What is the situation of midwives in Alaska, and do insurances reimburse homebirths?
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 is 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 to consult with a physician, 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. However, if you develop complications, or if your baby shows signs of fetal distress (with birth not imminent), you may need hospital assistance, intervention or surgical birth. In this case, your midwife would accompany you to the hospital. Please bear in mind that midwives transport less than 12% of their clients. High risk 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, pre-eclampsia (which is a preventable metabolic disorder) and VBAC (vaginal birth after cesarean).
I had Toxemia with my first baby. What if I get it again?
Midwives believe Toxemia to be a result of nutritional deficiency. Our approach is one of nutritional counseling, guidance, prevention and prenatal screening. We are vigilant with our care to make sure you stay under low risk parameters. Toxemia is less prevalent with subsequent pregnancies. 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
Anti hemorrhagic medications
Delee mucous traps for suctioning the newborn
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 at home and are not considered a risk. Very rarely will a baby grow too big for a mother's pelvis. No one can tell for sure if a baby can fit through the pelvis until there has been an adequate trial of labor. Some women were told their pelvises were too small… and had successful vaginal deliveries. In the last weeks of pregnancy, a hormone called Relaxin will go to work, softening the joints and ligaments and make the pelvis roomier. For this reason, midwives will often postpone pelvimetry (measuring the pelvis) until late in pregnancy.
I had severe postpartum hemorrhage at my first delivery. How likely is it to recur in my next one?
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 at home?
The homebirth epidural: a warm tub with essential oils of lavender and clary-sage. Midwives are very skilled in offering alternatives such as massage, showers, warm bath, aromatherapy, and homeopathy, to name a few. The fact that midwives stay with their clients throughout labor and delivery, offering emotional support and minimizing fear, help alleviate pain. 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 when necessary. However, their focus is on how to prevent tearing. They are skilled in suturing and 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.
Do you recommend eating/drinking in labor?
Our focus is on the "3 wells":
We believe women need calories and fluids in order to have the energy labor and delivery require. We recommend easily digested snacks that are appropriate for the phases of labor. For example: fruits, yogurt, herbal teas, miso, honey and electrolyte drinks. It is a bad idea to start labor feeling tired, hungry and thirsty. Since 37 weeks gestation is the earliest a mother qualifies to have a homebirth, from that date on, our focus is on the "3 wells" mentioned above.
Contact us reguarding any specific question you may have that wasn't covered here.
We will be happy to answer as best as possible.