I Have Questions!
Routine prenatal visits are scheduled in our office once monthly until the 28th week of pregnancy and then every two weeks until the 36th week. At 36 weeks we visit you at your home. From 36 weeks until you have your baby we see you weekly. Additional visits for other concerns are scheduled as needed.
The postpartum home visits are very important in our practice. A midwife comes to your home on days 1, 3 and one-two weeks or more if needed for lactation support. You come back to the office two weeks after your birth for your "first big outing" - a check-up for mother and baby. You return for a final 6-week postpartum visit. We recommend that your baby see your family doctor or a pediatrician sometime in the first week or two after birth. We offer the newborn screening blood tests and are happy to furnish all records of your baby's early care to his or her healthcare provider.
Most visits take place in our offices in Northampton or the home office of Jharna in Montague MA. We provide a home visit at 36 weeks so we can learn the way to your house and help you envision how your home will be your place of birth. During the home visit we will see where you have your supplies, meet any other people attending your birth (if possible) and answer any logistical questions.
Most visits are 1 hour in length. During this time we discuss your concerns, your health and plans for your birth. Education is an integral part of the midwifery model of care. Physical prenatal assessments include urinalysis, monitoring blood pressure, hydration and weight, assessing fetal growth, heart rate, size, position and well being. That being said, much of our visit time is spend simply getting to know you.
We do love to work with VBAC clients and have had many positive successes in homebirths after a previous Cesarean birth. Lets talk and see if you are a good candidate.
In addition to decades of training and experience, we bring many things. We have various ways of listening to a baby's heartbeat so we'll know the baby is responding normally to labor. We have a submersible electronic fetal Doppler so we can monitor fetal heart patterns if you are in the pool or shower. We bring herbs, homeopathic and pharmaceutical medicines, which would only be used when clinically indicated. We bring sterile instruments for cutting the umbilical cord and for suturing when a mother needs a few stitches. We also bring local anesthesia for suturing. We carry oxygen, resuscitation equipment and suction devices and the midwives and their assistants are all certified in neonatal resuscitation for out of hospital births. We also have several birth stools and many comfort supplies for birth.
We love pools for labor and birth. Water is a wonderful tool for labor, both for comfort and progress. There are many options for you. You may buy or rent your own tub. We have two inflatable tubs for your use – both are hospital grade and specifically designed for birthing in. Most pools have a liner you buy from us for approximately $35. You will need a new, drinking-water safe hose and an adapter for your hot-cold water source. We will give your clear instructions and you are responsible for setting up the tub for labor and birth. We recommend strongly having your tub and supplies ready by the 37th week of pregnancy.
Doulas (professional labor companions) can be wonderful resources prenatally and during the many hours of a long labor. They may provide comfort, physical support and reassurance. If you plan to have a doula at your homebirth, she must be comfortable with homebirth and midwifery care. The doula is a member of the team, not a go-between. Ideally, your doula will attend a prenatal visit with you so she can meet the midwives and address any questions or concerns about the doula's role at a homebirth. For those who find the out of pocket cost of hiring a doula prohibitive, we may know of someone in training who may be available at no charge. Ask us. Postpartum doulas offer tremendous support for families in the first weeks after birth, especially if partners return to work soon after birth.
Most children handle birth very well, often surprising their parents! Children do best when they are prepared, have an adult they know and feel comfortable with present for them and have the option to leave. The designated grown up is in the home for the children and their needs and is not invested in being there when the baby comes out. It is up to the birthing mother if she feels comfortable with her children there.
Pets are great. Cats will labor sit with you. Dogs should be given great respect during the birth of the baby and the placenta. Having a place they like to be during this time is a good thing. You have to factor in the temperament of your particular dog. After your birth, the baby and dog should be introduced to each other. Letting the dog smell the first hat or blanket the baby wore will introduce the baby's smell first. This can help ease the transition for sensitive dogs. We have attended many births with family pets in home, and will do everything we can to support what is most comfortable for the entire family and birth team.
Normally we stay until all are well, fed, clean and ready to be alone as a family. Three to five hours is the norm. During that time we monitor the mother’s well being, clean up, perform a thorough newborn exam, facilitate the initiation of breastfeeding and discuss what to look out for and when to call us. We also leave written postpartum instructions. We continue to be on-call for you 24/7 even after we leave and will return promptly to your home if needed. We will come to your home at 24 hours postpartum and again at three days and 1 week. A fourth visit is scheduled at 2-3 weeks postpartum and can be at your home or our office. Your last visit with us is typically 6-8 weeks postpartum.
We clean up as we go and try to minimize and control any mess. You will have a bag of garbage to put outside in the can at the end of the birth and one or two loads of laundry. We will put your placenta in a Ziploc bag in your freezer (until you are ready to plant it) or take it with us if you prefer.
We provide notarized forms as well as all the necessary papers needed to obtain these. You then go to your town hall , along with your ID and file them. We provide a check list for ease of process!
We like the baby to be seen by their doctor sometime within the first few weeks postpartum. We will weigh and exam baby at every postpartum visit. If at any time we have any concern about the baby, we ask you to consult with your baby's doctor immediately. Ultimately, the care that you choose for your infant is yours.
We work with families who choose all, some or no vaccines after thoughtful research. We expect you to learn and make the choice that is right for your family and we support you in your informed choice. We administer no vaccines.
Yes. Our postpartum care has been developed from many years of practice. Watching moms and babies has helped us to follow the needs of the nursing pair. Special needs modify care. There is no extra charge to you for lactation support.
When you have skilled midwifery care, signs of problems can be recognized and addressed before they become emergencies. If you or your baby needs medical care, which cannot be provided in your home, we contact the appropriate facility, accompany you with your records and a midwife stays with you for continuity of care and advocacy. We resume care on schedule when you and/or your baby leave the hospital.
Whether your insurance covers homebirth or not, individualized birthing experience is an investment.
Some families may have health insurance that will pay for our services, however, many HMOs do not cover homebirths, prenatal, birth and postpartum care. We have a billing service that can run your insurance to see if it makes sense to continue further inquiry.
You can also submit bills to your insurance on your own (called a super bill) after all services have been rendered (typically 6 weeks postpartum). However, even if you pursue insurance reimbursement, you will still need to sign our contract agreeing to pay your selected fee and make the regular payments to us.
In the event that your insurance does reimburse for our services, your billing sheet will be balanced at the end of care once the insurance payment has been received at which time appropriate refunds or adjustments will be made. It is important to go forward with your homebirth expecting to pay out of pocket while together doing all we can to try and get your insurance to cover it.
Birthing at home is an investment. An investment in your personalized vision of your birth. An investment in being heard and supported and having control over your vision without institutionalized interventive policies and mandates.
For information about our fees and associated costs of a homebirth, please speak to us directly. We are committed to supporting families to have the birth they desire and our very willing to work with each individual family to create a workable plan.
We offer payments plans, with the expectation that the total fee is paid by the 36/37 week homevisit. However, please talk with us if you need further assistance! We are open to some limited bartering, and we accept HSA payments through your employer, Venmo, CashApp, checks and cash. Though we do accept all major credit cards, it is not preferable as we then will need to pass along the 4% processing fee.