Gentle Hands Midwifery Services
Serving Michigan & Indiana's Home Birth families
“Those who know your name will trust in you, for you, Lord, have never forsaken those who seek you.“
Psalm 9:10

How to Choose a Midwife

Patients Bill of Rights.
Questions to Ask Your Midwife, Doctor or Hospital.
Differences of Midwives. Why Midwives Have Different Titles Behind Their Name.
What You Can Expect Me To Do.
What I (Midwives) Will Not Do
What I Expect Out of You

There are a number of factors you need to consider prior to choosing your care giver. The following are things to ask yourself and your care giver that will help you to make the choice.

1. How did she become a midwife?
2. What training has she had?
3. Is she certified or licensed with any organizations?
4. Does she belong to any midwifery organizations, attend conferences, workshops, subscribe to professional journals? (all to keep her current)
5. How many births has she attended as the primary midwife?
6. Does she handle higher risk situations, such as twins or breeches?
7. What is the fee for her services, how must it be paid, what does it include?
8. What kinds of services are included in prenatal care? (early detection of problem areas for the mother and baby; nutrition information; exercise recommendations; in-home care; recommendations for parent education via books, videos, or classes)
9. What does she do if there are two births at the same time?
10. Does she work with another midwife or assistant at births?
11. How does she handle problems or complications that might develop during labor?
12. What standard and emergency equipment does she carry? What herbs or medicine does she use? Which ones does she not carry and why?
13. Does she have any affiliation with a physician who can answer unusual questions either during the pregnancy or in an emergency?
14. What is her policy for transporting to a hospital?
15. What medical facility would she use?

Reprinted from http://midwiferytoday.com/articles/homebirthchoice.htm

The Patient's bill of rights

The patient has the right to:

1. Considerate and respectful treatment.
2. Obtain from their physician complete information concerning their diagnosis, treatments and prognosis in terms the patient can reasonably be expected to understand.
3. Know by name the physician responsible for their care.
4. Receive from their physician the information necessary to give true informed consent prior to any procedure or treatment. This information should include a description of the procedure or treatment, the risks involved and the probable duration of the incapacitation.
5. Information regarding medical alternatives.
6. Refuse medical treatment.
7. Refuse to participate in any medical experimentation.
8. Know and question hospital rules and regulations that apply to their conduct as patients.
9. Examine and receive and explanation of their bill regardless of the source of payment.

Questions to ask

1. How busy is your practice?
2. Do you limit the number of clients you serve so you have more individual time with each one?
3. How long is an average prenatal visit? (will you have adequate time to ask all of your questions?)
4. How did you become a midwife?
5. What is your training?
6. What is your certifications?
7. Do you have an assistant?
8. Do you have a back up midwife?
9. Are you available 24 / 7 ?
10. What emergency equipment do you bring to births?
11. What are your services?
12. What is your philosophy of birth?
13. Do you belong to midwifery organizations?
14. Do you do continuing education units to keep current with new information?(CEU's)
15. Do you subscribe to professional journals, to keep current with new information?
16. If you are on vacation, or have a day off, who covers for you?
17. What is your transfer rate?
18. What is your c-section rate?
19. What is your back up plan?
20. Do you have a back up doctor?
21. What post partum care do you provide?
22. How many births have you attended / helped with as a total?
23. What is you fee, and how does it need to be paid?
24. Do you accept insurance?
25. Do you bill insurance?
26. Does you fee cover everything?

Differences of midwives: (Why Midwives Have Different Titles Behind Their Name.)

Certified Professional Midwife(CPM)

Certified Professional Midwives are skilled professional who provide the Midwives Model of Care to women and families in a variety of settings, including birth centers, homes and hospitals. Preparation to become a CPM involves specialized, competency-based education programs and risk assessment training, that requires out-of-hospital clinical experience. A certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.CPM's are the only learning experience that require out-of-hospital training. copy right May 1996 Midwifery Task Force

Most CPM’s practice in hombirth or birth center settings. Some Practice in hospitals. Some states (only 8 left) do not allow CPM’s to practice, others grant a state license by using the NARM certification and CPM and even grant privilege to write prescriptions. Other states say once you have the CPM credential that is enough, and no state license is needed. State by state is different. CPM’s practice independently, but will still have a back up physician.

Certified Midwife (CM)

Certified Midwives are midwives who are certified by a state organizations or the ACNM (American College Nurse Midwives) Certified Midwifes are qualified midwives to provide you with great service.

CM’s most often practice in hospitals and birth centers. Some may do homebirths. Not all states allow CM’s to practice and not all have prescriptive authority.

Direct Entry Midwife (DEM)

A Direct Entry Midwife is one who has trained with a more experienced midwife, mastering the skills needed to practice the art of midwifery. A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college-or university-based distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings.

Many DEM’s go on to become a CPM. Not all are allowed to practice in all states. Some states grant a license to practice as a DEM.

Certified Nurse Midwife (CNM)

A Certified Nurse Midwife is a midwife who has first become a nurse, learning OB, and all other areas of nursing. They have then finished a program which may or may not require a masters degree in nursing. They attend an educational program accredited by the American College of Nurse Midwives Certification Council (ACC). They most often practice in hospitals and birth centers.

Some do homebirths, and not all have prescriptive authority. All states recognize the CNM but not all do homebirths. They usually do not practice independently from a physician. This means to practice in the homebirth setting they need to have a physician that backs them, not ‘just have back up’. This limits some midwives in some states. This can be due to the back up Doctor or the state that regulates them. Sadly, this is becoming more of a problem with CNM’s working in the homebirth setting. Many have been shut down from homebirth practice. Some have even went on to obtain their CPM in order to practice independently. In some states they are trying to get it so they can practice independently as the CPM does, and just have physician back up as the CPM does. Hopefully for them this change takes place

Lay Midwife

This is a midwife who has not had any formal training, but has been trained by older and more experienced midwifes who could themselves be a lay midwife, or a CNM, CPM, CN or DEM. They are often called ‘granny midwives’, this does not reflect their skills and care. There are still many lay midwives who practice, and provide wonderful care to many women who may other wise not have access to midwifery style of care.

What you can expect

I WILL

• Give a free consultation / interview in person or by phone
• Have the first visit last from 2-3 hours. Giving us plenty of time to get to know each other, providing you with enough information to make a decision that will be correct for you and your family.
• The second visit and each visit after that will last at least 30 minutes to 2 hours. I will continue to provide education including any new information. I believe you need to be informed at all times.
• Educate you about pregnancy, labor, birth, labs, tests, post partum, breast feeding, nutrition, and herbs.
• Come to your home or have you come to my home office (if you are over 1/2 hour from my office you are expected to come to my office for all of your prenatal appointments-any adjustments in this can be discussed at your first prenatal appointment)
• Not hurry your appointments. This is your time. I schedule all of my appointments so you have a minimum of 30 minutes to 2 hours. (as needed)
• Take time to get to know you and your family and give time for you to get to know me.
• Check your weight at each visit
• Check your blood pressure at each visit
• Do a urine test at each visit
• Palpate your babys position at each visit
• Measure your abdomen at each visit (this checks the babies growth, it is called the fundal height).
• Listen to your babies heart beat with a doppler
• Offer a lending library of books and videos
• Be available for your needs via phone or pager 24/7

IN LABOR I WILL

• Be there for you in labor and birth. This is why I limit the number of clients I take.
• Monitor your babies heart beat and your vitals (temperature, blood pressure and pulse).
• Work to keep your labor normal
• Do cervical checks for dilation at the first labor assessment, and after that, the vaginal exams are limited. If you do not allow me to do at least one at the initial labor assessment, your care may be transferred over to another care provider at that time. This is for your and the baby's safety to be sure that everything is progressing within a safe way. If you do not allow me to do this check, then you are placing your baby at risk. Why do you ask? What if your baby has changed position? I need to know if your baby is breech or face presentation.
• Use herbs and non evasive techniques to assist with your birth
• Encourage you to move, walk, and change positions often in labor
• Encourage you to eat and drink
• Continue to encourage you and support your decisions
• Use herbs for your birth and delivery

AFTER THE BIRTH I WILL

• Encourage bonding, skin to skin contact.
• Monitor your vitals and the baby's
• Monitor your bleeding, checking the uterus often to be sure it is contracting as it should to avoid excessive bleeding
• Help you get off to a good start with breast feeding
• Be in your home form 2 hours to as needed after the birth. (I do not leave if I feel that there is a need)

POSTPARTUM

• I will call you on the first day after the delivery. I remain available via phone 24 hours a day for you
• I will come out on day 2 to day 3 after the birth
• Do the new born screening after the baby is 48 hours old (also known as the PKU)
• Be available for you via phone in between the postpartum visits during the 6 weeks postpartum
• Help you fill out the birth certificate
• I will come out to see you again if needed between week 2 and 3. I will see you at the 6 week post check for a pap. You will come to my home office for these visits.
• If I feel at any time prenatally, in labor, or after the baby is born, you or your baby have moved out of the normal, I will transfer your care to a physician.

What I (midwives) will NOT do

• I do not practice medicine (nor do other midwives)
• I will not break your bag of water to get your labor started. This is due to the risk of infection, cord prolapse, and it puts you on the 24 hour rule. The bag of waters protects your baby, it provides a cushion.
• I will not use drugs to induce or augment you labor (pitocin, cytotec). If you feel that you need these, then you NEED to be in a hospital. These should never be given at a home birth. This is out of the 'norm' and you will no longer be a 'low risk'.
• I will not 'push' to get your labor going, just because today is your due date, or you are over due.
• I do not use Electronic Fetal Monitoring (EFM) I do use a doppler to listen to your babies heart beat. You need to be able to be up and moving around during labor. This movement not only helps your labor to progress easier, but is healthy for your baby by providing more oxygen to the infant. (lying flat on your back strapped to a monitor decreases the amount of oxygen your baby receives due to the compression of vessels)
• I do not do episiotomies (they increase the risk of infection, and complications) Episiotomies increase the risk of your tissue having a major tear. An intact perineum decreases the risk of you tearing. Third and Fourth degree tears often are a result of episiotomies that have extended into the rectal wall.
• I do not do routine shave prep or enemas.
• I do not tell you what position you need to labor or deliver in, I only encourage you to change your position if I feel it will help you with your labor and delivery, or if it will be a benefit to the baby.
• I do not allow you to do 'purple face pushing' unless the baby is in distress. This type of pushing lowers the O2 supply and changes the pH in the babies blood and cord blood. (nor do I allow you to push flat on your back for the same reason) This then increases the risk of fetal distress and lowers the babies apgar score (see Midwifery Today Spring 1995 No. 33)
• I do not use forceps or vacuum extractor, and these should never be used in the home.
• I do not cut the umbilical cord until it has stopped pulsating and this can take from 3 to 15 minutes. Cord Clamping.

What I expect out of you

• I expect you to take my child birth class if this is your first baby, or first home birth. This is not included in your fee. This is MANDATORY-NO exceptions!! If you do not take the classes, I can not and will not do your birth. When I have allowed couples to 'skip' this, these are the ones that have had problems, and if had been in class, many of these problems would have been avoided. If you want to take a class closer to your home, it will need to be one approved by me. Bradley methods are approved classes.
• Make all of your scheduled prenatal appointments. If you do not show up or call, I consider it a missed appointment, and after 2 of these you will be dropped from service. We must have a trusting working relationship.
• As soon as you learn of your pregnancy, call me for an appointment, as early prenatal care is best.
• Eat healthy! Junk foods, fast foods, pop and processed meats and foods are unhealthy. They should be consumed very little if at all. If you choose to continue to eat unhealthy, your care will be transferred out of my services. I can not make you eat healthy, you have to take the responsibility to do this. Is your health and your babies health important to you? Show your baby by eating for him/her in the best way!
• Drink plenty of fluids and water, juices, milk, and herbal teas. Dehydrating yourself will only cause health problems.
• Do not use illegal drugs. You will be dropped from my services.
• Do not smoke, chew or use any tobacco products at all. You will be dropped from my services.
• Do not drink alcohol or pop.
• Do take your vitamins and herbal supplements I have asked you to take. (most of these are a MUST if you will deliver at home). Again, if you want your home birth, you need to follow my advice.
• Report to me anything abnormal, or any signs of early labor.
• Listen to my advice, read about the information I have given you and make a informed decision. Take charge!!!!
• BE HONEST at all times, do not with-hold information just to attempt a home birth. By doing this you not only put me at risk but your baby also. This means that you will fill out your health history form in FULL. Do not leave out information! Any information left out will be considered as a form of being dishonest and your care may be transferred to another care provider.
• Pay me on time and as we have scheduled If you don't pay me, my family does not pay our bills. There is a late fee if you do not pay on time.
• Have your birth supplies bought in a timely manner. Don't wait until the last week. You might be caught off guard, and deliver before you have all of them!

What Midwives Want from Their Clients

DURING LABOR I EXPECT YOU

• To call me at the first sign of labor
• Eat and drink all you want to and can handle
• Be up moving around, not lying in bed for the duration of the labor
• Allow me to monitor you and your baby and do what I can to keep your labor normal.
• Allow me to monitor your labor progress- This means that I WILL do at least one vaginal exam. NO EXCEPTIONS. If you do not allow vaginal exams, then you will need to be transferred to another care provider. I do not do hourly vaginal exams, as are often done in the hospital but I do them to assess for breech or face presentation and for cord or other problems.
• Have your birth supplies ready as I have asked
• I expect you to be in charge, to become an informed consumer and make decisions by educating yourself. When you have done this and then choose a home birth, you are hiring me to monitor your baby and you during the birth. If the birth enters what is no longer considered normal, I will suggest that you transfer to the hospital. When I do suggest this, I expect you to listen and act then, not wait just because you want a home birth and your 'in it for the long haul'. If we need to transfer, we need to do it in a timely manner prior to baby becoming distressed. After the birth, again if for anyreason I ask you to transfer into the hospital for care, you will need to follow my advice, and not expect me to continue with your care at home if I feel that you need to go to the hospital.

AFTER THE BIRTH YOU WILL

• Allow me to monitor you and your baby and do what is necessary to keep things normal
• Drink fluids
• Breast feed, and continue to breast feed your baby, avoiding bottles until at least the baby is 2 weeks old.
• Have someone to be with you day and night for the first week. And from week 2 until week 4 you will have someone help with meals, laundry, and cleaning daily as needed. You will have someone come in twice a week for the laundry and cleaning.
• You will not do more than I have released you to do.

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