Why choose Out-of-Hospital Birth?

People generally choose 0ut-of-hospital Birth because they will feel more comfortable giving birth in water or in a home or home like setting. In addition, they are typically healthy and wish to avoid routine hospital interventions or non-evidenced based practices such as being confined to a bed, not being allowed to eat or drink in labor, continuous electronic fetal monitoring, routine IV fluids, non-medically indicated (pitocin) induction, episiotomy and other common birth interventions. There may be more personal reasons that are sometimes given. For example, our midwife, Caroline chose to birth at home because she desired a natural or “physiologic” birth and wanted to avoid an unnecessary caesarean section. Families that chose to birth at home or in the birth center tend to view pregnancy and birth as a natural process, not an illness, and therefore feel that the hospital or the “medical” model is not the appropriate approach to childbirth. Others wish for their older children to be present and engaged in the pregnancy and birthing process. What are your reasons? For more information, book a free consultation!


What is the difference between a home and a Birth Center birth?

The only difference is location! Both locations have access to the same emergency (anti-hemorrhagic medications, IVs, antibiotics...) and obstetrical equipment (doppler ultrasound fetal monitoring, labor tubs, birth stools...), supplies and medical providers (midwives!).  If you are birthing at home, we come to you, set up, and clean up following the birth. If you come to us, you get the benefit of a “spa” like setting within close proximity to the hospital. Additionally, if you are birthing at The Birth Center you have access to Nitrous Oxide in your labor. Both locations are safe for low-risk pregnancies and birth. For more information, book a free consultation!

 
 

Is out-of-hospital birth really a safe option?

This is a question that can only be answered by the birthing parents.  We can tell you that we believe it is safe for a low risk, healthy pregnancy and that research supports this belief. However, no birth including those in the hospital is without some risk. Most people that choose to birth at home have chosen this option after extensive research and feel that the small risk of a serious complication is preferable to the high rate of interventions in a hospital setting (including the 33% national caesarean section rate, 45% at some local hospitals). Let’s discuss in more detail at your free consultation!

 
 

What happens if something goes wrong?

We do not take complications lightly and safety is always the priority for mother and baby. We are licensed by the California Medical Board and are well trained to deal with complications, as well as to transport to an OB or hospital as needed. However, it is important to remember that our clients typically are healthy and have low-risk pregnancies. As such, our clients also typically have very normal low-risk births. We will not hesitate to transfer care to a hospital or OB appropriately in the event that a high-risk situation occurs. Let’s discuss what these circumstances might be at your free consultation!


What emergency procedures can you perform? What are you qualified or not qualified to perform?

We are trained in CPR and Neonatal Resuscitation. We are also trained to deal with complications such as cord prolapse, surprise breech, shoulder dystocia, hemorrhage, placental abruption, and many others. We cannot use forceps, vacuum extractors, perform surgical birth or external cephalic version (ECV is used to turn a baby from breech to a cephalic (head down) presentation). Midwives are qualified to attend the birth of a normal, low risk pregnancy and manage complications if they arise. If complications arise that necessitate hospital care, we stabilize and initiate transport to the hospital. Let’s discuss what these circumstances might be and more detail about these questions at your free consultation!


What happens in the event of hospital transport? Do you come with us?

Yes, in the case of a hospital transport our midwives (one or more) will accompany you. Even though most of our clients do not need to go to the hospital, we recommend all of our clients have a transport birth plan. If a transfer of care is necessary (as in high blood pressure or other high-risk health concerns develop), this will allow a smooth transition. In addition, our midwives will facilitate the transfer of care to the hospital by bringing your medical records and giving a verbal report to the receiving care providers.  We stay with you until after the birth and take on the role of advocate and birth coach.  We know it is important to help the parents understand what is happening and help you get the information you need to make informed decisions. For more information, book a free consultation!


When is out-of-hospital not a good option?

Out-of-Hospital Birth is not a good option for a person with preexisting disease or condition making pregnancy and birth high-risk.  Some examples are women with pre-existing diabetes, certain types of heart conditions, uncontrolled thyroid problems or hypertension. Being over 35 years of age is NOT a risk factor for pregnancy and birth if that woman is in good health overall.

We spend a great deal of time with our clients working preventatively using nutrition, supplements, and non-allopathic remedies, to keep a healthy pregnancy healthy and low-risk. However, occasionally, a pregnancy may begin as low-risk and develop a complication that becomes high-risk (such as preeclampsia). In those instances, the care of the pregnancy must be transferred to an OB and Out-of-Hospital Birth is no longer a good option.  We will continue to provide concurrent care and support, however the primary medical care is taken over by the OB and the birth will take place in the hospital. Let’s discuss what these circumstances might be and more detail about these questions at your free consultation!


How close do you need to be to a hospital?

There are no guidelines in place for this. Our midwives will deliver within 45 minutes from the hospital in the home setting. If you live further, we recommend you birth at The Birth Center. Find out which areas we serve at your free consultation!


How does prenatal and postpartum care differ from care with an OB/GYN?

The typical OB/GYN appointment is approximately 30-40 minutes of waiting for your appointment and 7 minutes spent with the physician. We spend at between 45-60 minutes with you at each prenatal appointment with no waiting time. Like your OB appointment, we test your urine, take your blood pressure, listen to the baby’s heart, screen for abnormal symptoms, and measure the fundal height. Later in the pregnancy, we also feel your uterus to determine the position of the baby. Many families love this process and we often help partners, grandparents, children and the pregnant person feel the baby’s back, knees, head, etc. Most of the hour is spent discussing general health, diet, exercise, pregnancy, including psycho-social issues, and answering any questions you or your family have. Any upcoming testing or screenings are discussed prior. With every decision, we offer a full informed consent. We trust that you will make the best decision for your family and your baby. Postpartum care is a minimum of 5 visits, 2 home visits (1 day, 3 days) and a 7-10 days, 3 and 6 week office visit.  Additional visits are available upon request and encouraged, including visits just for breastfeeding support. Book your free consultation!

 
 

How much does an out-of-hospital birth cost? Do you accept insurance?

Our fees start at $6,500 for our Midwifery Care Package that includes the entirety of your prenatal care, delivery with birthing pool, and postpartum care. If you birth in the Birth Center, we will bill your insurance for the "facility fee." There is no additional cost to you to birth in the Birth Center. 

Depending on your plan, you may find that our fees are comparable to your out-of-pocket costs of a typical hospital delivery. One big difference is that you know your fees upfront in an Out-of-Hospital Birth while, with a hospital delivery the cost can vary widely and arrive at a month or two in the midst of your postpartum period. 

We can help you bill your insurance, however we do not accept insurance. We cannot accept insurance prior to the birth, so most of our families make payments each visit through 37 weeks gestation. We work with a biller that specializes in midwifery care, and as a courtesy to our clients, your package includes the cost of this service. Families with private insurance are typically reimbursed a portion of the fee (typically between $800-$3000) in the postpartum period.  However, there is no guarantee that insurance will cover care; it depends on your policy. At this time, we do not accept Medi-CAL (We are working on it!), however we offer limited reduced-cost packages to those families in need. We would love to discuss this with you further. Please email, call us or book a free consultation!

 
 

What is What is nitrous oxide? Is it safe to use during my labor?

Nitrous oxide is a tasteless, odorless gas which can be used to provide some degree of pain relief during labor, delivery, or postpartum procedures (such as suturing). Women who use nitrous oxide in labor are fully awake, aware of their surroundings and able to respond rationally to questions and directions. Nitrous oxide typically causes a state of relaxation and a reduction of anxiety. It can offer some degree of pain relief, though absolute relief cannot be guaranteed. Nitrous oxide is self-administered by inhalation through a mask. It has been shown to be safe in labor (it has been used in the UK for decades), has not been shown to affect labor patterns, impact the strength of contractions, or caused depressed respirations (breathing problems) in babies after birth. It is available for use in our Birth Center.


Who attends the birth at an out-of-hospital birth?

Since we know birth is an important time in your life, we know that it is vital that you know your birth team. As such, you will spend time with all three of our midwives prenatally. We also feel the safest way to attend our clients is to provide two midwives to be present for births. As such, there will always be two midwives on call at any given time. In the rare case that two clients are in labor at a time, one of our midwives may bring another licensed midwife in the community to your birth and in some circumstances an experienced midwifery student.  


Where did you get your training?

Our midwives are California Licensed Midwives/Certified Professional Midwives who received clinical training through an apprenticeship model and didactic training from the National Midwifery Institute. We are licensed through the California Medical Board and through the North American Registry of Midwives. For more information about us, check out our About The Wifeys page. 


How long do you stay at my house during the birth? When can I arrive and how long can I stay at The Birth Center?

Typically, we are in communication prior to active labor for check-ins, encouragement and assessment. For a Birth Center birth, you will arrive in or near active labor and for a home birth, we will arrive to you at this time instead. We or you stay until mother and baby are stable, between 2 to 4 hours after the birth in the home setting and 4 to 6 hours in the Birth Center.  We stay longer if there is a complication or the mother or baby requires more attention. 


What is the schedule for prenatal and postpartum visits?

Our appointments are 45-60 minutes in length and done at our office. We see families once a month through 28 weeks gestation, every two weeks from 28 to 36 weeks, and every week from 36 weeks till you give birth. The first two postpartum visits are generally done at home (24-36 hours, 3-5 days) and a 7-10 day, 3 and 6 week check in the office. For those families who live further than 45 minutes away, we offer one home visit at 24-72 hours and the remaining 4 in the Birth Center office. 


What happens if I want pain medication at a home birth?

Many first time couples are concerned about the mother's ability to "handle the pain". Normal physiological labor also comes with a natural hormone cocktail that allows the "pain" of labor to be manageable for most women. We also find that childbirth education allows the couple to develop supportive coping techniques to assist in the management of labor. We will offer natural, non-drug alternatives (such as a birth tub, and movement in labor) along with love and encouragement.

If you are choosing to give birth in The Birth Center, you have the use of our nitrous oxide as well. Nitrous oxide is a tasteless, odorless gas which can be used to provide some degree of pain relief during labor, delivery or postpartum (such as suturing). It is safe and has not been shown to affect labor patterns, impact the strength of contractions, or cause depressed respirations in babies after birth. In the rare case, that these tools are not effective and the mother wishes to have pain medication, we will transport to the hospital (though of almost 1000 births, only 2-3 women have transported for pain relief). We will accompany the mother and make sure she is settled and receives care as soon as possible. Find out more by booking at your free consultation!

 
 

Can I still have a doula attend my birth?

Yes, a doula is a wonderful addition to an out of hospital birth. Our midwives typically arrive when the mother moves into active labor.  Some families hire a doula for support in early labor and for the consistent physical and emotional support throughout the entire labor. While we will offer emotional support in labor, we are also listening to the baby, charting, monitoring your vital signs, or preparing for the birth. There are doulas in the area that sometimes offer discounts to out-of-hospital birth parents. Please contact us if you would like a doula and need more information! 


What happens if two clients are in labor at the same time?

It is rare that two clients are in labor at the same time. However, with a practice of 3 midwives, we are able to split up and call another midwife in the area to assist us if need be. You will spend time prenatally with all of our midwives and we strive to ensure each birthing mother is attended by at least one midwife she knows. Most clients will have two midwives from our practice at their birth. In addition, we limit the number of clients we care for each month (typically 6-8 families per month).


Do I still need to see an OB/GYN at all during my pregnancy?

It is not necessary to see an OB during your pregnancy, as we are the primary care provider for your low-risk pregnancy. If a serious complication arises during prenatal care, we will consult and/or refer you to an OB.  Most clients do not continue or seek care with an OB once they have hired a midwife.


What do you bring to labor? What do I have to provide?

We bring all the medical and emergency equipment such as a Doppler to monitor the baby’s heart rate, oxygen, neonatal resuscitation equipment, anti-hemorrhage drugs, antibiotics, sutures and anesthetic to repair a tear, newborn supplies, and IV, nitrous oxide (at The Birth Center) and much more. We also two birth stools, a rebozo, essential oils, and other ways to support the birthing person.

We specialize in water birth and provide you with a full-size, two person professional birthing pool. If you are birthing at home, you will have to provide some basic supplies, often referred to as a “birth kit”.  Some examples of what you might find in a “birth kit” are: under-pads, peri-bottles, gloves, maternity pads, sitz bath supplies, a liner for the birthing pool, and a hose.


There are multiple midwives in the area. How do I go about choosing which one to use?

The Wifeys currently own and operate the only Birth Center in Monterey and the immediate surrounding area. If you wish to birth there, we are happy to be able to support you. However, we do believe that birth is a very intimate event and you will be spending many hours with your healthcare providers during prenatal visits, the birth, and postpartum visits. Many midwives offer similar services and have similar philosophies, but we do differ from one another. Ask lots of questions and choose midwives you think you can work well with as a team. Ultimately, you should really like your midwives, as it is it’s a very different relationship than you may be used to having with other healthcare providers. We end up spending a lot of time together (30-40 hours total)! Find out more about us at a free consultation!

Photo Credit: Rebecca Coursey: https://www.awonderedlife.com/