Do you deliver babies at home?
No, our practice of Certified Nurse Midwives delivers babies in the birthing rooms of the labor and delivery area of Maine Coast Memorial Hospital. We are hospital employees. In fact, most Certified Nurse Midwives in the USA perform hospital deliveries. In Maine, most home deliveries are performed by “Certified Professional Midwives” (also known as direct entry midwives or lay midwives). Nearly all Certified Nurse Midwives are registered nurses first, then obtain masters degrees or certificates of midwifery from a University program. Certified Nurse Midwives support the concept and choice of home delivery for low risk women. Currently legislation is being written (LD1827) to assure minimum competency and oversight mechanisms be set in place for the practice of the direct entry midwives in Maine.
Can you be “back up” for my plans for a home birth?
No, we are unable to be a back-up system for planned home birth. We feel it is crucial to build close relationships with our patients, to over see prenatal care ourselves, work closely with women in presenting options, and follow our own protocols for care of any out of the ordinary finding. Also, our employment within the hospital prohibits back-up arrangements. Home birth clients experiencing complications at home should go to the nearest emergency room where they will be seen as “unassigned call” (meaning not currently established within a practice of that hospital) by the obstetrical provider on call at that time for that hospital.
There are four CNMs in the practice. How does that work when I come for appointments or go into labor?
Your prenatal visits will rotate through all of the CNMs. Usually you will have about three prenatal visits with each one during the course of your pregnancy. We spend time with you at your visits, so that by the time of delivery you feel comfortable and happy with any one of the four of us. We understand that occasionally a woman will have a “favorite” midwife! The midwives rotate call in 24 hour increments (7 am to 7am), with Sat/Sun the same person. Which ever midwife is on call during your delivery is the midwife who will deliver your baby. Sometimes when the early labor is lengthy, you might have a change of midwife during that time. Of course, if you are pushing your baby out at 7:15 am, the midwife who has been with you will stay to help you through the final moments!!
When I think of “Midwife” I think that means that I have to have a natural birth, without any pain medications. Is that true?
No. We are able to order IV medications for labor pain (such as stadol), or an intrathecal (similar to a “walking epidural”) if either of these interventions would be what the woman wants and is appropriate/safe for the stage of labor and circumstances. We also will continue to help you through your labor with other, nonmedical comfort measures. It is impossible to give birth without any physical sensations; we (as well as the wonderful labor and delivery nurses) will help you through these stages, leading you to your incredible, fantastic experience of delivering your baby into the world.
I want to have a natural delivery. Can you help me to do that?
Yes. This all begins with your desire. Childbirth education is important for everyone, as well as learning relaxation techniques. “Hypnobirthing” is terrific. A healthy diet, lots of stretching flexible type exercise, and an ability to work through emotional issues are all helpful. The tub is a marvelous help with the sensations of active labor, helping most women to “melt“ into relaxation, and thus cervical dilitaion. We also recommend a doula in many instances. We use intermittent monitoring in almost all cases, and encourage being upright, moving around, aroma therapy, shower, music, massage, and we have a birthing stool for pushing if needed.
How many people can I have in the delivery room?
As many as you like. We know, however, that anyone who is with you should be someone important in your life, who is helpful and kind to you, who you don’t mind being naked in front of, or making noise in front of. We have seen cases where too many “watchers” cause labor to virtually stop. We will spend time talking to you about these issues during your prenatal care, and help you to decide who you want with you. It is our job to help you have the smoothest, best labor experience possible. Being with you at your birth is a privilege, not a automatic right.
What if I need a C-section?
We have back up Physicians available to us at all times. Reasons for a C-section are sometimes found before labor (such as a breech baby who won’t turn into head down position near the due date), but mostly occur during labor and are not known to be needed before hand. In any of these cases we (or the nurse at our request) would phone our back-up MD and explain the situation. A C-section can be performed in less than 30 minutes if necessary. The midwives usually serve as first surgical assistant during the C-section; if two doctors are performing the C-section, the midwife will accompany you into surgery for support.
Can I have a VBAC (vaginal birth after Cesarean)?
Currently the policy of MCMH allows VBACs in low risk women. It must be at least 18 months since your C-section, and you must have only had one C-section. Your pelvis should be thought to be adequate shape for vaginal delivery, and we will need to see the operation report to make sure that there were no extensions to the usual low horizontal uterine incision. During pregnancy we will ask that you have a consult visit with one of our back up MDs to discuss VBAC in your case. We will ask that you sign a VBAC consent form. Our policy requests that you allow us to place a saline lock (an IV not hooked up to anything) during labor for quick IV access if needed. We also will continuously monitor your baby, but this does not mean that you have to lay down- we have “telemetry” monitors that can be worn while you walk around in labor. We will not use pitocin at any time to induce or add to your labor. We strongly believe that women should have the choice to VBAC.
I know I want to (or have to) have a repeat C-section. Can I come to your practice?
In most cases, yes. You can receive your prenatal care through the midwives, and also have one or more consult visits with the MD who we arrange for you to have your C-section with. Repeat C-section patients with other high risk issues would be better served by establishing care with an OBGYN practice.