Frequently asked Questions
+Why use a Birth Center/Midwife?
As Licensed Midwives we closely follow the Midwifery Model of Care http://cfmidwifery.org/mmoc/define.aspx This Model of care is based upon the belief that pregnancy & birth are normal life processes. Midwives are there to monitor the physical, psychological and social wellbeing of the mother throughout the childbearing cycle. Midwives provide families with individualized education, counseling, comprehensive prenatal care, continuous & hands on support during labor and birth, and quality post partum support.
During the ante partum period, time is taken to build up relationships between the midwife and the clients enabling the midwife to give the best care specific to each woman’s needs and wishes. This type of personalized care minimizes the need for technological interventions.
The care and respect that a midwife has for her clients is evident in how she practices. She takes the time to listen and expresses genuine interest in the well-being of each family that she helps. Over the course of the pregnancy, the client-midwife relationship becomes one of trust and mutual respect. The midwife uses education to empower her clients, and encourages personal responsibility in decision making.
Licensed Midwives are experts in the care of uncomplicated pregnancy and birth. We are highly-skilled at caring for women in the birth center environment, where healthy women experiencing normal pregnancies can safely deliver with far less technology and intervention than is needed in the hospital for women with risk factors complicating their pregnancies. Our Licensed Midwives provide continuous support during labor and birth. Studies have shown that continuous labor support decreases the need for epidural anesthesia, medical interventions and cesarean sections. Licensed Midwives typically spend three times longer with their clients than do physicians. This allows ample time for developing the relationship most women desire with their health care-provider. The partnership that unfolds with our midwives will help you to stay healthy throughout pregnancy
+Is it safe?
Research has shown that planned, out of hospital birth with a Registered, Licensed or Certified midwife leads to fewer interventions and complications for both the mother and the baby. The chances of you having a cesarean section are greatly reduced (6% compared to the Florida average C/S rate of 36%). Your baby will not suffer the trauma of vacuum or forceps extraction and will not be subjected to unnecessary testing or examination. Studies have demonstrated that confinement to bed, continuous fetal monitoring, breaking of waters, induction, routine use of Pitocin and routine use of epidurals all combine to form a ‘cascade of intervention’ and lead to the majority of childbirth complications. Avoiding these unnecessary interventions will aid you to a safe, uncomplicated birth.
Nationally the transfer to hospital rate is 10-12% and the C/S rate is 5-6%. Maternal and newborn injury statistics are significantly less for Birth Center/home births. The Canadian Medical Association recently published a study showing that neonatal mortality is less with midwife attended out of hospital birth than with a physician or midwife attended hospital birth. Research has also shown that out of hospital birth with a midwife is just as safe as a conventional hospital birth, with a far lower rate of complication.
+What is a Licensed Midwife?
Florida Licensed midwives are graduates of a three year academic, midwifery program. The student midwife works alongside qualified midwives in the clinical environment to observe and learn good practice and quality care. She is required to attend at least 75 births, managing at least 50 on her own under direct supervision. As well as clinical learning, the student midwife must complete a full academic program specific to midwifery care. The student graduates to being a midwife upon completion of the States Board examination, which also is the North American Register of Midwives (http://narm.org) national certification exam, giving the added title of Certified Professional Midwife (CPM).
As autonomous care providers Licensed Midwives provide complete maternity care to low risk, healthy women who are expected to have normal, uncomplicated births.
+Is Birth Center/Midwifery care right for me?
Birth centers are for healthy moms and healthy babies. A healthy mother makes the kind of wellness choices that facilitate successful birth outside the hospital. The prenatal care given at Labor of Love Birth Center helps a mother-to-be achieve optimum wellness and avoid unnecessary risk. Extensive prenatal screening is in place to ensure that any potential problem is caught early.
Birth Centers are currently NOT allowed to facilitate the births of multiples (twins & more) or Breech babies.
At an orientation appointment, clients will meet with a midwife to review their “risk factor” when they will be asked questions about their current health and past medical/obstetric history. Clients who are at moderate risk are invited to meet with our consulting obstetrician who will review the risks and advise whether it would be safe to go ahead with midwifery care and out of hospital birth
+Do you take VBACs (Vaginal Birth After Cesarean section)?
Because of complicated Birthing Center/Licensed Midwifery laws, we are only able to care for women who have already had one successful VBAC. These births would need to be planned home births, we are not licensed to to do a VBAC in the Birth Center.
We are not able to care for a primary VBAC.
The Birth Center is contracted with most of the major insurance companies. We also accept Medicaid clients and have Self Pay plans available.
To find out if you are eligible and to apply for Medicaid coverage go to www.myflorida.com/accessflorida. We recommend that you apply immediately when you find out you are pregnant. It can take up to 45 days to be approved. A pregnancy test and your ‘Pregnancy Confirmation’ letter may be arranged through us.
The self pay plan includes all prenatal visits, routine screening & laboratory testing, childbirth education, labor & birth care, immediate postpartum care, newborn exam & screening, 3 postpartum visits (at 24-48hrs, 2 weeks & 6 weeks), breastfeeding support and filing for Birth Certificate and social security number (as required). If there are to be any additional costs incurred (i.e. extra labs, OB/Gyn consult, additional ultrasound, rhogam, water birth) the fees will be discussed and explained to you in advance.
Visa, MasterCard, American Express, Check & Cash are all accepted.
If you have insurance coverage our administrator will call your company to get details of your cover and advise you of your financial responsibility. All fees owed must be paid by your 36th week of pregnancy.
+Do I need to see a doctor at all?
NO – all your care will provided within the Birth Center and by our midwives. We give comprehensive prenatal care including all routine screening and lab work to ensure the ongoing wellbeing of both mom & baby. We are able to arrange standard prescription (i.e. for UTI) via our consulting obstetrician. If, at any time during the pregnancy, anything arises which is not within our scope of practice, we will arrange for you to have an appointment with our consulting obstetrician who will evaluate your ability to continue with low risk midwifery care.
+What does prenatal care include?
Our comprehensive prenatal care includes all routine screening and laboratory work – Blood testing, urinalysis, PAP smear, vaginal cultures, gestational diabetes screening and ultrasound.
A full series of Childbirth education is included along with a water birth class, breastfeeding class and sibling class as required.
At each appointment you will be seen by a midwife and given the time you need to cover your physical and emotional wellbeing. Your midwife will monitor your vital signs, urine & weight. You will have your belly measured and palpated to ensure good growth of the baby and the baby’s position. You will also get to hear the baby’s heartbeat. In addition your midwife will discuss good nutrition, exercise, childbirth preparation and important decisions that need to be made regarding you and your baby’s healthcare. You can expect one-on-one time with your midwife to last 20-30 minutes giving plenty of time to address any concerns or issues that you may have.
Additionally, there is a midwife on call 24/7 who will be available to speak with and address any serious concerns you may be having outside of your visits or normal office hours.
+What about after hours care?
There is always an ‘on call’ midwife available to you 24/7. You can call the office number (813 9491185) to get the number of who is on call.
She will discuss the issue and invite you in for an assessment or advise you as necessary.
+When should I start prenatal care?
Prenatal care should begin as soon as possible and definitely within the first trimester (before the 13th week). Early prenatal care enables you to get a head start on nutritional/exercise information and the easing of common prenatal discomforts. Additionally, the longer you are in the care of your midwives, the better the depth of your relationship and trust will be.
We are usually able to hear your babies heartbeat around the 11th – 13th week of pregnancy (that is 11-13 weeks after the date of your last menstrual period). This is the most popular time for women to begin their care.
+How do I begin my Care with Labor of Love?
Call the Center, 813 9491185 to arrange for a free, no obligation, orientation visit.
You will take a tour of the birth center, have our services explained and meet with a midwife to assess your ‘risk’ status. You and your partner will be given the opportunity to ask any questions you may have. If you have already had care with another provider we will arrange to have your records Faxed over to us for review.
+Can I transfer care to Labor of Love for my pregnancy/birth?
YES – we do accept transfers of care. While we prefer transfers to be BEFORE your 28th week, we will accept transfers up to 35 weeks, subject to a few rules;
1. There needs to be slots available in your birth month. We commonly reach our maximum capacity for most months at least 2 months prior to delivery.
2. Late transfers all need to be approved by our Clinical Director who will need to review your records of care.
3. Childbirth education for first time moms and for first time out of hospital births is compulsory – this is offered by the Birth Center.
4. All fees are to be paid in full by the 37th week of pregnancy.
If you’re currently with another provider for your prenatal care but are considering a transfer to Labor of Love you need time to meet all of our midwives and gain your trust in our model of care. We need time to bond with you as well. Also, our facility does have a limited capacity and our schedule can fill up quickly. When scheduling your first appointment with us, please keep in mind that our earliest availability is sometimes up to 2 weeks from the day you are calling.
Why do we have these requirements? In short – for safety and increased success. We need to ensure you are a good candidate for out-of-hospital birth and that you and your family/partner/support are well prepared. We also want you to spend time with our whole team so you have confidence in the midwife at your birth.
+How often will I come in for my appointments?
Routine prenatal care requires that we see you every 4 four weeks until your 28th week. After that you will be seen every 2 weeks until 36 weeks and then each week until you have had your baby. Should any issues arise over the course of your pregnancy you can, of course, be seen in between these scheduled appointments. If you are a late transfer, we may recommend that you come in more frequently so as to have the chance to become more familiar with our midwives, staff and the facility.
+Can my family come with me for my appointments?
We encourage you to bring your partner and children along to your prenatal appointments. Children especially love helping out the midwife at appointments and enjoy hearing the baby’s heartbeat. Attending appointments enables everyone to become familiar with the environment and the caregivers as well as enabling them to ask any questions they may have about the care of their family member. We do, however, ask that if your children are sick you either reschedule or arrange childcare. When bringing younger children, please remember the needs and comforts of other clients.
+Do you provide childbirth education?
YES – we have a full schedule of childbirth classes. Florida law dictates that any first time moms, or those having an out of hospital birth for the first time, attend childbirth education classes.
Our 5 week series includes a breastfeeding class and runs on Tuesday evenings from 6.30-8.30pm. This is included in the Global fee covered by your insurer/Medicaid or Self Pay plan. If this is not a convenient time for you, Saturday classes may be scheduled for an additional fee.
In addition we offer a ‘Refresher Class’ for returning moms, a ‘Water Birth Class’ and a ‘Sibling Class’.
+Who will be at my birth?
When you come to the Birth Center in labor, you will be greeted by one of your midwives. She will admit you and assess the progress of your labor. As labor progresses and we near birth one of our highly qualified assistants are called to attend as well. You will already be familiar with these assistants as you will meet them at your prenatal appointments. It is YOUR CHOICE as to whether a student midwife is in attendance during your labor & birth. Again, you would have met the student during your prenatal care.
+Who can be with me when I give birth?
We encourage you to invite whomever you would like to attend your birth, including your children if you desire. Some moms choose privacy while others choose to have many people at their births. We do have Direct TV, Wi-Fi and DVD players available. You may want to think about bringing things to keep children occupied and we strongly advise that you have a designated adult present to care for younger children if they will be at your birth.
When choosing who to invite to share your experience, take care to have people who are fully supportive of your decision to have the baby in a birth center. It is important that you feel fully loved and encouraged during your labor and birth.
+What if I am not the only mom in labor?
Occasionally we do have two moms in labor. The Birth Center is set up so that two families may have a complete private suite to themselves – consisting of a birth room, lounge, kitchenette and bathroom/toilet. Each suite also has a TV & DVD player. Wi-Fi is also available for those Facebook & Twitter updates!!
The attending midwife is usually able to attend both moms but if necessary there is always a backup midwife available to come in.
+What options are available for pain management?
Labor is undeniably hard work, and often painful. Not all women experience pain in labor, but most do, so it is important to prepare yourself well in advance.
We encourage women to prepare themselves during the pregnancy for the realities of labor. We encourage you to attend our series of Childbirth Education classes, where you will learn to prepare physically and emotionally for the experience of labor. Many other classes are available in the community as well, such as Bradley, Hypnobabies, Hypnobirthing and others, each with different ways of preparing women for the experience of childbirth. Prenatal yoga and other exercise and relaxation classes can be very beneficial as well.
During labor, we offer a variety of means to help cope with the intensity of labor. We offer freedom of movement, the use of water, both the shower and immersion in a deep tub, massage, emotional support and many other non-pharmaceutical techniques; use of TENS machine, birth ball, music, heating pads, aromatherapy.
Pharmaceutical anesthesia and analgesia are not available at the birth center or at a home birth. WE DO NOT OFFER EPIDURALS. Epidural anesthesia is not safe for use outside of a hospital, and we find nearly all women who desire an unmediated birth with our practice can do so without anesthesia. In case the woman requires or desires an epidural, we will accompany her to the hospital.
+May I take pictures/video?
YES – you are welcome to take whatever pictures/video footage that you want. It is a good idea to plan in advance what you want and designate a person to take these pictures. Remember spare batteries/charger!
We welcome you to share your pictures/video on our website.
+What about water birth – is it safe?
YES – birthing in the water is an all natural method which helps reduce the hours and stress of labor. In the water you will be more relaxed and experience less discomfort. Your baby goes from a watery environment in the womb and is birthed gently in to a similar environment, in to warm water. Birthing under water is safe because of the babies ‘dive reflux’. The baby will have been in water throughout the pregnancy and will not breathe until air hits its face stimulating breathing. The baby will continue to receive oxygen via the umbilical cord just as s/he did before birth. The midwife gently lifts the baby out of the water and up to the mom within seconds of birth.
+What is a Doula?
A doula is a professional labor support person who is there to offer information, support and advice for dealing with labor. She is also there to support and enable your partner to provide the best labor support for you. Unlike your midwife and assistant, who may have other duties to attend, a doula is there solely to support YOU and provide you with exactly what you need in labor.
There are also postpartum doulas who will be available to help you in your home in the days/weeks following your birth.
+May I have a Home birth?
YES – Home birth is available on a case by case basis. We are not currently able to offer home birth if you are pregnant with your first baby or if you live more than 45mins away from the Birth Center. Please discuss home birth options with our Office Manager Kristi, as soon as you think you may be interested.
+What do you do if there is a complication or an emergency?
Healthy women who experience healthy pregnancies will generally stay healthy and have normal, uncomplicated births. Most complications are not emergencies and will have clear warning signs ahead of time. Midwives are experts in the pregnancy and birth process. We are able to recognize slight deviations from normal, and usually get them back on track with minimal intervention. In the event of unforeseen complication we have emergency medical equipment readily available for use such as; IVs, oxygen, hemorrhage medication, and resuscitation equipment. Our entire team is fully trained in all emergency scenarios including CPR and neonatal resuscitation. If a complication does not resolve, we will transfer the mom’s or baby’s care to a hospital provider, in pregnancy, labor, or postpartum.
In the case of a true emergency, we are qualified to stabilize mom or baby while the Emergency Medical Service is called and we transport by ambulance.
+What happens if we have to transfer to the hospital?
In an emergency, we call EMS and transfer by ambulance to hospital. In an unrushed transfer, we go by private vehicle to the most appropriate hospital.
For women giving birth at the birth center, we will transfer to the nearest hospital, the Women’s Center at UCH on Bruce B Downs and Fletcher. In non-emergent situation, it may be possible to transfer to the hospital our consulting physician is affiliated with, Helen Ellis, and she will assume your care.
+What if the baby's cord is around the neck?
It is actually quite common for a baby to be born with cord around its neck. Approximately 40% of babies are born this way. Rarely is it a complication and is most often easily resolved. Upon birth of the head, the midwife will gently feel for cord and if possible, slip it over the head or birth the baby through the cord. On the rare occasion that the cord is too tight to do this it may be clamped and cut and birth hastened – this is a MOST unusual occurrence.
+What if I tear?
During your pregnancy you will be counseled on good nutrition and perineal massage. During birth, the midwife will encourage the use of warm oils, compresses and perineal support. At birth, your midwife will remind you about how to push in a controlled manner so as to ease the baby down the birth canal, encouraging gentle stretching of the perineal area. All these go towards reducing the chance of tearing but if you do have a tear the midwives are qualified to perform a repair, under local anesthesia shortly after birth.
In the unlikely event of the midwife assessing the need for an episiotomy she is fully qualified to do this.
Many studies have proven that it is preferable for both the healing process and for postpartum comfort to tear naturally rather than to have an episiotomy.
+What happens after the baby is born?
Your midwife and birth assistant will assist you back to your bed (if you have birthed in the tub or elsewhere) and settle you comfortably with your baby. For the first hour after birth, we will be checking on yours and the baby’s wellbeing (Bp, Pulse, Temp, Breathing, Heart rate and blood loss), every 15 minutes. After that it will be every 30 minutes. Your midwife will assess for tearing and repair as necessary. This rarely needs to be done immediately so there will be plenty of time for you to bond with your new baby and family. Your Birth assistant will remain with you and assist you breast feeding, get food for you, help you to the bathroom and anything else you may need. Your new baby will stay with you or your partner at all times. The midwife will do an initial newborn exam, where she will administer Vitamin K and Eye Ointment as required by you.
+How long do you stay after a birth?
Every woman is different and the length of your stay in the Birth Center will depend upon your own personal needs and how your labor & birth went. The minimum allowable stay is two hours – and some more experienced new moms are ready to go by then!! What we require of you before you leave is that all your observations (Bp, Pulse, Temp & bleeding) are all controlled and within normal limits. You need to have tolerated food and drink, have been able to take a shower and have passed urine. We also like to have seen the baby have a good feed. The average stay time is 4-6 hours. It is certainly possible to stay as long as you require in order to feel comfortable and ready to take your baby home. You will never be rushed out. The maximum time allowable under Birth Center law is 24 hours.
+Do I need a Pediatrician?
YES – Your midwife will do an initial complete physical assessment of your newborn. This will include, weight, measurements, assessment for any abnormalities, administration of Vitamin K and eye ointment (if desired). You will need to take your baby to see your pediatrician within 48 hours after birth. We recommend that you have plans in place for pediatric care before you go in to labor.
+How do I go about registering the birth and getting a social security number?
Our Office Manager will complete the relevant paperwork, register the baby’s birth and apply for the babies social security number. The social security card will be automatically mailed to you approximately 4- 8 weeks after the birth. To obtain a copy of the Birth Certificate you will need to apply to the Vital Statistics office and pay a $15 fee.
+Will I be seen for Postpartum care?
YES – You will be seen routinely at 48 hours after the birth of your baby, at 2 weeks and at 6 weeks.
If at any time outside these appointments you need to speak with/see your midwife you just need to call.
We also have a breast feeding consultant available should you have any issues feeding your new baby.