Informed Choice

Informed Choice in Place to Birth and Care Received

As part of the Midwives Model of Care, I seek to offer informed choice, not merely informed consent.  You are my client, never my patient.  Any decisions regarding options are yours to make.  At the same time, there are limits to what I am willing to take on as responsible care provider.  When and if my limits are reached, I will let you know immediately.  You have complete access to my book of Protocols.  My written guidelines on antepartum, intrapartum and postpartum conditions requiring consultation, transfer of care and transport to a hospital are available to you as a separate document, if desired and requested by the client.

Important Points to Remember When Choosing Homebirth

It is important to consider, that any environment, whether home, hospital, or birth center, presents a distinct set of risk factors for birth.  Nothing can guarantee a perfect outcome.  We believe each woman has the right to an informed choice of the environment she perceives as safest for her and her baby. Occasionally, a critical situation arises during pregnancy or labor which necessitates specialized care that cannot be provided in a home setting.  In such cases, a previously established medical back-up system will be relied on for appropriate care.

  • In the state of Virginia, CPM’s are prohibited from prescribing, possessing or administering controlled substances.
  • Although research indicates that safety of homebirth for normal, healthy pregnancies, we ask our clients to be aware that we do not possess all the emergency equipment and personnel available in a hospital.  In the rare cases that it is needed, we have to transport to a hospital which could affect outcome.  Each client must weight the increased risk for certain complications associated with hospital births with those associated with homebirths.
  • As a CPM, I do not have hospital privileges and therefore cannot practice as your midwife in the hospital nor can I admit you to the hospital. In case of transport, the physician on call or your personal physician (depending on your personal arrangements) will be the one to admit you to the hospital. However, I would continue on with you to the hospital, provide transport records to your physician and stay by your side in the role of a doula or friend.
  • In the state of Virginia, midwives are not required to carry insurance. I do not have malpractice or liability insurance at this time.
  • Virginia has a birth injury fund however, at this time midwives are not currently covered by this fund. The Virginia Birth-Related Neurological Injury Compensation Program was created 16 years ago by the General Assembly. The program cares for children who incur a lifetime brain or spinal cord injury resulting from an accident that occurs during birth. It was formed as an alternative means of compensation rather than malpractice lawsuits against doctors or hospitals and their liability insurance carriers. Claims against the fund are reviewed and awarded by the Virginia Workers’ Compensation Commission.

Philosophy and Responsibilities of the Midwife

As a trained health professional, I offer my expertise in supporting women to maintain a healthy pregnancy, and birth, and postpartum.  Key to my care is my belief in offering individualized care, counseling, education, and support.  This sense of client-centered holistic care is in alignment with the Midwives Model of Care, which holds as a core belief that pregnancy and birth are normal life processes.  In this understanding, pregnancy, birth, and breastfeeding are natural, normal functions of a woman’s body, mind, emotions, and spirit, all of which are equally important.

In my practice you will find that communication, partnership and honesty between myself and my clients is emphasized.  Safety is a high priority in my practice and midwifery in general.  Knowledgeable self care, and care by the midwife, in alignment with the body’s, mind’s, and spirits needs as well as those of the baby, form the foundation of healthy pregnancy and support the natural process as it unfolds.  I encourage women to actively participate in their pregnancy and birthing process. I do not ‘deliver’ your baby; I provide tools, safety, knowledge and encouragement to support you on your journey.  .

As part of my commitment to nonintervention, I do not advocate the use of pain medication, unnecessary invasive procedures and routine time management during the normal birthing process. These procedures are known to have detrimental effects on the wellbeing of some mothers and babies and have been shown to increase the rate of cesarean sections.  I consider these unnecessary risks.

A Note on Family and Friend Participation

Birth at home among family members, coupled with continuous care by skilled attendants, can provide an optimal environment for the majority of women.  When birth is integrated into life as a family event, the family is strengthened as well.  In my practice, I intentionally focus on the needs of the family, and encourage partner and family participation in the birth.  I also make a commitment to give special attention to the family traditions, cultural values, and the personal preferences of the women in my care.  With your consent, I welcome children and family members to participate in our care:  For example, at prenatal appointments, future siblings may listen to fetal heart tones with the fetascope, learn about baby’s position etc.   Children deemed ready by their parents to be present in the birthing experience, may attend after verification with myself that they will be adequately supervised and cared for by a 3rd party, such as a aunt or friend.

We encourage you to invite partners, friends or family to support you at your birth.  Being surrounded by familiar loving people or having the opportunity to labor in complete privacy are some of the benefits of homebirth.  When deciding who you would like to be present at your birth, please consider whether that presence would be reassuring and supportive or otherwise.  Notice if there are any problems you might anticipate with their presence such as disagreement with your birth choices or reduced privacy.

Let your family know: pregnancy is the perfect time to nurture a woman’s sense of personal strength and self confidence so that she may realize birth as an empowering and transformative experience.

Expectations

We expect honesty from couples we help and they can expect the same in return.  We expect couples to be well informed about home births, and to take seriously the special responsibility they bear for their health, pregnancy, and preparation for their labor and birth.  Please let us know what you expect from us.

It is your right and responsibility to make the best decisions for you and your baby. By choosing to have a homebirth, you are choosing to do something that is outside of the understanding of many people and thus, you may be presented with many questions.  Homebirth will take a certain amount of time and effort to plan. The following is a list of my requests as your attendant (*Unless otherwise discussed):

  • That you feel good about your decision to birth at home.
  • That you are willing to at least attempt to clearly communicate your needs, fears, questions and concerns as they arise.
  • That you will honor our financial agreement.
  • That you will attend prenatal and postnatal visits at the scheduled times or (aside from emergency or illness) will call within 24 hours prior to the visit if you need to reschedule.
  • That you are willing to make the necessary arrangements for an optimal birth experience in your home, including but not limited to collecting birth supplies prior to 36 weeks, making emergency back-up plans, arranging for childcare for other children in the home, making decisions surrounding things such as prenatal testing and newborn procedures, etc.
  • That you understand that no one can guarantee a 100% safe outcome for every birth, regardless of whether you birth in the hospital or in your home.
  • That you are willing to make well informed, conscious decisions and take responsibility for your choices.

The midwife reserves the right to resign at any stage of the pregnancy if she believes it is necessary to do so.  Risks, our concerns, and our reasons will be fully discussed with you if this becomes necessary.  Risk assessment is a tool we use from our initial consultation to six weeks postpartum to ensure you the most appropriate and best care possible.

SERVICES & FEES

The cost for my services is $2800. This fee includes:

  • Registration fee
  • Initial appointment and evaluation
  • Initial baseline blood work including HIV and Hep B
  • Pap smear and test for Chlamydia and Gonorrhea
  • Full prenatal care as well as your labor & birth & immediate postpartum care
  • Postpartum care for you and baby for a minimum of 4-6 weeks
  • Assistant midwife & 3rd set of hands (3rd set of hands optional)
  • Back up midwife (in the unlikely event that I were unable to attend your birth due to family emergency, contagious illness or if more than 1 birth wre to happen at the same time)
  • Unlimited telephone & email communication
  • Nutritional counseling
  • Homeopathic and herbal treatments
  • Group childbirth education classes

This fee does not include:

  • Any additional requested or desired laboratory tests (In certain cases additional testing will be required to safely remain in my care)
  • Any physician consultation or appointments
  • Sonograms
  • Hospital/ambulance costs
  • Pediatrician costs
  • RhoGAM
  • Birth pool & associated expenses
  • Your Birth Kit & misc. supplies for your birth

APPOINTMENTS

I provide prenatal appointments as follows:

  • Every 4 weeks up until 32 weeks gestation
  • Every 2 weeks from 32-36 weeks gestation
  • Every week from 36 weeks gestation to birth
  • Appointments may be more often, but will not be less often.

I provide postpartum appointments as follows:

  • 24 hour visit
  • 2-3 day visit
  • One week visit
  • 4-6 week visit

REFUNDS

In the event that care is terminated, the following will be evaluated in determining a refund:

  • A non-refundable deposit of $500 is required at the initial appointment
  • The fee for each subsequent prenatal appointment is $100, and is non-refundable.
  • The fee for labor support that results in a hospital transport before the baby is born is $600, and is non-refundable.
  • After the fees for the initial apointment, prenatal appointments, and labor support will be subtracted from the amount paid by the client.
  • The client must pay in full ($2800) by 36 weeks gestation.
  • I accept alternative currency and offer economic hardship discounted rates on a case-by-case basis.

INSURANCE

If the client’s insurance will pay for midwifery services, the client must pay the midwife out of pocket and submit receipts for reimbursement to the insurance company.  Reimbursement policies vary depending on insurance coverage.

 

Parents’ Statement of Informed Choice and Agreement

We have chosen to have a home birth based upon what we believe to be a thorough examination of the alternatives.  We have discussed our prenatal care and birth options between ourselves, and with other knowledgeable people to the extent we think necessary.  After considering these options we have asked Ancient Roots Midwifery & Doula Care, LLC, to assist us in our home birth.

We have read and understood the “Informed Consent Midwifery Care” packet.  In  addition to the agreements above, we also fully understand and agree as follows:

  • It is impossible at a home birth to provide the same type of care that is available at a hospital.  We are fully aware that in the event of a complication or emergency there are fewer alternatives available at a home birth then would be available in a hospital.
  • We believe that birth is a natural, generally safe process.  We have, however, discussed some of the problems which can arise in childbirth and feel comfortable with our decision.
  • It may become necessary during the birth to transfer the mother and/or child to the hospital.  We may choose to go to the hospital at any time.  If the midwives in attendance believe it is necessary to transport mother or child to the hospital, either before, during, or after the birth, we agree to go to the hospital upon their request.
  • We agree to take the baby to a pediatrician for a newborn exam within one week of the birth.
  • We agree to be seen by an OB or CNM if required prenatally.  We agree to follow our midwives’ recommendations as best we are able regarding healthy pregnancy, labor, and birth.
  • We agree to comply with basic prenatal testing as requested by our midwife, including Hepatitis B and HIV for the safety of the mother, child, and midwives.
  • We agree to participate as a couple in natural childbirth classes unless our midwives specifically indicate that this is not necessary due to our previous experiences.
  • If during labor it becomes necessary to transport to the hospital because of a complication, we realize that the midwives will have done their job to assess an abnormal situation and we agree that the midwives will be paid in full.
  • The midwives will be paid in full if they arrive after the delivery as a result of a delayed notification or a precipitous (very quick) birth.
  • We understand that there is no formal back-up agreement with a physician or hospital.  IN the event of transport, we would follow a mutually agreed upon plan that would consist of the closest hospital available in an emergency situation or our hospital of choice should the transport be non-emergent.
  • It is our responsibility to make prior arrangements with a back-up physician if we wish or we will be served by whoever is oncall.
  • We understand the midwife will accompany us in case of transport and will continue to provide care in the role of doula or friend but would likely no longer serve in a clinical role.
  • We understand that Ancient Roots Midwifery & Doula Care, LLC, is a Limited Liability Corporation
  • We understand that Ancient Roots Midwifery & Doula Care, LLC and the midwife do not carry liability insurance of any kind.
  • We have read the Informed Consent packet carefully and had our questions answered adequately.

Financial Agreement

A clear understanding of our financial obligation to the midwives helps insure a smooth working relationship.   Toward that end we have expressly entered into this financial agreement:

  1. By the 36th week of pregnancy, we agree to pay $2800 for the birth.  We understand that if not paid in full the midwives are not obligated to attend the birth.  Should this be the case, the midwives will notify the parents immediately by phone or in person.
  2. If the midwives travel outside a 75-mile radius, we agree to pay an additional $400, due by the 37th week of pregnancy
  3. We agree to pay for all supplies, lab work, medical visits, and childbirth classes requested by the midwives.
  4. We agree to payment on the schedule set forth in the financial agreement.
  5. We understand that Ancient Roots Midwifery & Doula Care, LLC, maintains a refund policy which we have read in the “Informed Consent for Midwifery Care” Package.
  6. If using midwifery services, we understand we must pay the midwife out of pocket and submit receipts for reimbursement to the insurance company ourselves.
  7. We understand that any breech of this contract could result in termination of care at the midwives discretion and releases the midwife from obligation to provide services.  Care can be re-instated with communication.

Ancient Roots Midwifery & Doula Care, LLC, and the parents each promise to work to establish an atmosphere of trust and cooperation that will contribute to a healthy, safe, and rewarding birth experience.

LM_________________________________________________  Date__________

Parent_______________________________________________  Date__________

Parent_______________________________________________  Date__________

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