Discussing 3 Myths You May Have Heard About Dental Care & Pregnancy

Amanda Tavoularis DDS, Dentably Magazine
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dramanda@dentably.org – www.emergencydentistsusa.com/dentably
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Becoming pregnant is a special time in a couple’s life, yet it can be overwhelming to be overloaded with information from friends and family members. When it comes to dental care during pregnancy, there are a lot of myths and it can be hard to know which information you should follow. As a dentist who’s been practicing for more than 20 years, it’s been my goal to help educate expecting mothers on dental health and debunk some common myths they may be hearing.

Myth #1:  Your Mouth Isn’t Affected By Pregnancy

 A common myth about pregnancy is that it doesn’t affect your dental health. However, changing hormones during pregnancy actually do affect your oral health quite a bit. Pregnant women are at a greater risk for certain dental issues such as gum disease and pregnancy tumors. These conditions can cause preterm births and low birth weights so it’s important to be aware of them. However, both of these conditions are treatable, so be sure that you visit your dentist during your pregnancy. To help prevent gum disease and tooth decay you should also continue with an effective oral care routine at home. This includes brushing twice a day, flossing once a day and rinsing with mouthwash. This is essential to your dental health and it’s important not to neglect your routine during pregnancy.

Myth #2: Dental Work Should Be Avoided During Pregnancy

 Another myth pregnant women often hear is that they should avoid dental work. However, it’s actually extremely important to receive dental care to help prevent gum disease. You will need to have regular cleanings and exams during your pregnancy, but for treatments like cavity fillings or anything involving sedation, it’s best to hold off on them until your second trimester as this is the time where it will be safest for you and your baby. If you’re worried about any adverse effects, it is possible for you to postpone the procedure until after birth. Note that if you experience a dental emergency, you may need to undergo a dental procedure anyway to make sure you and your baby are safe and healthy.

Myth #3: Risk of Disease & Decay Stops after Pregnancy

 Finally, breastfeeding mothers are still at risk for dental issues. The risk of oral disease and decay does not automatically go away after you have given birth. In fact, women who are nursing may experience up to 5 percent bone loss which can lead to gingivitis. If you are breastfeeding, keep a close eye on your dental health and make sure that you make time to visit the dentist after your baby is born. Also, many dentists and doctors encourage mothers to remain on a diet that is low in sugar to prevent tooth decay and continue their effective dental care routine at home after pregnancy.

 Growing a family is a beautiful part of life and pregnancy is a special experience for women. While you’re probably feeling excited, there may be some challenges that you are facing with pregnancy as well. Dental care during pregnancy can be confusing too, but having a healthy mouth is important for the safety of you and for your baby.

Emily’s Third Baby, Lauren, Born at Home

Lauren was born at just past 41 weeks. Labor was fast and furious – about 4.5 hours. It was exactly what the midwives had said is common for third labors. Unpredictable! Some contractions were far apart, some very close together. Most were very intense, but there were a few surprisingly light ones mixed in. I’m so glad we set up the tub earlier in the day because I started pushing right after I got into the water. She was born after several long pushing contractions. Oh, the relief! We are all so thankful for this sweet girl and her two big brothers, all born at home with the Mother to Mother midwives!

 

Pregnant and Penny Pinching: Tips for the Mom-to-be on a Budget

 By Emily Graham of Mighty Moms

Finding out that you’re pregnant can be a time of tumultuous emotions. While you may be ecstatic, there is also some fear about the financial strain of pregnancy and getting prepared for childbirth. Fortunately, pregnancies don’t have to be expensive. Here are a few ways you can save money while still taking care of your pregnancy needs.

Getting the Clothes You Need

As your pregnancy develops, you will need clothes that fit properly and comfortably. As tempting as it may be to buy a new wardrobe for each trimester, this would not be the best use of your funds. This article from Money Crashers introduces some options for getting what you need. One thing you should consider is looking inside your closet first. Look for clothes that can accommodate your growing body, such as stretch pants. Truly, your pregnancy clothing needs aren’t extensive, and a few key pieces are all you’ll need for those nine months.

Eating Well During Pregnancy

Now that you’re carrying a new life, you’ll need to pay close attention to your diet. Apart from the supplements your doctor may recommend, you can meet your nutrition needs without breaking your budget. These include buying fresh fruits and vegetables when they’re in season and buying essential foods in bulk. It may also be helpful to use coupons that would help you save a little money on your purchases.

Getting Ready for the Baby

According to this article on WhatToExpect.com, preparing your baby’s nursery doesn’t need to be an expensive process. When it comes to a baby’s needs, some items must be bought new such as bottles, bottle sterilizers, and bedding, while others can be bought used. When it comes to car seats, strollers, and cribs, some people may be more hesitant to get these used because of safety concerns. In this case, you should always err on the side of caution. Having a checklist of the items you will need for baby will keep you focused on the absolute must-have so you don’t feel overwhelmed by all the options.

Handling the Gender Reveal

Announcing the baby’s gender to the world can be budget-friendly and fun. If you’d like to throw a party, Kindred Bravely has some tips for your awesome gender reveal festivities. If a party is more than you’d like to put on your budget, consider other ideas such as fun gender reveal photographs. Photographs allow more creative freedom in revealing your baby’s gender, and you can get loved ones involved as well! Gender reveal photographs are also great because they can be easily shared on social media and via email, if your close family and friends live far away from you and wouldn’t have been able to attend a gender reveal party anyway.

Having the Baby

Your birthing options may vary depending on whether your physician has any concerns about your and the baby’s health. If your pregnancy is low risk and you have fully educated yourself on what to expect, a home birth may be right for you. More mothers are choosing home births because they are in the comfort of their homes and they have control over who can be present at their side. However, it’s best to begin preparing for a home birth as early as possible since the steps required to be mentally and physically ready can be extensive. It’s helpful to break the process into manageable stages so you won’t feel overwhelmed and everything will be in place when your little one comes into the world. These steps include learning the basics of a home birth as well as choosing the right midwife.

While pregnancy and childbirth will certainly lead to adjustments in your budget, it’s good to know that you can achieve the things you need and have fun while sticking to a budget. The last thing you need in these life-changing nine months is the added stress of money trouble.

Photo courtesy of Pixabay

Emily’s Homebirths With Mother to Mother Midwifery

Liam’s birth was my first. It started in the early morning and lasted 14 hours. At one point, when I thought I could go no more (but it was looking like there would be a lot more), my husband came alongside me and whispered “We will have this baby before sunset.” I could only nod and hope he was right.

It’s truly an amazing experience to feel your body opening itself and pressing a baby out. Little did I know that surrendering to something bigger than myself was my first step into motherhood. It took me days (and probably longer than that) to digest what my body had just done. In a hot shower the next day I shook and cried for a long time; in awe of the power and force my own body was capable of.

It wasn’t until several months later that I looked up the time of
the sunset on that day in 2015. It was 7:20pm, and Liam was born at 6:19pm.

Caleb’s birth was only 5 hours, fast and furious. I have no memory of how long I pushed with him. I do remember that I was holding onto the tub faucet (in my in-law’s house) with all my strength, and truly hoping I didn’t rip it out of the wall! Thankfully it stayed put.

Caleb’s birth was so much like who he is. Determined and full-forced. A baby freight train. He was also born just before sunset.

Birth stretches you beyond what you think you can do. So does motherhood. When I thought I had dug as deep as I could, I was called to dig deeper. And I did. And deeper. And I did. And I still do. As I write this, I am 34 weeks along with our third child, a girl. She will guide me to new parts of myself, and probably reawaken some of the more ‘girly’ parts of me that have fallen asleep. I’ve heard women say that they don’t want to lose who they are by having children. I have found it to be the opposite. I have discovered who I am in being a mother.

“Birth is not only about making babies. Birth is about making mothers…. Strong, competent, capable mothers who trust themselves and know their inner strength.” – Barbara Katz Rothman

Anticipating Life With a Disability and a Baby

The gift of life is something that is precious to every parent. There’s magic that happens when the unexpected and the amazing intertwine in a symphony of tender moments of love and exhaustion. For those soon-to-be parents with disabilities, the rush of excitement and the fear of the unknown can be amplified. Raising a child when you have a disability has its own unique challenges, but it doesn’t have to be intimidating. Here are a few ways you can prepare yourself and your home for what may be the biggest life-changing experience imaginable.

Exploring Surrogacy
For instances where pregnancy or childbirth is just not possible due to physical disability or infertility, using a surrogate to carry your child could be a great option to help you experience the unconditional joy of starting or growing your family. Many surrogacy programs offer customizable options so that you can cater the experience to your family’s needs and budget. If you decide to pursue this path, you’ll be involved with every decision along the way, including your baby’s arrival. If want your baby to be born in a quiet, peaceful environment, consider having your baby delivered at home rather than a hospital. A home birth might be preferable since you’ll be able to set up your home — or your surrogate’s home — to cater to individual needs, whereas a hospital’s traditional delivery unit might not be as flexible or as accessible.

Baby-proofing the Home
Living with a disability may require making special home modifications to aid in your mobility as a new parent. And while you’re getting ready for parenthood, you’ll also need to identify areas that could be dangerous for a wandering, curious toddler.

Baby-proofing could include securing large pieces of furniture, covering sharp or pointed furniture with bumpers or padding, blocking access to cabinets and electrical outlets, and making sure your smoke and carbon monoxide detectors are up to date. Some of these baby-proofing concepts might already be in place to accommodate your own disability; but if not, then there’s no better time than now to get the house ready for both of your needs. By prepping for your newborn’s arrival, you’re on the first step toward creating a loving and safe environment.

Anticipating Your Family’s Needs
When it comes to raising your child in the home, there’s a lot of pressure to anticipate their needs and stick to a schedule. Whether it’s making sure they’re fed, burped, changed, or just plain happy, the stress that comes with meeting their infantile needs can often be challenging when your own unique needs come into play as well. Don’t worry so much about being perfect and right every time, but practice your parenting by being prepared. Make sure your child’s supplies are accessible and within reach, especially if you have physical limitations. Beyond their supplies, you’ll also need to consider where they’ll spend most of their days. If you work from home, then you might want to move your baby’s crib near your office to reduce how much you move around.

Exploring the world
The excitement of the outside world is beckoning, and it won’t be long before you’ll want to introduce your newborn to the world through family outings. If you’re thinking about going on an adventure through the countryside or just a walk in the city, you might want to look into adaptive baby-care products to help both of you get around. There are many resources that provide flexibility and ease of movement for children and disabled parents.

Creating life opens you up to the daunting world of parenting, but the benefits of happiness outweigh the challenges. As you find the greatest joy in life through raising your child, it’s important to know your limitations and when to ask for help. You’ll find life as a parent easier to navigate once you take care of your needs in tandem with your child’s. And when you’re feeling overwhelmed with the struggles of caring for a baby, remember it’s only a temporary phase in an incredible lifelong journey.

Courtesy of Ashley Taylor of DisabledParents.org

Additional Resources:

Home Baby Proofing Guide

 

Ancient Birth Dances For Easier Birthing

Ancient birthing wisdom has been passed down to us in the form of fertility and birth dances from thousands of years ago.  The moves that make up these dances are secrets from our foremothers to position the baby for easier birthing.

These primal dances come to us from cultures all over the world. Belly dancing from the Middle East, Tahitian and Hula dancing from Polynesia and African dancing all embody the birthing moves of hip circles, figure eights, shimmies, hip lifts and undulations.

We currently regard these dances as seductive and entertaining but the original purpose was for fertility and birthing.

During pregnancy women gathered together and danced with the laboring mother.  The dancing was accompanied by rhythmic, repetitive percussion. The combination of the trancelike drumming and the support of other women helped the birthing  mother to relax and surrender to her labor.

The intuitive movements of the dances cause the baby’s head to flex and the baby’s back to roll toward the front of the mother’s pelvis.

The baby is able to descend better through the pelvis with a flexed head because she leads with the small occiput instead of the bigger top of the head. The occiput fits evenly into the cervix and the steady, even pressure causes the cervix to  dilate.

Modern midwives continue to teach mothers optimal fetal positioning exercises today.  There are many ways different to practice these exercises.  One midwife, Gail Tully, aptly named these exercises  Spinning Babies.

At Mother to Mother Midwifery, our midwives, lead Fetal Positioning Prenatal Groups once a month on Tuesday afternoons at Mother to Mother Midwifery, 1816 Howard Ave, San Diego CA 92103.  These are open to the public.  We also teach private fetal positioning sessions by appointment only.

One of our homebirth clients, Christiana Behke Simmons, will be leading a Baby Garoove Dance Class to dance your your baby out on Sunday March 24, 2019 at 10:30 at Culture Shock Dance Studio For more information, contact Nana at babygaroove@gmail.com.  Her dance class incorporates the very same moves that our ancient grandmothers to dance the baby out.

The fetal positioning exercises and dances can be done throughout pregnancy and during labor and birth.  They are intended to position your baby in the pelvis to have an easier labor and birth. Enjoy!

References:

Grandmother’s Secrets: The Ancient Rituals And Healing Power of Belly Dancing by Rosina-Fawzia Al-Rawi

Community Health Group Medi-Cal covers Homebirth

Community Health Group (CHG) covers Homebirth

Homebirth is such an amazing option for low risk mothers and babies.  There are so many benefits.  One simple benefit is that women do not have to drive anywhere when they are in labor.  The midwives do all the driving.  That’s even more of a relief if you’re in labor during rush hour traffic.

Homebirth is also very safe.  All good research shows it’s just as safe to have your baby at home as in the hospital for low risk mothers and babies.  Some argue that it’s safer, since unnecessary cesareans are so much less likely for women who plan homebirth.

Now that Medi-Cal Insurance covers homebirth, many more mothers are choosing to birth at home.

Community Health Group is one of the Medi-Cal health plans that covers homebirth.  Talk to our staff at Mother to Mother Midwifery to request a referral from Community Health Group to have a homebirth.

Discover why so many women choose homebirth!

 

Mother to Mother Midwifery San Diego proudly offers Medi-Cal for Homebirth

We have worked very hard for the last couple of years at Mother to Mother to Midwifery to offer Medi-Cal for homebirth.   We are very proud to announce this option is finally available.

Since January 2017, we have been working together as a midwife team to meet all of the requirements to offer Medi-Cal for homebirth.  After a long, patient, bureaucratic process, we have been approved.  It was not unlike a long labor, but patience prevailed, and here we are.  Mother to Mother Midwifery now proudly offers Medi-Cal for Homebirth.

Many thanks to all the midwife activists in California who pushed the legislation through for Medi-Cal to cover homebirth in California.

https://www.californiamidwives.org

If you would like a homebirth and you have Medi-Cal, please contact us by email info@mothertomothermidwifery.com or by phone 619-220-8189 to set up your homebirth consultation!

 

The Politics of Homebirth

To understand why insurance companies don’t pay well for homebirth in America, one needs to appreciate the absolute power and control of the American Medical Association.

The AMA spends hundreds of millions of dollars per year on lobbying it’s causes.  It lobbied against non-medical exemptions of mandatory vaccines, and for the ongoing use of animals in biomedical research, climate change and gun control.  The AMA spends the most money on lobbying, second only to the American Chamber of Commerce.

Consequently, when the AMA makes a resolution, insurance companies listen.  It so happens that the AMA recommends women deliver in hospitals or birthing centers within hospitals-not at home.

The AMA’s motivation to obstruct homebirth does not stem from concern for the safety of mothers and babies. Science supports homebirth as a reasonable and safe option.  The true motivation of the AMA is greed.

The AMA would lose money and power if they acknowledged the safety of homebirth for low risk women.  If the AMA endorsed homebirth, insurance companies would fall in line and pay for homebirth costs.  Doctors and hospitals would stand to lose up to 28% of the revenue generated by childbirth.

In countries where homebirth is a covered benefit, such as the UK, Canada, New Zealand, Netherlands, France, Germany, homebirth rates are as high as 30%, compared to 2% in the U.S.

The AMA is not only greedy, but also misogynistic to try to control women’s reproductive rights.  In the end, it is a woman’s choice how she births her baby. She shouldn’t suffer financial penalties for choosing Homebirth.

 

 

Bringing Baby Home

It’s 3 a.m. You’re up for the fourth time since you fell into bed at 8pm last night.

This beautiful, amazing creature is now nestled softly in your arms, content to feel the intensity of your love as you slowly rock, back and forth, back and forth. You never could have imagined how much you would love your baby. And watching your partner care for your child only brings more joy to your overflowing heart. But you’re exhausted.

Sleep never comes for more than two hours at a time…and that’s on a good day.

You can barely remember what food tastes like hot. You feel like you’ve scored a win for the day when you manage to sneak in a shower. Naptimes are the new “deadlines” you find yourself scheduling your days around. Babies are just supposed to eat, sleep and poop, right? So, why are you so, well, pooped?

The Gottman Institute has been researching couples, their behaviors, communication patterns and ability to connect for over 40 years. Through this research they can predict with over 90% accuracy whether or not a relationship is headed for divorce. Fortunately, for all of us, they have also determined numerous behaviors that happy and satisfied couples engage in that can help to keep your relationship strong. Evenwith the many changes that accompany welcoming a new member into your family as “Baby Makes Three”. The Gottman institute has developed a program specifically for expectant and new parents to help you navigate the ups and downs of bringing a new baby into your home and your hearts.

Certified “Bringing Baby Home” Facilitators Brittany Holmes, MFT and Jennifer Lundy-Aguerre, MFT

will guide you through the tried and true steps to maintaining and strengthening your relationship with your partner during this transition time. Come learn more about the tools to enhance your relationship for years to come!

http://www.pccounselingcenter.com/index.php/groups/

Positive Change Counseling Center  www.pccounselingcenter.com

Making Room For Baby www.makingroomforbabysd.com

Jennifer Lundy-Aguerre, MFT #42025
Licensed Marriage & Family Therapist

Office: (619) 733-6414
Cell: (619) 828-3306
Fax: (619) 303-3306
5480 Baltimore Drive, Suites 106 & 250
La Mesa, CA  91942

Effective 10/1/18! New North County Location!
11590 West Bernardo Court, Suite 230
San Diego, CA 92127

Sign up for Bringing Baby Home
Sat Jan 26 2019, 10-11:30 at our midwife office:
Mother to Mother Midwifery
1816 Howard Ave San Diego CA 92103
Registration is limited to 8 people
Cost is $25 for a single and $40 for a couple

Alternative Birth Options and Health Insurance Coverage

Although most women in the U.S. deliver babies in a hospital, that’s far from their only option these days. They don’t have to rely on doctors or obstetricians either. Doulas and midwives are increasingly common, as are birthing centers as well as home and water births. Here’s how health plans tend to treat them.

midwife touching pregnant woman stomach

In the early 1900s, nearly all American women gave birth outside a hospital. By the 1940s, less than 50 percent of them delivered their babies at home. And by the late 1960s, just 1 percent did so.

That’s pretty much where things stand today. Almost all babies in the U.S. are now delivered in a hospital–in stark contrast to what was commonplace a century or so ago.

No one is likely to argue the tide is racing back toward out-of-hospital births, but it does seem to be leaning in that direction–if only slightly.

According to the Centers for Disease Control and Prevention (aka the CDC), the percentage of out-of-hospital deliveries increased from 1.26 percent of all U.S. births in 2011 to 1.36 percent in 2012.

Most of these “alternative” deliveries occur at home, although a good number take place in freestanding birthing centers. (In 2012, just over 35,000 of the nearly 54,000 out-of-hospital births in the U.S. happened at home. Birthing centers served as the setting for around 15,500 of them.)

Having babies at home or in dedicated centers isn’t the only alternative birth option American women are embracing these days. They’re also increasingly utilizing doulas, midwives, and night nurses to help them through their pregnancies and deliveries.

The most recently gathered statistics associated with doulas, for instance, suggest about 6 percent of U.S. women use them during childbirth. A little over 8 percent call on midwives while pregnant, according to another study.

That’s all well and good, you say, but how much does a doula or a midwife or a birthing center cost? And how do those price tags compare to the ones attached to their more traditional counterparts, like doctors and obstetricians and hospitals? Also, does health insurance usually cover these alternative birth options?

Keep reading for answers to all of these questions and a few more.

By the way, if you’re currently uninsured, check out our article about how to choose the best health insurance plan for your pregnancy.

Doulas

Americanpregnancy.org says “doula” is a Greek word that means women’s servant.

Most modern doulas would balk at being called servants. “Helpers” might prompt a nod of agreement, though. Even better options: birth assistants, labor companions, labor support professionals, or labor support specialists.

That’s because, as americanpregnancy.org puts it, a doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience. (Although some doulas help women through abortions or help people who are dying, too.) Specifically:

  • Antepartum doulas assist pregnant women who are put on bed rest to prevent preterm labor.
  • Birth or labor doulas provide care during delivery.
  • Postpartum doulas support new moms in the first few weeks after they give birth.

Note: doulas aren’t medical professionals. They don’t actually deliver babies or offer any other kind of medical care. Many doulas are certified, however. To earn their certificate they must complete a training program and pass an exam.

Doulas may not have professional medical training, but many pregnant women swear by them anyway. Why? Because with their assistance you may be able to:

  • avoid a Cesarean section (or C-section) delivery
  • give birth without needing as many–or any, in some cases–pain medications
  • spend less time in labor

Studies also have found that women who work with a doula while pregnant are more likely to describe their deliveries in a positive way.

All of that positive support comes at a cost, of course. How much you pay depends on where you live. If you call a more rural area home, for instance, you may only pay a few hundred dollars. On the other hand, it isn’t unusual for pregnant women in urban settings to pay thousands of dollars for a doula.

Also impacting the potential price tag here: how long you employ a doula. In other words, if you only need one for a portion of your pregnancy, you’ll pay less than if you need one for the whole nine (or more) months.

As you might expect, health insurance coverage of doula services is all over the map. Some plans help pay the associated costs, while others do not.

The best way to find out how your plan treats doulas: pick up the phone and call your insurer. Or send them an email.

Do the same if you’re on Medicaid. A couple of states currently require their Medicaid programs to cover certified doula services and others may cover them even without legislative involvement.

If your plan or coverage won’t help in any way, head to Google (or your search engine of choice). You may find doulas willing to volunteer their time and expertise to women who can’t afford to pay them. Or you may find some who charge less in such situations.

Midwives

Unlike doulas, midwives are trained medical professionals. Like doulas, however, they can care for women before, during, and after their pregnancies.

You may think of midwives chiefly as pregnancy and birthing assistants–much like doulas. Although they sometimes take on that role, they’re just as likely to lead a woman through labor and delivery.

Something that differentiates midwives from physicians or obstetricians is they tend to be proponents of natural childbirth. At the very least, they usually try to minimize unnecessary interventions during a pregnancy.

Something to pay close attention to if you decide to hire a midwife: their level of certification. In particular, you’ll probably want to look for a certified nurse-midwife (or CNM). These midwives are registered nurses. And to earn this certification, they have to graduate from an accredited education program and pass a national exam. Certified nurse-midwives can practice in all 50 states and in the District of Columbia.

That’s not to suggest you should ignore certified midwives (CMs) or certified professional midwives (CPMs). Not all states permit CMs or CPMs to practice, though, and that may give some women pause.

Regardless of whether you hire a CNM, CPM, or CM, your midwife should be able to help you in a variety of locations–your home, a private office, a birthing center, or even the hospital.

What does “help” mean here? Typically, a midwife can do most of the things a physician or obstetrician can do while caring for a pregnant woman.

Generally, that means they’re knowledgeable about prenatal care, labor, and postnatal care. More specifically, it means they often can help with:

  • prenatal exams, tests, and screenings
  • diet, nutrition, and exercise advice
  • medications
  • emotional support
  • lactation and breastfeeding counseling or education

In addition to leading or assisting with your delivery, of course.

One catch to all of this: most experts recommend using a midwife only if you’re at a low risk for complications. As such, if you run into any problems during your pregnancy, you’ll probably want your midwife to at least consult with a physician, obstetrician, or other specialist. (On a related note, read our article about unexpected pregnancy costs and how health insurance covers–or doesn’t cover–them.)

Although you’ll typically pay more for a midwife than you will for a doula, you may not pay too much more. According to pregnancycorner.com, the average cost of a midwife in the U.S. is around $2,000. That means you’ll sometimes pay a good deal more than that amount, but it also means you’ll sometimes pay less.

Where you end up on that spectrum mostly depends on where you live and what services you need.

In any case, you can expect to pay less for a midwife than you’d pay for traditional obstetrical care in a hospital, the cost of which can go far beyond $5,000 or even $10,000.

Granted, those savings won’t mean much if your health plan doesn’t cover at least some of your resulting bill. And that’s a distinct possibility given how insurance companies currently treat midwives.

Some insurers don’t cover midwife services at all. Some cover them if the midwife helps you deliver your baby in a hospital setting or birthing center, but not if you deliver at home.

Because of this, talk with your insurance company before you start looking for a midwife so you know what your plan will cover and what it won’t in this regard.

You should have better luck if you’re on Medicaid. But even then you’ll want to check with your local agency before you shake any hands or sign on any dotted lines.

Night Nurses (or Night Nannies)

Don’t be fooled by the name “night nurse.” Although many of these women (and men) are registered nurses, many are not.

Some night nurses or night nannies are certified in various ways, while others simply have a lot of experience taking care of newborns.

Regardless, they all help new moms in basically the same ways. Primarily that means spending nights in their homes and feeding and otherwise taking care of their babies while they sleep.

A lot of mothers hire night nurses for the first week or two after they give birth. Others wait a while, such as until they’re ready to return to their jobs.

As helpful as night nurses or night nannies can be in these situations, their assistance isn’t cheap. Most charge between $25 and $40 per hour, according to various sources. (Once again, what you wind up paying probably will depend on where you live and how much experience a particular nurse or nanny has.) That means you could spend upwards of $200 a night, and more than $1,000 each week, for this specialized sort of care.

Unfortunately, you’ll most likely have to pay for a night nurse out of your own pocket should you decide to make use of one. Few, if any, health insurance plans cover them at this point–even though they cover a lot of other forms of postnatal care. (To learn more, see our article: “What Does Health Insurance Cover After Pregnancy?“)

That said, if you or your baby come home with any special health needs, it’s possible your plan will pick up some of the cost. You’ll obviously have to talk with your insurer to find out one way or the other, however.

Birthing Centers

According to CNN, the number of babies born in U.S. birthing centers increased 55 percent from 2007 to 2015.

Medicaid is responsible for some, if not most, of that growth, thanks to the Affordable Care Act (also called the ACA or Obamacare) requiring state Medicaid programs to pay these centers a facility fee. Still, their appealing nature probably played a role as well.

Basically, delivering your baby at a birthing center is more like doing so at home than in a hospital. Birthing centers tend to be cozy and low-tech. Midwives, rather than obstetricians or physicians, typically serve as their primary care providers. And natural childbirth is emphasized over the kinds of medications and medical interventions common in more clinical settings.

One of the main benefits of using a birthing center is the mother’s recovery time often is far shorter than it would be if she delivered her baby in a hospital. In fact, many women spend just a few hours in a birthing center after giving birth, while a couple of days isn’t unheard of in a hospital.

Another common benefit: birthing centers are almost always cheaper than hospitals. The average cost for a birthing center is around $3,000, while hospitals charge many times that amount.

There are a few downsides to using a birthing center. One is they’re not the best places for complicated pregnancies or deliveries.

Also, insurance coverage can be spotty. That said, more U.S. health plans cover birthing centers than in the past. So, if you want to go this route, contact your insurance company and ask how your plan treats this type of care. Talk with the birthing centers you’re considering, too; they may be able to help.

And what if you’re on Medicaid, as many women are during their pregnancies? You’re in luck. As mentioned earlier, Obamacare requires state Medicaid programs to cover the services of licensed birthing centers. For more information, get in touch with your local agency.

Home Births

There’s quite a lot of overlap between home births and midwives. Which makes sense, as midwives often run the show, so to speak, during home births.

There’s also a good bit of overlap between birthing centers and home births. Which is to say that women who give birth at home often do so for reasons that are similar to why women deliver their babies in birthing centers.

In other words, they usually want to give birth in a comfortable setting. They want to be surrounded by family or friends. They want to avoid all the medications and medical interventions or interruptions that are so common during hospital deliveries. And they typically want to feel more in control of the entire birthing process.

Cost tends to be a concern, too. As in, many pregnant women choose home birth so they can bypass the sky-high bills associated with most hospital births.

So, how much does a home birth usually cost? Around $3,000–or about 60 percent less than you’ll pay if you give birth in a hospital.

The thing is, you may have to pay some of all of that amount out of your own pocket whether you have health insurance or not. Although a number of U.S. insurers now cover certain midwife services, many still balk at covering planned home births.

Why? The most common answer is they consider home births to be “not medically appropriate.” They also often consider them to be risky.

Speaking of which, here’s what one health insurer, Aetna, has to say about the subject:

“According to the policy statement on home delivery of the American College of Obstetricians and Gynecologists, labor and delivery, while a physiological process, clearly presents hazards to both the mother and fetus before and after birth. These hazards require standards of safety that are provided in the hospital setting and cannot be matched in the home situation.”

There are health insurance companies that cover home births, though, so don’t give up if that’s how you want to deliver your baby. Contact yours to see how–or if–your plan treats this sort of situation.

And even if your health plan covers home births, don’t be surprised if it ties some requirements to that coverage. One example: you may have to use a midwife who has been certified by state regulators. Also, you might need to pay for various supplies or pieces of equipment.

Water Births

Once again, there’s often some overlap between water births, home births, birthing centers, and midwives.

This is because many water births take place at the home of the mom-to-be or at a birthing center. (Though some do take place in hospitals.) And midwives typically oversee these deliveries.

As for what a water birth is, it’s usually a birth–and this can mean labor, delivery, or both–that happens while the woman is in a pool or tub filled with warm water.

Some of the benefits associated with water birth are that it can:

  • ease pain
  • keep the pregnant woman from needing anesthesia or other medications
  • speed up labor

How much you pay for a water birth depends on a number of factors. For instance, if your water birth takes place in a hospital, you’ll probably pay what you’d pay for a more traditional birth. (The hospital may bill you extra for the tub, however.) The same is true if your water birth is done at a birthing center or at home.

What about insurance? Again, your health plan is most likely to cover water birth if it’s done in a hospital or birthing center. If yours takes place at home, you’ll face the same insurance challenges any woman who wants to give birth at home faces.

Few, if any, state Medicaid programs currently cover home births, so they’re also unlikely to cover home water births. Still, contact your local agency before you decide to pay for one out of your own pocket.

Actually, that’s good advice no matter where you get your health coverage. It’s never a bad idea to have a conversation with your insurance company about whether or not it covers certain services or situations.

Frequently Asked Questions

Q: Does health insurance cover doula services?

A: Unfortunately, it’s hard to answer this question with a simple yes or no. Some U.S. health plans cover doula fees, and some don’t. Yours is more likely to do so if you deliver your baby in a hospital, but don’t assume that to be true across the board. The only way to be sure about how your plan treats doulas is to contact your insurer before you hire one.

Q: Will my health plan pay for a midwife?

A: Some good news for a change: your health insurance is more likely to pay for, or help you pay for, a midwife than it is to pay for a doula or night nurse. That said, there are plenty of insurers and plans that don’t cover midwives, especially if they’re attending a home birth. Your best bet to get your health plan to pay for some or all of your midwife bill is to deliver your baby in a birthing center or hospital.

Q: What’s the difference between a midwife and a physician or obstetrician?

A: Although obstetricians, physicians, and midwives all are highly educated professionals, they don’t go through the same training. That doesn’t mean your average midwife–especially if she or he is a CNM–isn’t more than capable enough to help you through your pregnancy or deliver your baby. On the contrary. The key is to do your homework before you make a hire. Of course, the same could be said whether you’re looking to work with a midwife, obstetrician, or physician.

Q: What’s the difference between a doula and a midwife?

A: Doulas usually take a supporting role in a pregnancy and birth. They help mothers-to-be feel comfortable and provide assistance wherever and whenever it’s needed. Also, they usually don’t have formal medical training.

Midwives, on the other hand, tend to be registered nurses or certified professionals. As such, they can offer women a wide range of health and medical care over the course of their pregnancies. And of course they can deliver babies, too–something doulas aren’t trained to do.

Q: Does health insurance cover birthing centers?

A: Although more health plans cover birthing centers now than in the past, it’s still not uncommon to come across ones that don’t cover them. So, talk with your insurance company–and talk with potential birthing centers, too–about your plans before anything is set in stone. The last thing you want to do is have to pay for this out of your own pocket because you assumed insurance would cover it.

Q: Will my health plan pay for a home birth?

A: Probably not. It’s not completely out of the question, though, so contact your insurer about it before you’re too far along in your pregnancy (if possible, of course). You never know, they may surprise you and tell you they’ll cover every aspect of your planned home birth.

Originally posted at https://quotewizard.com/health-insurance/alternative-birth-option-coverage

Birth story for Augusta

  • Name: Melanie Keeton (Founder of Returning to Birth)
  • Baby Name: Augusta Nicole
  • Weight: 7lb 6oz
  • Length: 20 in
  • Birthday: November 8, 2017
  • Gestation: 40 weeks (born 15 min shy of her due date)
  • Time of Birth: 11:44 pm
  • Location of Birth: San Diego, CA Home birth with Mother to Mother Midwifery


I had a few days of feeling a little crampy on and off where I thought maybe something was going to happen but it always stopped.  I never had Braxton Hicks with my first pregnancy so that was a little confusing. The day she was born was just another day and I felt fine for most of it.  Later in the afternoon I felt more and more uncomfortable but wasn’t having contractions. Around 8pm I was uncomfortable enough that I just wanted to be by myself and not have to worry about my toddler Eleni (read her birth story here). The plan was for her to go stay with my sister in law Nicole when I went into labor but I wasn’t sure if this was another false alarm.  I called my mom (she’s also a doula) who told me it would be a good idea to have Eleni picked up.  That way maybe I could relax enough to let my body go into labor.

I think Eleni was picked up around 8:30 or 9pm. My mom was now at the house with us convinced I was in labor (I wasn’t so sure yet) and Nicole’s boyfriend Ian was on his way over. Ian is an acupuncturist who agreed to come to the house to give me a treatment. I hate the crampy feeling of early labor. It’s actually more uncomfortable and harder for me to cope with than actual contractions so when he asked if I wanted needles that would help me relax or get things going I said “get things going”. My mom thinks I was crazy to say that as my first baby’s labor was pretty quick (9 hours total). I laid on my bed on my side so Ian could place the needles in my back. Almost as soon as I laid down and got two or three needles in, I got intense heartburn where I needed to sit up. I also had a couple small contractions. He took out the needles and I sat up which felt much better. We then had the idea to sit me backwards in a chair in the living room so I could stay upright and still get the acupuncture treatment.

While sitting in the chair, my husband Clinton was on the phone with the midwives to let them know tonight is looking like the night so they can be ready for our call when it’s time for them to come over. Our midwife Kayti said to call her whenever we wanted her to come over as it would probably be awhile. She ultimately decided to head over to the house now and just sleep on the couch until we were ready for her help instead of waiting for a call (good idea on her part as I soon found out). Right about as Clinton got off the phone, Ian continued with acupuncture in my new upright position. It almost instantly put me into active labor! This was about 10:00pm. The contractions were strong enough that I needed to move and could no longer sit still enough for acupuncture. These were really intense contractions and they came one after another with barely any break in between. It was very difficult to stay relaxed and focused with how intense it was and this felt completely different from labor with my first.

Clinton started filling up the birth tub while my mom suggested I get in the regular bathtub in the meantime. The water helped a lot. We had prepared hot washcloths with lavender essential oil in the crockpot and I draped them over my belly with each contraction. It felt amazing! The calming smell helped to distract me from the contractions. At this point we sent Ian on his way as I assumed it will be a few more hours and I didn’t want him to just be sitting around with nothing to do.

At about 11:15pm Kayti arrived and started getting her supplies ready. My mom was with me in the bathroom and helped me over to the birth tub. The water heater ran out of hot water before we got the birth tub filled but it was suggested that now would be a good time to get in. The warm water felt amazing. In the birth tub I could be upright and lean over the side with each contraction which was so much more comfortable than trying to be on my back in my bathtub. This is when my mom could switch into photographer mode and my Husband could step in as my support. He had been getting the tub and bedding all ready while I was laboring so it was nice to reconnect with him.

I had some intense contractions in the tub. I remember burying my head into the towel Clinton had draped over the side and holding on to his arms for support. I looked into his eyes between each contraction and felt like I was telling an essay long story with each glance. This was HARD….way harder than my first baby. These contractions felt completely different; they had the force of a train thundering through me. It took all my focus to relax and surrender to the intensity but they were still getting away from me. It felt like riding a tsunami and I was holding on for dear life.

At this point Kayti was still unpacking her supplies (it was about 11:30pm) so my mom called her over to check on me. Turns out the baby was crowning! Since we didn’t get the tub filled all the way up, she said I needed to change positions so the baby would be born into the water (In a water birth you want to make sure they are born under the water and then come up to the air for their first breath). Kayti and Clinton helped me get from hands and knees flipped over to my back. Once you’re in pushing mode its extremely difficult to move so that was interesting. Once I was on my back, I was able to do some much deeper breathing and try to slow down. The downward force of my body pushing for me was insanely strong. I tried my best to relax and open with each breath and use Hypnobirthing “J Breathing” instead of pushing to “breathe baby down”. It felt like the baby was exploding out of me!

I heard Kayti say she was coming as I felt her move down and out into her Daddy’s hands. That’s right, Clinton got to catch her! As I closed my eyes and took my sigh of relief I heard Kayti say she was born en caul! This is extremely rare and means that she was born completely still inside the amniotic sac (my water never broke). I got a quick glimpse of it before she broke out of the sac on her own on the way out. She was handed over to me and I got to say hello for the first time to my beautiful Augusta at 11:44pm. About an hour and 45 minutes of active labor! No wonder it was so intense. Shortly after she was born, our second midwife Sunshine arrived. She couldn’t believe she missed the birth but was there to help with all the postpartum care for me and baby for the next few hours before leaving us to bond with our new little one.

I laid in bed with Augusta and nursed her for the first time while we waited for the cord to stop pulsing. It was actively pulsing for around 45 minutes! Then we asked my mom to cut the cord. Augusta took to nursing no problem which is always a relief. She was calm and alert. The midwives stayed until around 3am to make sure everyone was doing well. I had a bit ore bleeding than we wanted so after a few rounds of painful fundal massage and the most disgusting Chinese herbal drink I’ve ever tasted, I asked for the postpartum pitocin shot. That stopped the bleeding almost right away. We then settled in for the night for the first time with our little “Gus”.

This birth experience taught me that I am strong and capable of amazing things. By trusting my body and my support system, I was able to surrender and be truly present for the birth my baby needed. This birth taught me that I deserve to feel safe and supported and that I have amazing people in my life like my husband and my mom that want that for me too.

Thank you Augusta!

Read more birth stories here at www.returningtobirth.com

WHAT is Postpartum Rehab, and WHY should EVERY mother have it?

By Sheri DeSchaaf, PT, DPT

http://www.shefitpt.com

Most women are familiar with the common postnatal recommendation of “no exercise for 6 weeks,” or until she is seen for her postpartum check up. But is doing nothing really the BEST way to restore a woman’s body and prepare her to care for a growing child, and all the responsibilities that come with it?

After any physical trauma, minimizing strain on healing tissues is crucial to allow the body to heal and recover, and the same applies to childbirth. After any comparable athletic trauma, rehabilitation (physical therapy) would be a standard part of the plan of care – helping the patient to regain mobility and strength, and educating them on what not to do to avoid reinjury, as well as what TO do to restore injured muscles, fascia, tendons and ligaments, and regain strength and stability. After any significant surgery, such as a rotator cuff repair or knee arthroscopy, patients are immediately referred to 6-16 weeks of structured rehabilition from a qualified physical therapist. I think we would ALL classify a C-Section as significant surgery, and yet no such referral is made – mothers are simply instructed to go home and “rest” for 8 weeks, then go back to doing “whatever feels good”.

You may be surprised to discover that there actually IS specialized phsyical therapy for women to repair their bodies after childbirth. However unlike in France, where every new mother is referred for 6-8 weeks of postpartum therapy, American doctors almost never refer to PT, leaving women to sort out the myths and somehow make it back to fitness on their own.

Women in American society often feel far too much pressure to get their pre-baby body back within months of childbearing. And while we must encourage women to REST during the early postpartum phase, we should also consider that:

  1. Women HAVE to use their bodies the minute the baby is born and every minute after that – to roll over, stand up, lift and carry a 6-10lb newborn, breastfeed for long periods in various positions, and often care for older children and tend to their normal daily duties, whether or not they are “exercising”.
    The deep core muscles that have been overstretched, overloaded, strained and torn during pregnancy and childbirth often do not simply resume their perfect pre-pregnancy function and coordination. They often require careful, intentional retraining to function normally again. This does not magically happen at the 6 week time point.
  2. Every move we make as a human body requires a functional deep core system. Even something as simple as rolling over in bed requires the effective coordination and activation of more than 10 different muscles, including the diaphragm, transverse abdominis, pelvic floor, multifidi, and more superficial spinal and abdominal muscles. We need these muscles to turn back on or get stronger after pregnancy (babies get bigger, helpers go home or back to work, older children forget you just had a baby…). The key is, how do you progress appropriately in this delicate healing period, to restore normal core function and begin strengthening while promoting tissue healing and preventing injury. This is where postpartum PT comes in.

After any injury, the first task is to assess the muscles that are most impacted and restore their normal mobility, tone, and activation. Pelvic PT helps women manage and navigate pain, identify any red flags, ensure that the pelvic floor, abdominals, and other core muscles are functioning well, and that mothers are educated on proper body mechanics, posture and breathing for postpartum tasks like breastfeeding and carrying baby. After the trauma of childbirth (with about 25% currently ending in surgery), pelvic floor therapists assist mothers in careful retraining of the muscles most impacted by pregnancy and birth – the pelvic floor, transverse abdominis, superficial abdominals, and diaphragm. They help restore proper posture and breath patterns to allow a woman’s body to function in optimal alignment, avoid injury, and prepare for return to “real exercise” like running, weightlifting, HIIT training etc.

If a woman goes home from her birth experience and does nothing to strengthen her deep core muscles, retrain her pelvic floor, restore normal posture and mechanics, then the likelihood she will NOT be ready to resume exercise at the 6 week mark is pretty high. On the flip side, if she goes home and gets antsy and frustrated and starts up with her “normal” core exercises again at week 3 or 4, she is likely to hurt herself and further damage the healing soft tissues of the pelvis and abdomen. There is a safe, intentional way to restore the core and return to exercise, and it is imperative that women who want to return to rigorous exercise after their 6 week clearance take the necessary interim steps to rebuild the pelvic floor and core muscles, retrain the appropriate postural responses and breath patterns, and learn how to move optimally prior to resuming impact exercise, heavy lifting, or aggressive abdominal exercise.

There are a few things that most women will find beneficial to begin as soon as you are physically comfortable doing them, as they are natural ways to promote initial retraining of the deep core. The first one is walking. As soon as you are physically able, start walking a little more each day, focusing on good posture and deep breathing. (If you have any increased bleeding or pain, stop the activity and consult your doctor/midwife.) Second, mind your posture and breathing. When you sit, sit up straight. When you stand, stand up tall. And at all times remember to breathe evenly, never holding your breath. As you practice your posture and breathing, focus in the gentle expansion of the abdomen and ribcage with inhale, and the gentle contraction of the abdomen and pelvic floor with exhale. This focused awareness will help you get back in touch with these muscle groups while also focusing on restoring normal posture and alignment to your body.

If you’d like to learn more about safe and effective return to fitness after pregnancy and childbirth, please join us June 16th with Dr. Sheri DeSchaaf, DPT for Bellies, Bladders and Beyond.

Riding the Postpartum Waves: Understand the wide range of feelings

By Rachel Rabinor, LCSW

http://www.rachelrabinor.com

Riding the Postpartum Waves: Understand the wide range of feelings that come with a new baby and how to let your community support you

Becoming a mother is the biggest transition a woman goes through in her adult life. We’re taught to think and plan for the birth: Will I have an epidural? Pitocin? Vitamin k? I’ll bring music, wear an eye mask… There’s such a huge range of considerations. But what about after the birth? We anticipate happiness, love, deep connection with our partner and an instant bond with our baby. How will we foster these emotions and experiences? Will they just happen? And what else might I expect?

When baby is up all night and your partner is snoring, how will that impact you? What about the emotions coursing through your body after a few weeks in the NICU—is it anxiety or the oxytocin you’ve heard so much about. Despite your text-book home birth that you planned to a T, you might find yourself crying uncontrollably for what feels like no good reason. The postpartum period can feel unpredictable to a new mother and even like a roller coaster at times.

So what does it feel like to be a mother? What is normal? In this workshop we’ll discuss the common range of emotions new mothers may experience. We’ll talk about the baby blues and if what you’re feeling is something more, like depression, anxiety or post-traumatic stress disorder.

We’ll also talk about some of the many (many) myths of motherhood that can contribute to feelings of guilt, fear or shame and strategies for cultivating more joy while coping with the challenges of motherhood.

Bio

Rachel Rabinor, LCSW is a psychotherapist and licensed clinical social worker. She has a private practice in Banker’s Hill where she specializes in reproductive and maternal mental health. She is passionate about supporting women (and those who love them) on their journey to and through motherhood. She has specialized training in treating pregnancy and postpartum mood and anxiety disorders, traumatic birth, infertility, miscarriage, loss, and early parenting. She believes in the healing power of community support and enjoys facilitating groups for new mothers and women experiencing infertility. Rachel is a member of ASRM, Resolve and San Diego’s Postpartum Health Alliance where she was the former training chair. She is often featured on podcasts and webinars, and regularly presents to local groups and organizations on topics of maternal mental health.

 

Diastasis Healing with Dr. Stephanie Libs

We were so fortunate at MothertoMother Midwifery this weekend to welcome Dr. Stephanie Libs to our Fourth Trimester Talk in the Garden.  Dr Libs is a chiropractor and owns her practice, Cafe of Life in San Diego.  She has a daughter and is expecting a second baby.  So she has personal and professional experience of the subject she shared with us: Healing the diastasis after having a baby.

I learned so much from Dr Libs. She is knowledgable, energetic and personable in her presentation.  I’m eager to pass on to my own clients all the tips Dr. Libs shared with us.

“Diastasis is when the linea alba (midline) separates from the rectus abdominis. During the second and third trimester the linea alba starts to thin due to babys growth. The linea alba is made of connective tissue which has little blood supply, and makes it difficult to heal”, according to Dr Libs.

To feel your own diastasis, use your fingertips when you are lying down and your head lifted to feel the separation of the muscles. It seemed like everyone in our group of mothers had a diastasis at least three finger tips wide.

Diastasis doesn’t just cause tummy bulging but actual back pain and even urinary incontinence.  It’s challenging to accept these changes in the body after having a baby.  It can even lead to some depression.   Women don’t realize they don’t have to accept these changes though.

A lot of women continue their entire lives with a gaping diastasis after childbirth and consider it to be normal.  But it’s not normal and there are some very simple things to do to heal the diastasis.  We discussed within our group that most care providers do not give instructions how to heal the diastasis after having a baby.  It’s unfortunate these instructions aren’t common knowledge because they can make a big difference for a woman’s comfort and her self-esteem.

How to heal the diastasis after childbirth

It’s possible to have a strong core after childbirth.  Those abdominal muscles can be knit back together to close the diastasis.  Here are a few highlights from Dr. Libs presentation.

Did you know bone broth and wheat germ oil are excellent for healing the connective tissue of the diastasis?  Yes, it’s true.  I will add here that organic gelatin powder is an easy and affordable alternative to bone broth.

“Crunches” and traditional abdominal work outs are the worst for healing the diastasis. I guess those “Abs of Steel” videos 30 years ago were counterproductive!  You can check for yourself if your work out is working against you.  Feel the diastasis when you’re working out and check if it’s more pronounced.  It should be getting smaller and closing together.  By the way it’s possible to place tapes on your diastasis to better support it’s closure.  Dr Libs can help you with this.

The best exercises for healing the diastasis are done with the umbilicus drawn in and the abdomen engaged as if bracing for a strike.  With this posture, mindfully sit down and stand up.  This should be your first abdominal exercise after having a baby.  Dr Libs says mindful baby wearing with the core engaged is another of the first postpartum work outs.  Don’t forget to breathe!

Never hoist yourself to sit up. This makes the diastasis worse!  Always roll to the side and then sit up when trying to heal the diastasis.  Twisting and leaning down are also a big culprit.  Avoid twisting when you reach down to pick up your child.

There are several progressive exercises to do to heal the diastasis.  They all involve lifting one leg at a time, never two. One is to lie down with your knees bent and feet flat on the ground. Draw in your umbilicus and engage your abs.  Now lift one bent leg at a time to a perpendicular position and then slowly lower.  This exercise is one of the first to do to heal and to close the diastasis.  There are several more as you continue your progress toward your mother strong core.  I recommend looking at youtube for demonstrations.

Most importantly, instead of thinking about trying to get your former body back, think about going forward, toward a stronger, wiser, mother body.  Work out wise and strong like a mother!

 

 

 

Cord Blood Collection and Homebirth

Cord blood collection is possible at your home birth.  Mother to Mother Midwives will help interested families collect cord blood at their Homebirth.

The stem cells in your baby’s umbilical cord blood are a valuable resource.  They are undifferentiated cells that can be used to treat many diseases such as stroke, heart disease, Parkinsons Disease  and Diabetes.  This could be a life giving donation from your baby to another individual and an early act of good karma..

Unfortunately, due to our current scientific limitations,  it is very unlikely the stem cells collected from your child will later benefit him or her.  The likelihood your child will benefit from his/her own stored stem cells is approximately 1/100,000.

It’s much more likely that these stem cells could benefit an ill family member or an anonymous individual in need.

There are two options for collection and storage of stem cells, private companies or local, community blood banks.

To collect stem cells for a family member, consider a private stem cell collection company such as Stemcyte. Such companies charge for collection and storage of your baby’s cord blood.

A practical option for those who want to donate to the public is the Community Blood Bank.  They will collect and store cord blood at no charge. Best of all, they match the donated stem cells to needy, sick individuals.  If your motivation is to help someone in need, blood banks are the best option.

Altruism aside, the individual most likely to benefit  from his or her own cord blood is your baby.  Allowing a baby to keep all of his or her own cord blood means he will receive all the benefits from the precious stem cells, red blood cells and platelets.

Delaying cord clamping for at least 30-180 seconds after birth results in higher concentrations of hemoglobin and hematocrit and blood volume during the neonatal period and less iron-deficiency anemia at 4-6 months of life.  There is also a correlation to improved neurological function for those who kept all their own cord blood.

For families who do choose to collect stem cells, our midwives prefer to delay cord clamping and cord blood collection for 30-180 seconds after birth before collection. This is a compromise between collecting all or none of the cord blood.

Mother to Mother Midwifery preferred method of cord blood collection is delayed clamping and collection. For families who choose it, this is a good compromise.

ohhh the vernix-Birth Photos

“The International Association of Professional Birth Photographers has announced the winners of their 2017 contest, and the photos they chose show the struggles mothers go through to bring new life into the world, and the sheer joy that follows.

We took your breath away with last year’s contest, and these new photos will leave you even more amazed. Each one tells a story of pain, perseverance, and finally, relief. They document a baby’s first moments of life, and a family’s first moments of unity.”

http://www.boredpanda.com/professional-birth-photography-competition-winners-labor-2017/?page_numb=12&utm_source=Epictexts&utm_medium=referral&utm_campaign=SBP

one of the many waterbirths

SO many raw images…careful if you are sensitive to images of cesareans. Many Midwife and Homebirth pics…tons of beautiful images.  Enjoy

Why a Doula? But we have a midwife…

One of the big questions that we get asked at Mother to Mother Midwifery during our interview process is ” Do I need a doula at our homebirth?”

The short answer?  Yes

We as midwives have very refined doula skills.  We know what words to use, what touch works, positions for you to get into, how to engage the father in the process, we know about aromatherapy, homeopathies etc….  We do all of the things that a doula does.

What we can’t do is provide that support continuously as a good doula does.

We ask that you have an extra person at your birth especially for first time mothers and you will frequently hear us say that we can provide some labor support but our focus is on the clinical aspects of labor, birth and postpartum.  We ebb and flow in our physical support, always on alert for you and the baby but we can’t always be hands on.  Often we need to conserve our energy and focus for the important moments of the baby’s emergence and the postpartum period.  This means that we may rest while you labor and we are doing other clinical things while you may need hip squeezes.

Do we need to pay for one?  That depends…

We have a regular and low cost doula list in the office.  You don’t need to pay for one but…

We encourage you to have someone who has experienced natural birth, ideally in a home setting.  We ask that the person have some labor support skills and some awareness of what it is to be on continuous call for someone.

That person could be a close family member or a friend as well.  As long as they possess the above, then you will have a solid team of support.

For 2nd and subsequent babies we just ask that you have someone that is not your partner there if your other kids are in the house with you.  Most laboring mother’s want their partner with them, not looking after the toddler, so the third person fills another role for the family.

It is one of our big topic at prenatal visits.

#keeptheoxytocinflowing #mothertomothermidwifery #homebirth

Sunshine supporting a laboring mother with belly binding and rebozo

Evidence Based Birth Practices

One of the goals of midwifery care is “Evidenced Based Birth Practices” which means that our care is guided by more than just our personal experiences and instincts.  We strive to provide what we think  is a blend of available science and technology as well as good old fashioned nurturing…

A webisie that families can reference when making decisions is
Evidence Based Birth
We feel strongly in this model of care that empowers families to make good decisions.

This article on GBS is something that we reference from the website…there are many informative articles and we invite you to explore  when making important decisions that impact your care.

 

ENJOY!

 

#homebirth #mothertomothermidwifery #Midwife #licencedmidwife #CNM #midwifeminds #evidencebasedbirth

NIPT: Early Genetic Testing

Non-Invasive Prenatal Testing (NIPT)

Introduction

NIPT analyzes cell-free fetal DNA circulating in maternal blood. It is obtained from a simple blood draw. It is a relatively new technology in prenatal screening and testing for trisomy 21 and other fetal chromosomal aneuploidies. It differs from the California State-sponsored Prenatal Screening program in the following ways:

NIPT CA Prenatal Screening
Cost Cost is based on your insurance; out of pocket max, $200 Free with most insurances
Tests The most common chromosomal disorders only: Down Syndrome (Trisomy 21) trisomy 18 & 13. Can also tell if your baby is a boy or a girl.  More advanced testing also available. Screening for chromosomal AND “mid-line defect” issues (spina bifida, Open Neural Tube Defects, gastroschesis)
Accuracy 97-99% Sensitive and Specific (almost diagnostic) Accuracy varies: up to 90% accurate for Down Syndrome, 80% for ONTDs
Timing Can be done any time in the pregnancy from 10 weeks. Done at particular intervals; Final results available after 16 weeks

 

NIPT Test Characteristics

Genetic testing using cell-free fetal DNA

DNA from the fetus circulates in maternal blood. Unlike intact fetal cells in maternal blood, which can persist for years after a pregnancy, circulating cell-free fetal DNA (ccffDNA) results from the breakdown of fetal cells (mostly placental) and clears from the maternal system within hours. Fetal DNA detected during a pregnancy, therefore, represents DNA from the current fetus. Although only about 10-15% of the cell-free DNA circulating in maternal blood is from the fetus, it can be detected and measured. Quantitative differences in chromosome fragments in maternal blood can be used to distinguish fetuses affected with trisomy 21, and a few other fetal aneuplodies, from those that are not affected.

NIPT is currently offered by a host of companies:

Natera: Panorama

Sequenom: Materniti21

Illumina

We like NIPT because it offers families early testing for genetic diseases that can affect their choices in pregnancy- like early follow up care, education about place of birth, or opportunities to consider further testing.   The drawback with NIPT is that it does not test for “mid-line” defects which could also impact a family’s choices.  So we’re very careful when counselling our families about the wise use of this new emerging technology.  People DO love to find out early if it is a boy or a girl.  We enjoy their reactions, too.

 

Cesarean births affecting human evolution: The female pelvis is not to blame

Recently some British researchers came up with a dodgy, new spin on an old obstetric myth. They warn us that the high rate of cesarean births is afffecting human evolution.  They claim the female pelvis is shrinking through evolution.  They report, selection pressure from the overuse of cesarean deliveries is accelerating this evolutionary shrinking process. Consequently, more women now require cesarean births because the pelvis is too small and narrow to birth normally.

Rate of cesarean births is climbing

Researchers are baffled by how quickly the cesarean birth rate is increasing.  Their best explanantion for this phenomenon is evolutionary pelvic shrinking.

This isn’t a new conclusion, folks.  The size of the female pelvis has always been the scapegoate for complicated deliveries.  The original diagnosis for cesarean delivery was cephalopelvic disproportion.  Translation is the pelvis is too small to fit the baby.

It’s possible that high cesarean rates will lead over time to the an evolutionary smaller pelvis, but the size of the pelvis is not the cause of the high rate of cesarean births.

female pelvis

The pelvis is not the problem

The truth is, the size of the pelvis is not too blame for the high rate of cesarean births.

In fact cesearen rates for women who plan to birth at home in the U.S. have remained a steadily low below 10%. This proves the problem is not the pelvis.

Its imperative to lower the cesarean birth rates but not by blaming the female pelvis.

The Brits were on the right track two years ago when they announced their campaign to steer low risk women away from birthing in the hospitals.

In an effort to lower the rate of interventions and cesareans, in 2014 Great Britain’s National Institute for Health Care Excellence (NICE) recommended that women with low risk pregnancies are better served by giving birth at home.

More than half of cesareans are unnecessary

In our modern, developed countries the cesarean birth rate is more than twice what it should be. According to the World Health Organization, the ideal cesarean rate should be 10-15% for any country. The U.S. cesarean rate is 33%, meaning that more than half of the cesareans performed are unnecessary.

This is a good cause for all of our concern.

The overuse of technology is the real cause for increasing cesarean rates

The real problem for rising cesarean rates is not a shrinking pelvis, its the overuse of modern technology

While we are indebted to modern medicine for saving lives from time to time, it’s overuse is driving up cearean birth rates.  In time this may indeed cause selection pressure against normal vaginal birth!

Giving birth in the hospital with all its practices and technology directly increases the liklihood of delivering by cesarean.

Interventions such as labor induction with cytotec and pitocin, Friedmans curve, continuous fetal monitors and anesthesia increase the cesarean rates when over used.  Impatience of the providers, driven by production demands, also drives cesarean birth rates.

In order to decrease the cesarean rates, modern medicine needs to be used judiciously and only for delvieries that become high risk.

Planned homebirths have low cesarean rates

Planning a homebirth is the best way to avoid an unnecessary cesarean delivery.  The likelihood of requiriing a cesarean delivery for a homebirth mother is under 10%, well within the World Heatlh Organizations recommendation.

A woman planning a homebirth can trust that even if she ultimately delivers by cesarean, it is necessary and life saving.  It won’t result from the overuse of technology.  She should also believe that her pelvis is adequate and has not shrunk through evolution.Stages in human evolution

World Health Organization reommendation for cesarean rates

Cesarean births affecting human evolution

NICE recommendation for low risk mothers

Birth in the Caul

It is rare and special for a baby to be born in the caul.  It’s also known as ‘born in the veil’ because the membrane covers the baby’s face like a veil at birth.

Caul- the amniotic membrane enclosing a fetus.
Caul- The amniotic membrane enclosing a fetus.

Benefits of strong water bag

To be born in the caul is the result of a strong amniotic membrane that doesn’t break.  There are many physical benefits to an intact water bag including decreased infection, protection of the umbilical cord, and more freedom of movement for the baby.

How to have a strong water bag

The best known method for an expectant mother to grow a strong waterbag is to eat a diet high in Vit C, amino acids lysine and proline and phytonutrients.

Spiritual benefits of birth in the caul

Beyond the physical benefits, there are long standing beliefs about the spiritual gifts of caul births.  Supposedly these people inherit the gift of clairvoyance and healing abilities.

Legend tells us the “caul carriers” can never drown and are able to divine sources of underground water.  Best of all, birth in the caul bestows overall good fortune to these chosen ones. Parents and midwives used to save the membrane and keep it for the child for good luck and protection.  It’s possible to put the membrane a locket or wear it as an amulet.

Superstition and persecution

It’s not all good news though.  During the medieval inquisition, the inquisitors accused “caul bearers” of heresy,  along with midwives and healers, for suspicion of witchcraft and supernatural powers.  The penalties for heresy at that time were various tortures and punishments, including burning at the stake. In spite of persecution and torture, caul births have survived.

Modern birth in the caul

Even in modern times, we continue to recognize the rarity of caul births and respect them as such.  The majority of babies are born in hospitals nowadays, and attended by obstetricians. Only 9% of births are attended by midwives in the U.S.  Since doctors are more likely to artificially rupture the membranes to hurry along the birth, caul births are more and more rare.

We midwives still have the good luck to attend caul births because we do not routinely break the water bag.  It’s not our practice to rush the birth and we respect the benefits of the intact water bag. Allowing the membrane to remain intact increases the likelihood for a baby to birth in the caul.

How to deliver a baby in the caul

If the baby births in the caul, we simply wipe or peel the membrane from the face so the baby can draw his or her first breath.
Influenced by our predecessors, we modern people continue to unconsciously believe birthing in the caul bestows certain good qualities.
If we check, a lot of us believe caul babies and waterbabies, their waterbirth siblings, are lucky and have an affinity for water.  We might even believe they will grow to be talented swimmers, surfers and water people.

Caul birth and water birth

Nowadays many birthing women instinctively choose to birth in the water.  Water births and caul births are virtually the same because both result in the baby born in water.

Surfer
Surfer

Women can’t give precise reasons for their interest in water birth but I suspect their  unconscious attraction to it grew out of our ancestors  folklore about birth in the caul.

Would you like your baby to be born in the caul or in the water?

NY Times Midwife Article

A Strong Water Bag-How to Avoid Premature Rupture of Membranes

There are many benefits for a strong water bag.  The risk of infection for mother and baby remains low, the amniotic fluid insulates the umbilical cord, and the baby is better able to navigate the pelvis.  Here is an evidence based prescription for you to follow to grow a strong water bag!

The chorioamniotic membrane, fondly known as the water bag, is made of the connective tissue, collagen.

Nutrition for a strong water bag

Nutrition is the best known way to build and protect collagen. Eating a daily diet high in vitamin C, lysine, proline and phytonutrients will give you a strong water bag that is more likely to stay intact through labor.

Vitamin C Foods for a strong water bag
Vitamin C Foods

Vitamin C is necessary to build collagen and to prevent damage from free radicals.
Studies show that consuming Vitamin C 100mg daily decreases the rate of premature rupture of membranes from 24% to 7% of pregnancies.

Prenatal vitamins contain approximately 70 mg of vitamin C that contribute to building a strong water bag.

The best and safest way to consume additional Vitamin C is through dietary sources. Foods such as bell peppers, oranges, strawberries, broccoli and papaya are all high in Vitamin C.

Amino acids, lysine and proline, found in animal proteins and egg whites contribute to the formation of healthy collagen. A plant based source for both of these amino acids is wheat germ.

Phytonutrients in berries, dark colored fruit and green tea protect collagen from breakdown.

Our prescription for a strong water bag is a diet high in Vitamin C (strawberries, oranges, broccoli, papaya, bell peppers), lysine and proline (animal protein, egg whites, wheat germ) and phytonutrients (blueberries, raspberries, cherries, cranberries, green tea).

Qualities of Amniotic Membranes

Effects of Vitamin C on Amniotic Membrane

Giving Thanks for an Intact Water Bag

We all know there are two membranes that surround the baby in the womb: the inner amniotic membrane and the outer chorionic membrane. These two membranes don’t always release at the same time.  Sometimes a mother may leak amniotic fluid, believing her water bag to be broken, only later to learn the water bag is still intact! How can this be?  Because the chorionic membrane released and the amnion remained intact.

This is a true Thanksgiving story of an intact amniotic membrane after leaking amniotic fluid for 40 hours.

We recently attended Adriana’s inspiring birth of her baby Amos,  whose water bag had been leaking for 40 hours before labor started.  The mother was sure the leaking fluid was amniotic fluid. And we midwives were certain it was amniotic fluid because we confirmed it with nitrazine paper.  When we finally performed the first vaginal exam in active labor, we were surprised! Our midwives’ concerns and surveillance were relieved to discover an intact amniotic membrane.  We knew the risks of prolonged ruptured membranes no longer applied.

water-break-pregnancy

 

Ten minutes before the birth the amnion finally released with a huge gush of clear fluid, quickly followed by a healthy, vigorous baby boy.

As a midwife, I’m grateful when the amnion remains intact because it protects mother and baby against infection; the umbilical cord is insulated; and the baby has more freedom of movement.

A common challenge in childbirth is when the membranes release before labor starts.  In medical terminology we call this premature rupture of membranes (PROM).

The literature tells us the longer the membranes are ruptured before birth, the more likely it is for the mother and baby to develop an infection. This is why hospitals and birth centers induce with pitocin (or Misoprostol) 24 hours after spontaneous rupture of membranes (SROM) if labor hasn’t started.  (Birth Centers transfer to a hospital for induction).  Homebirth midwives also recommend a variety of home therapies to naturally induce labor after the membranes release.

When the membranes release before the beginning of labor, the homebirth midwife and her client have concerns of increased risk of infection while waiting for labor to start.  Of course the expectant mother is informed and has the option to go to the hospital and induce labor- but she usually doesn’t want to!

So the homebirth midwife and her client are very careful to minimize the risks by monitoring both mother and baby and following precautions to decrease the likelihood of infection.

Then we wait… and wait…and wait some more.  It can feel like a long time.

diagram

According to the literature, 95% of women with PROM will start labor spontaneously within 72 hours.  I’ve never known an expectant mother in this situation to exceed 72 hours before labor finally started.

As a midwife, what gives me more patience and reassurance during this suspenseful time is the hope of a remaining, protective amniotic membrane.

The presence of an intact amnion is usually unknown since we avoid vaginal exams after SROM to limit infection.  We usually aren’t able to confirm the presence of the amniotic membrane until the first exam.

If it does remain intact, the amnion will release later during active labor or birth, often with a big, dramatic splash of amniotic fluid. Be ready! This can be a baptizing event. Or even more rare, the membrane remains intact and the baby is born in the caul.

I give thanks for our healthy mother and baby this Thanksgiving and all those strong amniotic membranes that stay intact until the very end. They give a nice sigh of relief for the homebirth midwives.

Stay tuned to learn how to grow a strong water bag!

Inspired by Adriana and Amos
Inspired by Adriana and Amos

Are there really more births on the super moon?

The full moon will be closest today to planet earth than it has been since 1948.  It won’t be this close again until 2034.

Surely this strongest gravitational pull will help a full-term, expectant mother, patiently waiting for her baby, to finally start labor. Unfortunately ladies, there is no scientific evidence to prove the full moon initiates labor. In fact, the birth rate does not increase during a full moon- even a super moon!

Don’t despair! We midwives, the world oldest profession, have tried and true methods to nudge you into labor when the time is right.

Contact us for our natural labor induction protocol !

Julia Layton “Are there really more births on full moons?” 10 August 2009.

It’s called the lunar effect, and, as far as births are concerned, the primary explanation for the effect focuses on the moon’s gravitational pull. It basically states that much the way the moon’s gravity controls the tides, it can control a woman’s body. The human body is 80 percent water, after all. And, given that both menstruation and ovulation roughly follow a lunar cycle — occurring on a monthly basis — it doesn’t seem too far off to think that the moon could have a say in childbirth as well.

But does it? In this article, we’ll take a look at some evidence for and against the lunar effect in birth rates, and find out if labor wards should be increasing their staff numbers every time there’s a full moon. We’ll also find out why so many people believe in the effect.

If you were to judge by word of mouth alone, it would seem as if the lunar effect was a sure thing. According to believers, one need only conduct a survey in a hospital to prove the connection between full moons and childbirth.

From ... HowStuffWorks.com. 14 November 2016

On Cutting the Cord and Newborn Anemia

Our practice is very protective of that cord after the baby is born.  Midwives have always respected the natural process and it has been our standard of care to let that cord pulse for as long as needed to insure the newborn receives its full complement of blood.

Pic showing before and after the cord is done pulsing.  If you clamp that right away, the newborn misses quite a profusion of blood into it’s system

As often happens new research surfaces that backs up an natural process. We as midwives pat ourselves on the back for doing what we know makes sense.  We also are indignant about the lack of evidenced based care that hospitals provide.  Hospitals have not even begun to change their procedures on this issue and parents have to fight tooth and nail to get an OB to delay the clamping of babies born in the hospital.  Most OBs will refuse to delay the clamping stating antiquated, non evidence based reasons for this procedure

http://www.bmj.com/content/343/bmj.d7157

this article illustrates that just waiting 4 minutes before you clamp the cord can prevent anemia up to 4 MONTHS OF LIFE…

From the article….

Conclusions Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia.

In honor of Midwifery Week

In honor of Midwifery Week, please join the San Diego Chapter of the American College of Nurse Midwives to enjoy this documentary. Held in UCSD’s auditorium.
Offical Selection of Los Angeles 2012, Winner Audience Award Los Angeles Film Festival 2012.
Suggested donation $10 at the door. No reservations necessary.
Q&A with the director to follow.

http://www.facebook.com/events/357947447624631/

Homebirth…For Dads

Homebirth
A recent article in the Pathways to Wellness Magazine

Recently one of our favorite magazines on Wellness published a few articles on a much neglected perspective:  The father’s

Here is a quote from the article, but you can read it in our office, or request a free copy here

” Any reservations I had about having a homebirth were erased almost from the first contraction.  Having our own vibe-the sounds, smells, sights and feelings of our our own things and our own home-made a huge difference in our level of connection and relaxation.  There were no machines, no beeping noises, no nurses bustling in and out…..There was just relaxation, comfort, connectivity, listening, laughter, tears and love-with all four (soon to be five) of us, working together in perfect harmony to bring a new child into the world”

In other parts of the article he contrasts it to the births of his 1st child where he felt “helpless” and “stunned”

While the perspective of this quote more caters to the spiritual or emotional experience of the father, often times father’s need more of a linear understanding of the benefits of homebirth.  A friend of mine recently said, “well my husband would never want to do that, he is a scientist you know”  To which I replied, “there is a lot of science behind what we do and a scientist would read the research and know that homebirth is a very safe option for low risk women”

Homebirth is not only for the people who seek a more spiritual experience, it is for families who know and are educated about their options.  Midwives across the globe actually improve outcomes for mother’s and babies.  The countries with the best morbidity and mortality outcomes used trained midwives for normal labor and birth.  Science supports quality care and homebirth.  Lucky for us, we can provide both evidenced based care, and a sane, grounding experience for both mothers and fathers.

 

Birth Dance with Brooke

Come prepare your “body/mind” for birth.  One of Brooke’s strengths as a midwife is her dance background.  Come learn about the “4 Ps of Birth” and the importance of movement in labor.

Sept 22nd 3-4:30pm $25 Right outside of our office in Nature’s Whisper Garden Studio

To register: http://joliecash.com/index.html

Sunshine Featured in Mothering Magazine Article

“My Birth Tiger” by Megan Pincus Kajitani

A pregnant mom faces her worst fears in Pam England’s “Birthing from Within” class.

“I’m afraid my body isn’t strong enough,” I whispered, choking back a sob as I stared through the open door to the dancing fire on the beach. The primal thumps of warrior music pulsed into the warm house from outside. Then I stepped across the threshold into the cold coastal night.

My body had always betrayed me. From childhood asthma and allergies to teenage backaches and, oh, those fun colon spasms of my twenties. I forever envied the strong girls – the ones who could lope around the track without a single huff or puff, or scale a boulder, their muscled hands grasping granite – even the ones who could pet kittens without breaking into fits of sneezing. I never felt like one of those strong girls.

Now, here I was at 32, on the final night of my “Birthing from Within” class, and I had to speak my fear aloud. though I was determined to birth naturally, and knew that my will was strong as an ox, a nagging voice in my brain’s nether regions warned me that my body might still be too weak, might give out again, that I might be transferred from the homey birth center to a sterile hospital and end up with my arms full of IV drops. My pregnancy was already complicated, with gestational diabetes and continuing hyperemesis (constant heaving). I wasn’t gaining as much weight as I should.

Still, as I spoke me fear aloud, an anger rose in me – a healthy, challenging anger. It echoed the howls and drumbeats of the music that called me across the windy beach. It smelled of the black smoke of the flames ahead. It reddened my face and clenched my gut below the wriggling baby in my womb. For the birth of this child, I didn’t want to be the wheezing girl on the sidelines. I wanted to be present and powerful in every way…

Click here to read the entire Mothering Magazine article as a PDF…

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Click here to read the entire Mothering Magazine article as a PDF…

Click here to visit Megan Pincus Kajitani’s website

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Mother to Mother Midwifery Featured in San Diego UpTown News

Local San Diego newspaper “San Diego UpTown News”, runs a feature about Mother to Mother Midwifery in their May 11th – May 24th, 2012 publication, (Volume 4, Issue 10), entitled, “Midwife-attended home births on the rise. Hillcrest practice provides a natural alternative to hospital deliveries”.

Click here to view the article online: sduptownnews.com/midwife-attended-home-births-on-the-rise/

or

Click here to download a PDF of the article.