Why is it called community birth?

For years, births that took place in birth centers or at home were designated as “out-of-hospital” births. Since this terminology reflects a bias for hospital birth, midwives and the families they serve have begun to call home and birth center birth “community birth”.

This subtle shift in words helps to equalize a very lopsided system. Throughout this website, you will see references to home birth and community birth used interchangeably.  

What is a Midwife?

The word midwife comes from Middle English and means “with woman.” She is a healthcare professional with specialized training to serve women throughout the childbearing year and beyond. A midwife is skilled in assessing and managing the physical and emotional needs of a woman and her family, collaborating and consulting with other providers when indicated. She is trained in normal physiologic processes of the female body, as well as the complications and treatments for various conditions.  

In California, there are two types of midwives in practice: Certified Nurse Midwives (CNM) and Licensed Midwives (LM).

CNM = Certified Nurse Midwife

A CNM is trained as a nurse and also as a midwife. Her certification is governed by the Board of Registered Nurses. Currently, CNMs are required to work under the supervision of physicians, meaning that most work in hospital settings. Few CNM programs include specific training in community birth.  

LM = Licensed Midwife

An LM is trained solely as a midwife. Her license is governed by the Medical Board of the State of California. LMs are not required to work under supervision, and they are able to work in homes, birth centers, and hospitals. LMs in California are required to attend specific educational institutions, all of which require clinical components in community settings.  

Some LMs also maintain an additional designation: Certified Professional Midwife. This certification is granted by the North American Registry of Midwives and is the only earned after completion of clinical and educational studies specifically including community birth. 

For more information about the midwifery model of care, go here.

Is home birth safe?

Short Answer: Yes. Home birth is as safe or safer.

Long answer: Community birth is a difficult thing to study. Very few countries collect data in a way that allows for the same populations to be studied, under the same conditions, with distinguishable variables. You might get a study of home versus hospital, but it fails to control for planned versus unplanned home birth (there is a BIG difference here) or maybe it fails to control for the low-risk population typical of home births and compares to a higher risk population in hospitals. Some of the biggest indicators for safety—perinatal, neonatal, and maternal mortality—are so rare, that large sample sizes in well designed studies would be needed to glean truly accurate data.

Because it is deemed unethical to create a study that would randomize home versus hospital birth for low-risk pregnant women, comparisons will always be tricky to create.

However, with the available information, it appears, time and time again, that home birth is as safe or safer than hospital birth. Consistently, home birth has fewer interventions and similar rates of perinatal and neonatal mortality. Additionally, planned home birth tends to yield higher rates of vaginal births, exclusive breastfeeding, and client satisfaction.

When families plan a community birth with a trained professional in a well functioning system (meaning access to transfer to hospital if need be, access to needed medical supplies and training, etc.), outcomes are favorable.  

RESOURCES

• Meaningful discussion on data in studies

• The NIH’s discussion on home birth

• Improve maternal mortality

California Licensed Midwives furnish statistics to the Medical Board each year, stats can be found here.

While California Obstetricians do not submit to a similar statistical database, information about statewide California birth statistics can be found here.

One thing people fail to ask is:

Is Hospital Birth Safe? 

From available evidence in well-developed countries, statistics are showing a greater use of interventions and increased medicalization of birth leads to an increase in maternal, infant and perinatal morbidity and mortality. In fact, the US currently spends the most on pregnancy and birth and ranks last in the developed world for maternal mortality.  Neonatal mortality yields similar rankings among comparable countries.  [Source 1 / Source 2]

Can anyone have a home birth?

For low-risk, healthy women, midwifery care and community birth is a reasonable and safe option. By our best estimates, about 80% of women are low-risk and healthy enough for midwifery care and community birth. If a woman has a pre-existing condition like high blood pressure, diabetes, or cardiac issues, the safest place for her to birth is a facility with access to practitioners and equipment to meet her increased needs. 

Additionally, in the State of California, midwives can only attend women carrying one baby in a head-down position from 37 weeks to 42 weeks gestation. Multiples, breech presentation, and extremely pre- or post- term increase risk and therefore are referred to physicians for delivery.  

Do you do water births at Pacific Midwifery?

Yes, we support water birth at Pacific Midwifery. Studies have shown the safety of water for both labor and birth. In fact, in home or hospital, water is used in labor as a natural pain relieving tool. Through a variety of physiological mechanisms, immersion in water during labor has been shown to not only reduce the sensation of pain, but also lower stress hormones, which in turn has been shown to reduce the length of the all stages of labor. While not all women will choose to birth in the tub, the use of warm water immersion is a valuable tool to have available.

Common concerns about water birth are risk of infection and transition to breathing for the baby. There has been no reliable data indicating an increased risk of infection during water birth when hygienic conditions are maintained. Babies are grown in water. The mammalian dive reflex will keep a baby from inhaling a breath until his/her face is exposed to air, so it is with bringing your baby up out of the water that you will see the first breath. [Source 1 / Source 2 / Source 3].

What happens if something goes wrong?

Because midwives have safeguarded normal for thousands of years, they have developed a keen sense of risk assessment. At every visit, the midwife is gathering information to understand a fuller picture of the client. During the course of pregnancy, birth, or postpartum, if conditions arise that are outside normal, the midwife consults with and refers to a physician and/or hospital. 

While there are no guarantees in pregnancy, labor and birth, a midwife’s job is to use her years of experience, her training and education to keep moms and babies safe. Sometimes the safest place to birth is a hospital. In those cases, arrangements are made to transfer to a hospital and the midwife goes with the family, gives report to the hospital staff, and, while no longer acting as primary caregiver, stays as a support and advocate until birth.  

How much does it cost to have a baby with Pacific Midwifery?

I always think this question should be:
“How much does it cost to NOT have a baby at Pacific Midwifery?” 

Short answer: We have a deposit fee ($6,000) due by 36 weeks. 

Long Answer: Interestingly, the cost of having a baby in a hospital is a complete unknown. One study showed it could be as little at $3,000 and as much as $36,000 for a vaginal birth. There is no obstetrical practice that could predict what the overall cost will be for a patient in their care having a hospital birth.  The truth is our fee is a fraction of what a hospital birth costs. While most doctors and hospitals contract with insurance, so rates charged to families are reduced, it is estimated that the average cost of hospital birth is about $18,000. With deductibles, co-pays, and out-of-pocket contributions, a hospital birth can cost a family upwards of $7,900.

More importantly, there is really no way to put a dollar value on the care and attention families get in our practice. There is no way to calculate the hours of education, experience, and training that our staff has acquired and puts to use for you and your family. An average family in care at Pacific Midwifery has at a minimum of 25 face-to-face hours of care with staff.

This is a very different type of model than conventional obstetric care. 

That being said…

While a particular appointment for lactation consultation or an annual exam is easy to price—pregnancy, labor and birth care is more difficult. In order to offer the type of care we do, we operate differently than a regular doctor’s office. We have a deposit fee ($6,000) due by 36 weeks. For families with no insurance coverage, this deposit acts as the service fee. For families with insurance, this fee, in all or in part, may be reimbursed by insurance once our care is complete. Our financial agreement clearly outlines what this deposit covers and what it excludes. Because each pregnancy and birth is unique, there may be additional services required. If there are additional fees, we will send a final bill at the conclusion of care for cash paying clients. For clients with insurance, we will first attempt to secure payment from insurance for additional services before billing the client. We strive to have no unexpected or unexplained fees for our clients. While we deserve to be compensated for our time, services, and supplies, we also believe that families deserve to be fully informed about the cost of care.

We do understand that our deposit fee is a considerable amount for most families. We understand the sacrifices families make to invest in midwifery care and do our utmost to honor those sacrifices with quality care and attention. 

Sources

• Ultimate Guide to Home Birth Insurance Reimbursement

• The Cost of Having a Baby in the United States

• Analysis of variation in charges and prices paid for vaginal and caesarean section births: a cross-sectional study

Do you take insurance?

We do not contract with insurance. We do give our clients a detailed financial contract so they understand their financial obligation and when it is due. Fees are paid prior to birth. However, we are happy to submit a claim on your behalf or give you a superbill to submit yourself. Any fees not covered by a client’s insurance are the responsibility of the client. Submission of a claim is not a guarantee of reimbursement. We want midwifery care to be accessible to families and understand some families may be experiencing financial hardship. For these families, we are happy to discuss longer payment plans and other options. Please call Pacific Midwifery to inquire further.

Do you take MediCal/CenCal?

At this time, Pacific Midwifery is not a MediCal/CenCal provider. Reimbursement rates for this program are not sufficient to sustain the type of care model that we take pride in delivering. If this changes in the future, we will be sure to let everyone know. Payment plans are available for MediCal/CenCal families interested in care. Please phone Pacific Midwifery to get more information.  

Who should see a Lactation Consultant?

Every mother being discharged from an area hospital is set up with a follow-up appointment with a lactation consultant. Oftentimes these appointments are merely to confirm that everything is going well. Sometimes, however, these appointments might address issues before they become troubling, add insight to an already great plan, or offer educational input in those early days. Of course, any family struggling with latch, weight gain, pain during feeding or milk supply should certainly be seen by a local Lactation Consultant. Pacific Midwifery is one of the few practices offering the option of in-home appointments to new families needing breastfeeding support of any kind.  

Why would I see you for my annual exam?

Midwives are trained in gynecology and able to offer a holistic approach to annual wellness exams. We offer all the same screenings as a physician’s office and can order any lab work or diagnostic tests that are necessary. A typical first visit is an hour or longer, allowing for your midwife to really get to know you, your medical history, your current health status, and your health goals.