BirthCare & Women's Health Certified Nurse-Midwives
1501 King St. Alexandria, VA 22314 703-549-5070
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Common Questions

Please send your questions to midwives@birthcare.org.


Q: Do any insurance companies cover home birth nowadays? What do you tell potential clients about insurance options?

A: The majority of insurance companies cover home birth including managed care plans and many state Medicaid plans.


Q: Where do prenatal visits take place?

A: Our practice provides prenatal care in our office. Our birth assistant makes a home visit before the birth to assure the home and the supplies are ready for the birth. We (BirthCare midwives) occasionally do home visits if the mother is on bedrest.


Q: How do you tell women to prepare their homes for a home birth?

A: The main preparation of the home for the birth is gathering together the supplies. There are many things needed for the birth that are already in the home and need to be assembled in the planned birth room. The medical supplies need to be purchased or provided by the midwife. The home should be clean with heat, running water, and telephone service. We generally ask the family to double make the bed with a full set of linen covered with a plastic mattress cover or shower curtain on the bottom and a clean old sheet placed on top of the plastic. The bed can than be used as desired during the labor and birth. A fresh clean bed is ready for the mother postpartum after removing the plastic and the top set of linen. If planning to have children present, they must be prepared as to what to expect. Arrangements should be made for the mother to receive assistance for the first 1-2 weeks postpartum. The mother should have an adult in attendance at all times for at least the first 48-72 hours. If the mother does not have adequate support for labor and the immediate postpartum period, she may need to consider giving birth in the hospital.


Q: Do you have an assistant at the birth? Do women frequently request/hire doulas for home births?

A: Most home birth practices have an assistant at the birth. The assistant may be another midwife, a nurse, or a lay person that has been trained as a birth assistant. Some mothers want to have a doula present and that works well. The majority of our clients do not use a doula, but when the doula has been present, the mother uses her services and extra hands at a birth are always useful. Our birth assistants have special training beyond the skills of a doula. There are birth assistants that are also doulas.


Q: Under normal birth circumstances, how much time after delivery would the mother be considered incapacitated due to the birth and therefore need to be cared for (i.e. by a partner or other relative)?

A: We consider you totally incapacitated for 2 weeks, although you can still do things. It is important for you to rest and have help during that period. If you do nothing for 2 weeks, you can more quickly get back into a normal routine. Ideally you are partially incapacitated for another 4 weeks, which means for a total of 6 weeks you should take it easy.


Q: How many births do you do each month?

A: We increased our monthly census to 20-25 births. Since we got a contract with Kaiser about in 2001, we are having more birth center births. We needed to increase in order to accomodate the extra business. It's busy, but things are going well.


Q: I am expecting my fifth baby in early December. My fourth birth was a successful, unmedicated hospital VBAC. It is very important to me to plan an out-of-hospital birth this time. My first three babies were delivered after some labor and dilation, via C-sections for non-repeating reasons. I have never had any sign of dehiscence or rupture after any of my four labors. My incisions were low-transverse. All my pregnancies and babies have been healthy and normal. I live in southern Maryland. Please let me know if you would attend my birth, and if so please send me a list of your cooperating OBs.

A: Thanks for inquiring about our services. With a history of having three Cesarean births, we would not be able to help you give birth out-of-hospital. We wish you well, and we anticipate you will have another successful VBAC. Due to the Cesareans, we do recommend that you give birth in the hospital.


Q: I am a BirthCare client looking to donate breastmilk without going through a milk bank since there isn't a local one. Please contact me if this is of interest. I tried calling the local La Leche number but it is useless for getting through to anyone (just a recording with a bunch of phone numbers that don't work).

A: I don't know of anyway to donate milk in the area since the Georgetown milk is closed. I can only suggest that you check with Lactation Consultants of Northern Virginia (703) 207-9091 to see if they know of any way to donate milk. I guess you have a lot of extra milk! Breast milk is good in pancakes!!!(another use). Hope this helps.


Q: My paramount concern is the care my newborn would receive after the birth. I know that assessments/tests/procedures (eg PKU, hearing) that would otherwise be performed during a hospital stay would need to be arranged by me after delivery at your birthing center, and I'm wondering how that works. (Frankly, the idea of taking a one-day-old to the pediatrician on a cold February day is almost as unappealing as a hospital delivery!) In any event, do you have some sort of checklist of these items and when they should be performed? Do these procedures vary by hospital? I've learned that with my health plan, non-standard situations can pose some difficulties, so I would want to be sure in advance that my newborn's care would not be compromised simply because it was not a "standard" hospital birth.

A: We do a complete physical at the birth and do have you make an appointment with the baby's healthcare provider within 24-48 hours after the birth. That appointment can be arranged through Kaiser. Kaiser usually does the PKU test and refers you for the hearing screening test. We do not do the hearing tests at BirthCare. The baby's care is not compromised in anyway by your coming to the BirthCenter. We do have a person at Kaiser to call if we have any difficulty with the system.


Q: My husband and I are having our first baby and would like to have a waterbirth. We are in Richmond Virginia and have been unable to find anyone who does this..On your website I saw in the birth ceter description of the birthing suites, the jacuzzi...does this mean that you do waterbirths? I have found many places that will let me labor in the tub, but say I must get out to deliver. But I want to do the delivery in the tub.

A: We do have a large jacuzzi in our birth center, but we do not use it for underwater births. The tub is only accesble on one side which makes it nearly impossible to safely attend you in the tub. We generally ask for you to get out of the tub for the birth.


Q: Could you provide information about your prenatal care protocol (schedule for visits, lab tests, and ultrasounds) so that I could do a side-by-side comparison of the prenatal care I would receive through your center and the care offered by the Kaiser OB teams?

A: We see you once a month for the first 7 months, then every 2 weeks between 7-9 months and every week for the last month until you give birth. Our care is very personalized. We do not do routine ultrasounds, but refer you out for one if you request it or if it is indicated. Our initial visit is 1hour and each return visit is 30 minutes. We spend a lot of time with you.


Q: I'm back in the DC area and my partner and I are currently planning on having kids soon. My partner is a little leery of birth centers, being of the 'but isn't it dangerous' mindset, but I'm slowly bringing him around. I think I remember you guys having (mandatory?) intro sessions and I was wondering when the next one is and if we could come, even though we're not pregnant (yet!).

A: We have a meeting twice a month, usually the 2nd and 4th Tuesday. Call and let us know which week you want to come. It is not a mandatory meeting, but you can say that if you think it will get your partner to come! We like clients to come early to the meetings - before they conceive is great. Hope to see you soon.


Q: I am not pregnant yet, but my husband and I are about to start trying so I'm investigating lots of information about pregnancy and childbirth. I like the idea of giving birth in a birth center or at home but am not sure if I would be a candidate to start with. Obviously, I know that things can change during the course of a pregnancy. So here are the basics: 1) It would be a first pregnancy. 2) I'm somewhat overweight (5'4" and 160 lbs), but otherwise in generally good health. 3) I have a probable or unconfirmed case of herpes. My current OB/GYN has taken cultures twice that have come back inconclusive, but I have had a few outbreaks a year for the past several years although they seem to be getting milder. Famvir seems to help them clear up quicker. I know that if you have an active outbreak, a caesarean is required, but I don't know if just having herpes puts you in a higher risk category. 4) My husband is quite a bit larger than me (6'5" and 205lbs). I would say that I'm about average in build. I don't know if I would have a higher chance of having a large baby. I was actually small at birth (6 lb 1oz).

Do any of these four above items, put me in a risk category that makes in inadvisable to even look into home birth/birth center?

A: Thanks for the inquiry. None of the items you listed would exclude you from home or birth center birth. If you had a herpes outbreak and went into labor with an active lesion, we would transfer to the hospital for a Cesarean birth.


Q: If I was to choose a home birth, the closest hosital for an emergency would be Fairfax Hospital (I live in McLean). Do you have relationships with any physicians at Fairfax or would that required transport to Alexandria?

A: We currently do not have physicians at Fairfax Hospital. We do have consultants at Alexandria Hopsital.


Q: From either the birth center or home, if emergency transport is required, would my midwife be allowed to remain with me or would I be only in the care of the doctors at that point?

A: Usually if you need to transfer, the midwife and/or the birth assistant does go to the hospital with you for emotional support. The midwives do not maintain hospital privileges.


Q: Seven years ago I had my first child successfully at home. Three-and-a-half years ago, I gave birth to twins, one vaginally, one by C-section. Can I still have a home birth attended by one of your midwives?

A: BirthCare used to provide services for women who had already had a vaginal birth since the cesarean. We currently are not providing VBAC services due to recent changes in reccomendations from ACOG (American College of OB-GYNs).


Q: Grateful if you could let me know how much it costs for somebody who does not have an insurance. Thanks in advance.

A: Thanks for the inquiry. Our fees for prenatal, birth, and postpartum services is $4500. We offer a free information meeting called BirthCare Beginnings which will give you a better overview of our services and a tour of our Birth Center. Please contact us if you need more information.


Q: I will be moving to the Richmond, VA area, and each time we move I look and find out if there is a birth center near by our new home. My mother is a CNM, and I have always wanted to use a birth center. This one seems to be the closest to Richmond, is that right? If so, would it be close enough to use?

A: Thanks for the inquiry. Richmond is too far. If you plan to stay with friends in the DC area when you get close to term, it could possibly work. Traffic is a concern when commuting from Richmond to the DC Metro area.


Q: Hi! I am a certified Doula and I attend births at MWH in Fredericksburg,VA. I just got a call from someone who is wanting to do a homebirth and was wondering if I might have any information about homebirth midwives for her area. She lives in King George,VA. I told her to check out your website to see if she can find out more information. Anyway, this has gotten me all curious and I wanted to ask a question. If homebirth is not legal in Virginia, how do you guys get around that? I have wondered this before but didn't have anybody to ask so hadn't figured it out yet. Do you do births in the Fredericksburg area? Thanks for your help.

A: Thanks for asking your question. Home birth is not illegal in VA! We are licensed CNM in DC, VA, and MD. Home birth is illegal if you are not licensed by the state in which you practice. We used to go to the city of Fredericksburg, but due to the increase in traffic, we no longer attend births in Fredericksburg unless iti s for a client we attended before. Fredericksburg clients are welcome to come to the Birth Center to give birth.


Q: I have a friend who is trying to get pregnant. She lives in Oxon Hill and since her last labor was a total of 4.5 hours, I'm trying to convince her to birth at home with you. Only thing is, she has Kaiser insurance. Do you guys accept that and if so, do you know if they pay for homebirths? She is considering your birth center, as well, but is afraid of crossing the Wilson Bridge during labor.

A: We do accept Kaiser Insurance, but they only pay for the birthcenter. Kaiser does not pay for home births. She would have to pay out of pocket if she wanted a home birth. Kaiser would only pay for the prenatal care and postpartum care. If she lives in Oxon Hill, she should be able to get to the birth center without a problem. I live in Brandywine and cross the bridge almost every day. You can suggest that she come to one of our free information meetings. Encourage your friend to call our office if she has other questions.


Q: Would I come to your clinic for checkups, or are those done at my home?

A: You would come to our office for regular prenatal checkups. Our service provides births either in the birth center or in your home.


Q: I am interested in finding out some more information about your group. I am expecting my third baby in July. I have had two healthy babies in the UK and my last birth was totally drug free. I wasn't attached to an IV in either case. I am told I am going to have to have treatment for GBS at the time of birth with this baby as I have tested positive. I am willing to take meds but was wondering on the policy at your centre. I am not keen on being hooked up to IVs, etc., and wonder why I can't get treatment beforehand as I have heard this can be done.

I also wanted to have both my children (aged 5 and 8) at the birth but understand that many hospitals have policies about the presence of more than one child. The children have both expressed a desire to attend.

Do you have a centre other than the one in DC?

A: Thanks for inquiring about our services. Our service provides home birth and birth center services. Our birth center is not in DC, but in Old Towne Alexandria, VA. You have a choice of giving birth in the birth center or in your home. We help families have their babies in their home if they live within a 45 mile radius of DC. Children are welcome to attend the births as long as they have a person designated to care for them at the birth other than your primary support person. If you tested positive for GBS in this pregnancy, we do recommend treatment with IV antibiotics in labor. You do not stay connected to the IV. The medication is run in via a saline lock in 15-20 minutes. After the antibiotics run in, you are disconnected from the tubes and the IV bag and only the small plastic catheter stays in your arm and is kept open by flushing it with saline. You are reconnected to the tubes and IV bag every 4-6 hrs for the additional doses of antibiotics. Hope this information helps you.


Q: I am not yet pregnant, but my husband and I plan to start trying within the coming year. I'm 26 years old and have always been a healthy person, but a few months ago I was diagnosed with hypothyroidism. I now see an Endocrinologist and am on the proper medication (Synthroid). I will not attempt to get pregnant until I'm sure my thyroid levels are normal and the medication is at the right dosage. Does the fact that I have this condition automatically disqualify me as a patient of yours for prenatal care? I have no other health problems that I know of. My lifestyle is not high-risk (i.e. I don't smoke, drink, etc.) I found out about you via the web and was impressed by what I saw. I've been doing a lot of reading, and I very much hope to have a birth with a nurse midwife, either at a birth center or at home. I only want to have a hospital birth if it's necessary. I know that birth centers only accept those with low-risk pregnancies. I don't want to get my hopes up for an out-of-hospital birth if my hypothyroidism disqualifies me. I realize you can't guarantee my eligibility solely based on the thyroid issue, but does it rule me out? If in fact the hypothyroidism does disqualify me for birth care in your facility, do you have any recommendations on where I should look next?

A: Thanks for your inquiry about our services. As long as your hypothyrodism is well controlled with medication, you would not be risked out for a home or birthcenter birth as long as you are healthy otherwise, the pregnancy progresses normally, and your labs are within normal limits. Hope this information helps you in your decision process.


Q: My girlfriend is 7 months pregnant, and currently we are seeing an obstetrician who delivers at Alexandria Hospital. We made this decision before we really knew about birth centers and midwifery. I knew that midwives existed, but not to the extent that they really do, and how much better they are for birth.

We are currently in a Bradley Class, and plan to have a natural childbirth. After talking with our instructor it seems that hospitals try to discourage it. Child birth is a natural process and should not have medical intervention unless it is necessary for the health of the baby and mother.

There is a problem that we have though. My girlfriend does work, but her work's insurance company went bankrupt before she was eligible; she no longer has coverage. The work's new insurance considers her to have an existing condition. My insurance will not cover her because we are not married. We tried several alternatives; county clinics, hospital programs, and Medicare. The problem is that they say that I make too much money; which I feel is ridiculous.

I was wondering if there was any way that we could work something out, so my girlfriend and I could have a better chance at the birth experience that we want? I understand and am expecting that there is not much that can be done for us. We are a slave to the system right now. I guess I am just writing on a slim hope that something might be able to be done. If there is anything that you can do, or you have any suggestions, I would greatly appreciate any help given to us.

A: Thank you for inquiring about our services. We can probably accommodate her in our service. We need a copy of her records to review and need to meet both of you ASAP so we can work out details. We really discourage clients from transferring for fianancial reasons. As long as everything remains normal, it may be cheaper than birth in the hospital. If the mother has complications and needs to transfer to the hospital, the birth becomes very expensive. In reading your letter, it sounds that you are not inquiring about the transfer for financial reasons only. It seems like you want to birth outside the hopsital for the right reasons.



 

BirthCare & Women's Health Certified Nurse-Midwives • 1501 King Street / Alexandria, VA 22314 / 703-549-5070

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