Frequently Asked Questions
What is a Certified-Nurse Midwife?
As explained by the American College of Nurse Midwives:
Certified nurse-midwives (CNMs) provide care starting with a woman’s first period until after menopause, plus all the important health events in between, such as:
- Annual gynecologic exams
- Family planning needs
- Treatment of sexually transmitted infections
- Care during teenage years
- Care for pregnancy, labor, and birth
- Menopause care
CNMs are independent health care providers. They also work with other members of the health care team, such as physicians and nurses, to provide the highest quality care. They work in a variety of settings, such as hospitals, medical offices, clinics, birth centers, and homes. Their care is covered by most insurance.
When looking for a midwife who will best meet your needs, it is important to understand the different types available to you in the United States.
Types of Midwives
Certified Nurse-Midwife (CNM)
CNMs are registered nurses with graduate education in midwifery. They have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME). This education includes a university degree as well as hands-on clinical training by practicing CNMs. They also have passed the national certification exam of the American Midwifery Certification Board (AMCB). CNMs are able to prescribe a full range of substances, medications, and treatments, including pain control medications. CNMs work in many different settings, such as hospitals, health centers, private practices, birth centers, and homes.
Certified Professional Midwife (CPM)
CPMs prepare for a national certification exam administered by the North American Registry of Midwives (NARM) in different ways. There are two primary pathways for CPM education with differing requirements: apprenticeship training alone or an accredited formal education program. The health care services provided by CPMs are not as broad as those of CNMs. CPMs provide pregnancy, birth, and postpartum care for women outside of the hospital—often in birth centers or homes. CPMs are not able to prescribe most medications.
Other midwives who are not certified by AMCB or NARM may be practicing in some states. These midwives may or may not have formal education and have not passed a national certification exam. They may or may not be licensed. Their services are usually focused on pregnancy and birth, and they are unable to prescribe most medications.
What's the Difference Between a Doula and a Midwife?
Doulas do not replace nurses or medical staff such as midwives or doctors. Doulas do not perform clinical or medical tasks such as assessing blood pressure or temperature, monitoring fetal heart rate, doing vaginal examinations or providing postpartum clinical care.
Doulas are present to comfort and support the mother, and to enhance communication between the mother and medical professionals. Doulas can be a tremendous source of emotional support, encouragement and wisdom throughout labor and birth. During labor, your doula can use different techniques such as massage and different labor positions to help you through delivery. During the postpartum period, your doula can help with caring for an infant, breastfeeding, and healing after childbirth. The training and experience of doulas varies.
Why Give Birth at Del Mar Birth Center?
Del Mar Birth Center is a nationally accredited birth center, meeting the stringent standards of the Commission for the Accreditation of Birth Centers (CABC).
Del Mar Birth Center provides a safe, clean, comfortable, calm, hotel-spa like environment where expert midwifery and nursing services can be provided with all of the necessary supportive equipment and medications, if necessary.
The comfortable private birth rooms with full size beds, baths, kitchen facilities, and areas for children and other family members to congregate provide a tranquil, private and accommodating setting.
Our midwives spend time getting to know you and educating you about your body, your pregnancy and birth. You are an equal partner in your care and you are informed about your options so that you can make educated decisions.
Birth center birth means evidence-based midwifery care – including the freedom to move around, eat and drink, and give birth in whatever position seems most natural to you. You are not strapped to a fetal monitor, tethered to an IV or confined to bed. We do not interrupt your labor with beeping equipment, florescent lights and strangers. We allow your labor to progress naturally and do not push unnecessary interventions. Once baby is born it is placed on Mom’s chest for skin-to-skin time, cord clamping is delayed until the cord stops pulsating and we assist you with nursing your baby. Your baby never leaves your side.
The cesarean section rate for women receiving care in accredited birth centers averages 4.4%, significantly below the rate at most hospitals, including for low-risk deliveries.
Do You Monitor the Baby During Labor?
Your midwife is present throughout your labor and birth, carefully monitoring you and your baby’s safety in accordance with the standards set by the American College of Obstetricians and Gynecologists (ACOG). A handheld Doppler is used to listen to the baby’s heartbeat during labor and birth, referred to as intermittent fetal monitoring.
Research has shown intermittent fetal monitoring to be equally effective as continuous electronic fetal monitoring (EFM) in detecting problems during labor and delivery; however, intermittent monitoring does not limit your mobility and has also been found to result in fewer cesarean sections with the same neonatal outcomes.
What About Pain Management?
Many women, particularly first-time moms, fear the prospect of pain during delivery. Labor is different from other types of pain in that it’s not continuous and can provide valuable feedback about the position you need to be in and what you need to be doing in order to facilitate dilation and descent of your baby. Your midwives will help you prepare for the experience, developing a relationship of trust during prenatal appointments, while childbirth education classes will assist you with addressing your fears, building confidence in your abilities, and providing you with coping and relaxation techniques.
During labor, we encourage you to both rest and move about freely, offering numerous assistive measures, including cold and hot packs, birth balls, rebozo, birth ladder, hydrotherapy in our deep birth tubs and showers, birth sling and birth stools.
Nitrous Oxide “laughing gas” is also available to alleviate anxiety and take the “edge” off, while continuing to allow mobility and active participation throughout labor. Unlike epidurals and narcotics commonly administered in hospitals, nitrous oxide is self administered, does not affect the baby, dissipates quickly, and does not leave you feeling numb or “out of it”.
Do You Offer Water Birth?
Yes! Our chromatherapy birth tubs are specifically designed for water immersion, promoting comfort and relaxation during labor and/or birth. Our midwives are experienced in safe water birth practices and have assisted many clients with water deliveries.
Some of the benefits of water birth include:
- Provides significant pain relief
- Promotes relaxation
- Provides buoyancy enabling you to assume positions that are comfortable for labor/birth.
- Reduces blood pressure
- Reduces perineal trauma, eliminating episiotomies
- Encourages an easier birth for mother and a gentler welcome for baby
Do You Offer Vaginal Birth After Cesarean Birth (VBAC)?
For women desiring VBAC, Del Mar Birth Center offers hybrid VBAC care. We recognize that choosing a VBAC birth can be part of the healing process for you. Clients benefit from midwifery care with half hour appointments, allowing time for thorough discussions about any issues should they arise as your pregnancy progresses, along with assessment and nutrition analysis – all in the comfort of our center.
When labor begins for women receiving hybrid care, we have an arrangement with the midwives at a local hospital where you will continue to receive midwifery led care, but in a hospital setting where should the need arise, you can also have necessary medical intervention. The VBAC success rate for this hospital midwifery practice is over 80%!
The Postpartum period includes a home visit by a Registered Nurse, routine phone “check-ins” by your midwife, as well as a 2 week and 6 week postpartum check-up at the birth center.
Some of the benefits of VBAC include:
- Faster healing after birth.
- Less risk of infection after delivery as compared to Cesarean Section.
- No complications caused by surgery (infection, injury to bowel or urinary tract, blood loss).
- Quicker return to normal activities without the pain from surgery.
- Reduced risk for problems with how the placenta attaches in future pregnancies.
Who Can Attend My Birth?
One of the advantages of birth center birth is your ability to control the environment in which you give birth. This means having whomever you choose for support, whether just a partner, or parents, siblings, children and a doula.
What If There’s a Problem During My Pregnancy or Birth?
Midwives specialize in normal pregnancy and birth. We do not handle high-risk deliveries i.e. twins or breach birth, and you must be at least 36 weeks to deliver in the birth center.
Our midwives focus on building up healthy moms and healthy babies to prevent problems. Conditions such as Gestational Diabetes requiring medication management or Pregnancy Induced Hypertension may require a transfer of care to a consultative physician.
Our midwives have extensive experience working in both hospital and out-of-hospital settings. They are highly trained in how to handle complications, and we have medications and emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and pain medication) to deal with situations should they arise, and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation).
Midwives are experts at normal birth, thus they are expert at identifying if things are starting to veer off the path of normal.
In the rare case where more aggressive medical intervention is necessary, we have a transfer agreement with Huntington Memorial Hospital, located 1.5 miles from the birth center, and we can quickly arrange paramedic transport with the South Pasadena Fire Department, located 1 block away. If you need to be cared for in the hospital, your midwife or a nurse, whenever possible, will accompany you to the hospital to get you settled in for a smooth transfer of care. After discharge, you continue to receive your DMBC postpartum care including daily “check-in” by the midwife for the first week, a home visit and 2 postpartum appointments at the birth center.
Unlike the stories you may have heard from friends who gave birth in a hospital or the portrayals of birth on television, birth is generally a straightforward and safe process. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time allowing us to calmly plan for, prevent or manage a problem. The more interventions performed during the birth process, the greater the likelihood for the development of problems.
Can I Transfer My Care to Del Mar Birth Center?
Del Mar Birth Center welcomes healthy women at all stages of pregnancy generally and will accept transfers after we receive your complete medical records, perform a risk assessment and are satisfied that you have received appropriate pre-natal care and preparation for natural childbirth. Of course, we encourage you to start your care here and enjoy the benefits of the time and attention our midwives provide, and to gain familiarity with our staff and facilities.
Do You Accept Medi-Cal?
At this time we do not accept Medi-Cal.
Do You Have Payment Plans?
We are happy to offer affordable payment plans, allowing you to make payments over the course of your care, with all payments due in full by 36 weeks. We accept credit card payments with either Visa or Mastercard.
Are Birth Centers and Midwifery Care Covered by Insurance?
Most insurance companies cover birth center birth and midwifery care with Certified Nurse Midwives. Del Mar Birth Center works with a third party insurance billing company that bills exclusively for midwives, birth centers, and parents. Please call us today to talk about your options.