Homer Birth and Wellness Center

What is the situation of midwives in Alaska, and do insurances reimburse homebirths or birth center births?

Alaskan Certified Direct Entry Midwives are licensed by the state of Alaska and are governed by a regulatory Board, which sets standards for education, apprenticeship and ongoing review. Except for Tricare and Champus (military), homebirth and birth center births are reimbursed by Insurances, Medicaid and Denali Kid Care.

Do you have physician back up? What if I need a cesarean section or there is a complication?

Direct Entry Midwives are not required to have formal back up arrangements. We are independent practitioners. Midwives do all of your prenatal care, delivery and postpartum care. However, should the need arise due to some complication, we make arrangements for a doctor to see you. The genuine need for a cesarean delivery is lower, statistically, than you may realize, especially in the population of low risk mothers, who qualify for out of hospital delivery.In rare instances, or if your baby shows signs of fetal distress, you may need hospital assistance, intervention or surgical birth. In this case, your midwives would accompany you to the hospital. Please bear in mind that midwives transport less than 12% of their clients. High risk status is ruled out during prenatal visits. Included in the high-risk category are: twins, breeches (turning the baby to head down may be taken care of by a version, prior to the onset of labor), true diabetes, heart disease, pre-eclampsia (which is a preventable metabolic disorder) and VBAC (vaginal birth after cesarean).

I had pre eclampsia with my first baby. What if I get it again?

Midwives’ preventative approach to this metabolic disorder is through nutritional counseling and prenatal screening. Pre eclampsia is less prevalent in subsequent pregnancies but if you do become high risk, appropriate medical consultation or referral will be arranged. How do midwives handle emergencies? Midwives carry an array of equipment and supplies, such as: two medical oxygen tanks, Infant and adult resuscitation equipment, IV equipment, anti hemorrhagic medications, Delee mucous traps for suctioning the newborn and suturing equipment in case of tears.

This is my first baby.  Am I at risk for a homebirth? What if the baby won't fit through my pelvis?

Many first time mothers choose to have their babies in an out of hospital setting and are not considered at risk. True CPD (Cephalo Pelvic Disproportion) is very rare. No one can tell for sure if a baby can fit through the pelvis until there has been an adequate trial of labor. In the last weeks of pregnancy, a hormone called Relaxin will go to work, softening the joints and ligaments and make the pelvis roomier and Relaxin is released in greater amounts during labor by the laboring woman.

I had severe postpartum hemorrhage at my first delivery. How likely is it to happen again?

Midwives carry anti-hemorrhagic medication and medical oxygen, and are trained to handle emergencies. Prevention and vigilance are the midwives' approach. Postpartum hemorrhage can be prevented with diet rich in iron, fresh vegetables and adequate fluid intake. Many midwives carry herbs and homeopathic remedies for use in pregnancy, labor and delivery. Rushing the delivery of the placenta is another cause of postpartum hemorrhage, and midwives will patiently wait up to one hour for the placenta to deliver, granted there is no other obvious problem. In the hospital I can get an epidural.

What can you give me for pain in and out of hospital setting?

Midwives are very skilled in offering alternatives such as massage, showers, warm bath, aromatherapy, and homeopathy, to name a few. Studies have shown the benefits of having a known, trusted person at your side during labor. Our midwives will be with you from the first prenatal visit to your last postpartum, offering emotional support, minimizing fear, and help alleviate the intensity of labor. Education about the birth process and coping techniques, are taught prenatally.

What if I need an episiotomy or stitches?

Midwives are trained to perform an episiotomy if necessary, but prevention is their focus with warm compresses, perineal support and slow head delivery. Should there be tearing, they are skilled in suturing, carry appropriate equipment and local anesthetic for repairs.

Can my children be present at the birth?

Midwives encourage family-centered birth. Many families wish to have siblings involved in the prenatal care and plan to have them present for the birth. Others desire their children to be supervised close by and to be brought in immediately following the delivery. Education is a priority in midwifery care, and often a midwife can help facilitate preparation of siblings, offering videos and books, and recommendations for appropriate age involvement.

Can I eat and drink in labor?

We believe women need calories and electrolytes in order to have the energy labor requires. We recommend easily digested snacks that are appropriate for the phases of labor such as fruits, yogurt, herbal teas, miso soup, toasts and electrolyte drinks. It is a bad idea to start labor feeling tired, hungry and thirsty. According to Dr. Michel Odent’s research, explained in his book “Childbirth in the age of plastics”, the antidiuretic hormones work in synch with the chief labor hormone oxytocin, reason why women may not always feel thirsty in labor and why pushing IV fluids may be counter-productive to a normal labor.

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