Homebirth with JJB - Frequently Asked Questions
How often are your prenatal appointments?
Prenatal care generally begins at 12 weeks. Routine prenatal visits are scheduled every six weeks until the 28nd week of pregnancy and then every three weeks until the 36th week. From 36 weeks until you have your baby we see you weekly. Additional visits for other concerns are scheduled as needed.
Who will come to my birth?
We always bring two midwives to every birth. Karen or Martine, depending on who is on call when you go into labor, will come as the primary midwife. Shana, or one of our assistant midwives, will also be there as the second midwife.
How often do you see mothers and babies after the birth?
Postpartum home visits are very important in our practice. A midwife comes to your home for a full check of you and your baby on days 1 and 3, and more if needed for breastfeeding guidance or troubleshooting. Families usually begin to take their babies to their family practice or pediatric providers around one week old. We perform the newborn screening blood tests and pulse oximetry and are happy to furnish all records of your baby’s early care to his or her healthcare provider. We return for a final 6 week postpartum visit at which point you have "graduated" from our homebirth care.
Where are the visits held?
Most visits take place in your home.
How long are visits and what happens during visits?
Most visits are approximately 45 minutes long. 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 monitoring blood pressure, hydration, nutrition and weight, and assessing fetal growth, heart rate, size, position and well-being.
What about lab work and testing?
We discuss prenatal testing at visits. We teach and encourage families to learn as much as possible to make informed choices. Routine tests include screening for anemia, gestational diabetes, blood-typing and screening for infections which could affect your baby. We perform pap smears and cervical and vaginal cultures when indicated or requested. The midwives draw blood at your home, so you don’t have to go to a lab. We do not perform ultrasound exams in our offices; however, when they are indicated we will gladly give you a referral. We do not require “routine” ultrasounds, however there are reasons we may request that you have one.
What do you bring to births?
In addition to decades of education 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 a pool or shower. We bring herbs and pharmaceutical medications, which would only be used when clinically indicated. We bring sterile instruments for cutting the umbilical cord and for suturing if stitches are necessary. We also bring local anesthesia for suturing. We carry oxygen, resuscitation equipment and suction devices and the midwives and their assistants are certified in neonatal resuscitation for out of hospital births.
What about a birthing tub?
Water is a wonderful tool for labor and birth, both for comfort and supporting good progress. There are many options for you. You may buy or rent your own tub. We also have two inflatable tubs that we lend to clients, as due dates allow. Ask us if our pool is available for your due month! You'll need to buy your own disposable liner, a new hose, and an adapter for your hot-cold water source. You're 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.
Will I need a doula?
Doulas (professional labor companions) are wonderful prenatally and during the many hours of a long labor. The provide comfort, physical support and reassurance for both moms and partners. If you plan to have a doula at your homebirth, s/he must be comfortable with homebirth and midwifery care. The doula is a member of the team, not a go-between. For those who find the out of pocket cost of hiring a doula prohibitive, we may know of someone in training available at reduced fee. Ask us. Postpartum doulas offer tremendous support for families in the first weeks after birth, especially for single moms or families with partners returning to work soon after birth.
Can my older children attend the 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 grownup is in the home for the children and their needs and is not invested in being there when the baby comes out.
I have pets. Is this a concern?
We're happy to have your furry family members around during labor and birth as long as they are friendly and you don't think they'll get too upset to see you in labor and making noises. Sometimes for dogs this means they (and you!) will be more comfortable if they are at a neighbor's home. Other dogs do great at births and even help with the labor support. After your birth, 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.
How long do you stay after the birth?
Normally we stay until all are well, fed, clean and ready to be alone as a family. Two to three hours is the average. During that time, we clean up, perform a thorough newborn exam, facilitate the initiation of breastfeeding and discuss what to look out for and when to call us.
How messy is it?
We clean up as we go and try to minimize and control any mess. You will have a bag of garbage to put outside at the end of the birth and one load of laundry. We will put your placenta in a ziplock bag in your freezer or take it with us for encapsulation if prior arrangements have been made. Some of our assistant midwives offer this service. We'd be happy to put you in touch with them for more details.
When do I take my baby to the doctor?
We generally see the mother and baby exclusively during the first week. During this time if anything is notable we may have you consult with your baby’s chosen healthcare provider. Most of our families go for their first pediatrician visit at around 1 week old.
Is there breastfeeding help if I need it?
Yes. Our postpartum care has been developed from over 30 years of combined practice. Working exclusively with our mothers and babies helps us to follow the individual needs of the nursing pair. When indicated we will refer you to a lactation consultant.
Will my insurance company pay for my homebirth care?
We are out-of-network. In most cases, insurance companies reimburse for part of your care, depending on the type of policy you have. Once you give written consent for us to care for you and to contact your insurance provider, Haya, our dedicated biller, will obtain the necessary prior authorization in writing. The date of service on your insurance claim will be the date of your baby’s birth. Most reimbursement occurs between two and six months after your birth. You will be required to pay $1500 towards our fee during the pregnancy.
What if I need to go to the hospital?
We observe carefully for signs of problems which 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 always stays with you to provide continuity of care, support, and advocacy. We go to the closest place near your community where you’ll receive respectful and appropriate care. We resume clinical care on schedule when you and/or your baby leave the hospital. We will bill your insurance company differently in the event of a transfer. Care given by other facilities or providers is not included in our fee.