will be thoroughly prepared through pre-natal visits with the midwife. The continued presence of the midwife during labor will reassure you that you and your baby are safe. We strongly recommend childbirth preparation Should you desire some form of pain relief during labor, we have injectable narcotics, Nubain or Stadol, available. We use it very rarely, because our clients usually surpass their own expectations of what they are capable of, but some like to know it is there just in case. Can I have an epidural at the birth center? Epidurals are not available outside of the hospital. While epidurals are commonly used and relatively safe, there are major risks to the mother and baby involved in using an epidural. The mother's blood pressure can drop Is underwater birth safe? Most people worry about the baby breathing under water and this is a very common question. When the baby is born in water, it is still attached to the umbilical cord and receiving oxygen exactly as it was in the womb. As a matter of fact, a baby born under water doesn't even realize it is born until you take him or her to the surface. The midwife brings the baby out of the water within a few seconds of birth, to minimize any risk. Waterbirth has been proved through thousands of birth around the world to not only be safe, but perhaps safer for the mother and baby. Can I become a client during pregnancy? Women may transfer in to care at Inanna Birth and Women's Care at any point in their pregnancy. Some women need some time to realize that their fears about birth are misplaced and that they want to have their baby in a private, relaxed setting. Becoming a client during pregnancy is as easy as coming for a tour and interview and if we agree that Inanna Birth and Women's Care is the place for you, we will fax a request for your pre-natal records to your current care provider. What are your policies on episiotomies, intravenous fluids and newborn treatment? The nurse-midwife does not cut routine episiotomies. Episiotomies are used occasionally in cases of fetal distress. Over the years, our episiotomy rate has remained less than 3%. Intravenous fluids are used in the Center for women who become dehydrated, need IV antibiotics, have significant blood loss after the baby is born, and occasionally in other circumstances. Our philosophy about newborn care is to prioritize family bonding. At the moment of birth, the baby is passed directly to the mother. The newborn exam is done in the room with the family present. What kind of post-partum care will I receive? If the mother and baby are healthy, and the mother desires, the family may return home after a two hour post-partum stay. Some families stay at the Center longer depending on patient preference and the health of the mother and baby. Most of our families are eager to go home to their own home and snuggle in bed with their new baby. You and your baby will receive a follow-up visit from the nurse-midwife on day 3. When the baby is 2 weeks old, you and your baby will have an appointment at the Center. The mother has a six-week post-partum visit with the nurse-midwife. The midwife is available throughout the post-partum period to answer breastfeeding questions or other concerns you may have. What happens if two people are in labor at once? It has happened before! We have a back up midwife on call to ensure that every woman in labor will receive the attention she requires. Who is your back up doctor? We have the privilege of working with Dr. Fred Cummings and will consult or refer to him accordingly. Your midwife will accompany you to Presbyterian Hospital of Denton and your care will be managed with Dr. Cummings should transfer be necessary. How many babies do you deliver per month? We do not generally exceed 12 women with due dates in each month. Because some go early, some go late, and some right on time, we deliver approximately 10-15 babies a month. What routine prenatal tests do you require? We will offer to you all tests recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM), as well as those of the State of Texas. We will offer education on the screening, so that you can make an informed choice. Some of those screens are:
What method of childbirth preparation is recommended? Jean and Betty are certified instructors of Birthing From Within. In these classes, parents practice and master a variety of proven pain-coping exercises and build their pain-coping confidence. You and your partner will explore feelings about pregnancy through creative birth art. Topics covered include birthing as a rite of passage, "losing it" in labor, unique pain coping techniques, suggestions to make labor easier and shorter, pitfalls of labor "coaching," and early postpartum issues. Jean offers a series of six evening classes in her home, located near the birth center. Please call Inanna Birth and Women's Care to register for classes. Hypnobirthing and Bradley Method classes also offer excellent birth preparation. Of course, you are free to participate in whatever method of childbirth preparation best meets your needs and interests. What complications have you handled? How did you handle them? Briefly, many complications can be and are handled at home or in the birth center without further incident. For instance, a cord around the neck, shoulder dystocia, fetal distress, maternal exhaustion, dehydration, postpartum hemorrhage, and newborn respiratory distress. If the situation cannot be stabilized, we will not hesitate to call for emergency assistance. What procedures do you require on the newborn? We are required by the state of Texas to offer antibiotic eye ointment to prevent infection caused by undetected or untreated gonorrhea and/or Chlamydia infection (screening for these infections is offered during prenatal visits, but not required) Also offered is a one-time injection of Vitamin K to prevent Hemorrhagic Disease of the Newborn. We encourage you to educate yourself and make an informed decision as to whether or not you would like these procedures for your newborn. You have the option of refusing treatment with a signed waiver. A Newborn Screening Test for inborn metabolic errors, obtained by a heel stick for blood collection, will be offered between 2 and 5 days after birth. It is required by the state of Texas that you have proof of the test or a signed waiver for it in order to apply for a birth certificate for an out of hospital birth. We can administer the test at the birth center or have you sign a waiver if you decline the collection. What if I want a circumcision for my baby boy? The American Academy of Pediatric does not recommend routine circumcision. Studies have shown that there is little benefit to this procedure. However, the risks of the procedure are few. If you desire a circumcision for your son, Jean can do this simple procedure in the office. She uses comfort measures as well as local anesthesia to make the experience less stressful to your baby and to you. She generally prefers to wait eight days after birth to ensure your baby is nursing well and his blood clotting capabilities are at their peak. What do I need to do to transfer care to Inanna Birth and Women's Care? If you have decided that Inanna Birth and Women's Care is the place for you, transferring to us is very simple. You will only need to sign for a release of records from your previous care provider. It is never too late to transfer, as long as you have a normal healthy pregnancy. |
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