Frequently asked questions:
Am I too “high-risk” to have my baby outside of the hospital? Very few pregnant women are unable to have their baby with a midwife in the birth center or at home.
Age is not a risk factor, neither is infertility, nor is a history of miscarriages.
We are very sad that we can no longer care for women with a prior cesarean section, but the current guidelines require that VBAC (Vaginal Birth After Cesarean) be attempted in a hospital setting.
Women of any age who begin their pregnancy in a healthy state generally remain healthy and have a normal delivery. During regular pre-natal visits, we conduct thorough screening to ensure that you remain healthy and normal. We also use education and nutrition and exercise to prevent problems and can manage most of the common pregnancy complications.
Florida Law regulating birth centers requires that women who plan to deliver out-of-hospital be medically low-risk and be expected to have an uncomplicated birth.
The following conditions would place a woman in the “higher-risk” category, according to state regulations, and she and her baby would be better off being cared for by a physician (or a Nurse Midwife working with a Physician) and giving birth in a hospital: Chronic High Blood Pressure – Heart Disease – Kidney Disease – Current addiction to drugs or alcohol – Diabetes** – Bleeding or Blood Clotting Disease – Prior Cesarean Section – Multiple Pregnancy (twins or triplets) – 7 or more childbirths – Toxemia (Pre-eclampsia) in current pregnancy – History of Placental Abruption.
*Note: Gestational Diabetes in a prior pregnancy does not automatically exclude you from consideration for a birth center birth. Except for women with these conditions, all pregnant women are eligible for care by the midwives at
Baby Love Birth Center. We suggest you call us to discuss your questions with the midwife, or schedule a free tour of the birth center and an interview with a midwife.
If you have any of these conditions, you can still be cared for by the midwives at the birth center and give birth in the hospital. Your care will need to be coordinated with our "back up" doctor, Dr George Kovacevic, of Cape Women's Care, located next door to the birth center.
Read more about hospital birth.Top Why would I want to have my baby in a birth center? “A birth center birth is gentler and easier on both the mother and the baby and the rest of the family can be active participants in the process.”
- Freedom – Not only are you allowed to walk around during labor and eat and drink, we
actually encourage it. You can have your baby in any position and are never confined to a “birthing bed” or strapped to monitors. You will wear your own clothes, instead of a hospital gown. During labor we monitor the mother and baby and the progress of labor in a way that doesn’t interfere with your ability to move around. Studies have clearly shown that labor is shorter and easier if a woman is active and is able to eat and drink. The baby also suffers less distress if mom is upright during labor.
- Privacy – You and your family will have complete privacy and will never be taken care of by strangers. You will get to know our small staff during your pregnancy and by the end we usually all feel like family. You can have as many or as few friends and family members with you to welcome the new baby.
- Bonding – Your baby will never leave your side. Your partner will play a pivotal role in assisting you in labor. Your other children can be present for the labor and birth.
- Personalized care – During your pregnancy, we get to know what is important to you and your family, so that we can accommodate your wishes. Would you like to avoid an episiotomy? Would you like to avoid unnecessary labs and procedures? Would you like your husband to help “catch” the baby? Would you like to be the one to “announce” if your baby is a boy or a girl? All of these and more are routine at the birth center.
- Choices – Midwives believe that optimum health and safety are achieved when you are making the decisions regarding your care. We like to say that everything is up for discussion and nothing is routine. We will help you to be informed and educated about your choices, through teaching during pre-natal appointments and childbirth classes.
- Breastfeeding support – We will encourage and assist you to nurse your baby soon after birth. We have a pro-breastfeeding policy and actually require that you nurse successfully before you may leave the birth center. We follow up with a home visit and daily phone calls for the first week, so that we can help you with any difficulties that arise. We have a La Leche League Leader on staff who can answer your questions and even make a home visit if you need extra help.
- Safety – Research has proven that out-of-hospital birth leads to fewer interventions and complications for both the mother and the baby. The chances of you having a cesarean, for example, are greatly reduced. Your baby will not be pulled out with forceps or vacuum. Your baby will not be subject to unneeded injections and examinations. Your body and your choices will be respected.
As a matter of fact, the National Association of Childbearing Centers statistics show that Birth Centers have very low cesarean rates and infant and maternal death and injury rates. A
study comparing out-of-hospital birth to in-hospital birth showed that for first time mothers, out-of-hospital birth was as safe as in hospital birth, and for mothers who have already had one baby, out-of-hospital births are actually safer than in-hospital births.
Learn more about this study.
The National Birth Center Study
NEJM -- Outcomes of care in birth centers. The National Birth Center Study
A multi-center study of over 17,000 women seeking birth center care published in the New England Journal of Medicine concluded that birth centers offer a safe and acceptable alternative to hospital birth for healthy, low-risk women, and that birth center care leads to fewer cesarean sections.
British Medical Journal Reports on Safety of U.S. Home Births
Outcomes of planned home births with certified professional midwives: large prospective study in North America -- Johnson and Daviss 330 (7505): 1416 -- BMJ
In the newest and most comprehensive study of U.S. planned out-of-hospital births, researchers at the British Medical Journal analyzed the outcomes of over 5,000 home births in the U.S. and Canada. The study found "planned home births for low-risk women are associated with similar safety and less medical intervention than low risk hospital births". In other words, having your baby in the hospital is not the only safe choice, despite what so many of us think. A planned birth center (or home) birth can be just as safe as a hospital birth, for a low-risk pregnancy. |
“The entire time I was in the birth center, I never once felt like a patient” - Tonya
Top What if something goes wrong? First of all, the chances of you having a problem are very small. Unlike the stories one hears or the dramas on television, birth is generally a straightforward and safe process. Healthy, normal women generally stay healthy and normal and have a normal birth. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time and we can calmly plan for preventing or managing a problem.
We do not handle high-risk pregnancies and you must be full term and essentially healthy to have your baby in the birth center. If we run into a problem with the mother or the baby, we have emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and pain medication), and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation).
Stalled labor is, by far, our single most common reason for hospital transfer. Although we must resolve the situation in a timely manner, it is not truly an "emergency" and we generally have plenty of time to try various natural methods to get labor going again. By the time we decide to go to the hospital, generally the entire family is in agreement that it is the only reasonable course of action. Mothers can be driven to the hospital in their own car. Accompanied by the midwife, who continues to provide care in the hospital, we will attempt to complete the birth with as little artificial intervention as possible.
If we need to transfer urgently to the hospital, Cape Coral Hospital is 5 minutes away. Depending on the medical situation, you will continue to be cared for by your midwife or your care will be temporatily transferred to our "back-up" doctor at Cape Coral Hospital. Dr. George Kovacevic, ObGyn provides advice when high-risk situations occur and is available to take over care in the hospital, but only at Cape Coral Hospital. The midwives have admitting privileges and can often continue to be your care provider.
Nationally, about 10% of women who plan to have their baby out-of-hospital end up transferring to physician care and have their baby in the hospital. About half of these transfers happen during pregnancy, for conditions such as gestational diabetes and high blood pressure. During labor, the single most common reason for hospital transfer is actually not an emergency; most of our hospital transfers are due to stalled labor.
Our rate of transfer during labor is about 1%; of those who transfer during labor about 75% require cesarean birth.
Baby Love Birth Center has an even lower rate of labor transfer than national statistics in other birthing centers. If you need to be cared for in the hospital, the midwife will accompany you to the hospital and continue to provide your care.
If you develop a problem during the pregnancy that is too "high-risk" for an out of hospital birth, you may be able to continue care with your midwife and plan a hospital birth with a midwife from the birth center.
If your condition is more serious, we will encourage you, but not require you, to consider transferring to our "back-up" doctor, Dr. George in Cape Coral. Dr. George's management and philosophy are very similar to ours and
Cape Coral Hospital has staff and a physical set-up that encourages natural labor and birth. Top How much does it cost? We have very affordable self-pay rates and flexible payment plans.
We cannot quote an exact price on this web site, because of contracts with some insurance companies, but complete care at the
Baby Love Birth Center costs about 1/2 to 1/3 of a typical hospital birth.
Please call us to schedule a tour and interview where we can discuss your specific situation.
Do you accept Medicaid? Yes, we do!
Medicaid pays for most of the cost of prenatal care and birth at the birth center. Medicaid, however, does not cover 100% of birth center charges. Please call us to schedule a tour and interview where we can discuss the details.
Will my insurance pay for it? Insurance companies in Florida are mandated by law to cover midwives and birthing centers.
Read more about insurance and request insurance verification.
We are in-network providers for the following insurance companies:
Top I called my insurance company and they said I will have to pay “out-of-network” to use the birth center. This is not always true. Florida insurance law requires that insurers cover birthing centers at close to “in-network” rates, unless there is another birthing center “in-network." Most insurance companies are either not aware of this, or do not offer this information when you call.
We use a professional billing service experienced in the coverage of midwives and birthing centers. When you come for your tour, we will take your insurance information and contact your insurance company. If necessary, we will appeal for “in-network” coverage, and we usually succeed, because we are the only free-standing birthing center in Lee County.
Top
“You all don’t charge enough for this!” – Jamie (10 minutes after her daughter was born underwater in the Angel Room)
What happens when I go into labor? When your labor starts, you will page or call the midwife. For early labor, you will be more comfortable at home, so we expect you to stay at home until your labor is active. When you are in active labor, the midwife will meet you at the birth center. When you arrive with your family at the center, you will get settled in your choice of
private birth suite.
We ask you to bring nutritious snacks and energy drinks. Not only are you allowed to eat and drink during labor, we will actually make you. Most hospitals have rules against laboring women having anything but ice chips, expecting you to rely on IV fluids for the strength to get through labor. You will wear your own comfy clothes, instead of a scratchy hospital gown. You may bring your own music to play on our CD player. The room will be set up with the tub full of warm water, candles lit; a generally relaxing atmosphere awaits.
The midwife stays at the birth center for your entire labor. A birth assistant will be present for the
birth and stays with you until you leave the center after birth. We will closely monitor your labor and the baby's health during labor, but we do so in such a way as not to interfere with your mobility. No belly straps and fetal monitors! We have a variety of tools to help you with labor - cold and hot packs, birth balls, massage, jacuzzi tubs, and the constant supervision of a skilled midwife.
Rest assured that we have emergency plans and equipment in place, should anything go awry. We are monitoring you and the baby throughout your labor. Although we expect that healthy women will have a normal labor, we are vigilantly watching for any signs of trouble. We have resuscitation equipment readily available for the baby at birth; we have oxygen and IV supplies; we have medication to treat bleeding (hemorrhage). For more details, see
What if something goes wrong? We encourage you to consider a
water birth. Laboring in water shortens labor, eases labor pains, makes pushing easier, and protects your vagina from unnecessary trauma. It is also the gentlest way for your baby to enter the world. Protected by the "Dive" Reflex, the baby doesn't even know it is born until we lift him or her gently out of the water and into your arms.
During labor and birth, we don't tell you what to do; instead, we guide you to the best way for you to get through the hard work of having your baby. You can be in any position you like for the
birth. Basically, you will find the right way through labor and we will be there to support you.
We encourage you to invite anyone you wish to be present at the birth. If you bring children, they must have their own support person, but they are welcome to be part of the magical experience. There is a separate room with toys and DVD/VCR for the entertainment of children and family while they wait.
Your friends and family can participate in whatever way you wish. You may photograph or videotape any part of the birth.
Top How long do I stay at the birth center after I have my baby? After your baby is born, you must stay for a minimum of 4 hours, according to Florida law regulating birthing centers. The maximum stay is 24 hours.
Can't imagine going home so soon after having the baby? Most of our clients feel great after their unmedicated labor and birth and are ready and anxious to get back to their own bed and their
own home. It is amazing how much energy you have after accomplishing your goal.
Once your baby has nursed and you have had a snack and a nap, we send you off with a small Happy Birthday celebration for the new baby. We have birthday cake and champagne (or sparkling cider) and all sing Happy Birthday to the little one.
Before you leave, the midwife does a thorough check of the mother and newborn. In most "regular" Obstetric practices, you are "discharged" from the hospital two days after you have your baby and you don't see or speak to your doctor for the next six weeks. If you have questions or concerns, especially about Breastfeeding, it can be very difficult to get help from your doctor.
At
Baby Love Birth Center, we take the "fourth trimester" as seriously as we do the three trimesters of pregnancy.
The midwife will call you regularly during the first few days; you will have a homevisit with a nurse on the second or third day.
We expect you to have an office visit at 2 and 6 weeks post-partum.
Adjusting to breastfeeding and life with a newborn can be confusing and challenging. We will remain your partner and support as you navigate these difficult waters.
The “PKU” test (Newborn Screening Test) on the baby can be done at home during the homevisit.
We expect your baby to be examined by your choice of pediatrician within 72 hours of birth.
Top Can my other children attend pre-natal visits and be present for the birth? Absolutely!
One of the greatest joys is helping a toddler come to terms with the enormous changes life with a new sibling brings. We help you introduce the concept of the new baby by welcoming your other children at pre-natal visits and making the birth center feel like a comfortable, welcoming place for them.
No need to hire a babysitter, just to come in for a check up. We love getting to know your entire family and making everyone feel at home and part of the process.
“You are creating a family; we are here to support you.”
Some people worry about having their young children present during the birth. Our experience with hundreds of siblings and cousins has been overwhelmingly positive. The only way to make the experience negative is to not allow the child to control his or her level of participation.
Very few children under three are interested in actually seeing the baby born, but they are often anxious to be the first to hold their new sibling. Older children, especially girls, are often fascinated by the process and want very much to be a part of the experience. Having your other children present for the birth can be an important part of their bonding experience and acceptance of the newest family member.
Little ones need their own support person while in the birth center (not daddy, because he will be busy with mommy). In our experience, they are usually content to play or nap and check in on mommy periodically. With basic age-appropriate preparation, children of any age can participate fully in the experience.
"I really wasn’t sure about having my two and four-year old with me, but they were such a delightful distraction during labor and actually helped me focus” - Emily
Top Can my family be present for the birth? You can have as many people with you during labor and birth as you like. Some clients have
multiple friends and family; others prefer the privacy of being alone with their partner.
We have a separate “family” room where people can be close by without actually witnessing the birth, allowing you privacy while still having your important people nearby.
“We had five generations of my family present for the birth. This was very important for me because it was the first grandchild for my mother” - KB
Top Can I take pictures and/or videotape? You may do anything you like during labor and birth. Unlike most hospitals, we have no restrictions on what you may photograph or videotape.
We welcome you to share your pictures and video on this web site.
Samantha, the nurse midwife, was a professional photographer in New York City before becoming a midwife and is always happy to pick up a camera and take a few well-timed shots.
Top Do you work with Doulas? Absolutely! Achieving a natural birth is often a team event. Having a professional labor support person with you only adds to the team. A doula can offer extra support, trick and tips for dealing with labor, teaching for your partner to be the best labor support he can be.
Unlike the midwife and birth assistant, who have other duties and responsibilities during your birth, a doula is there just for you, to give you exactly what you need to achieve your goal.
Top Natural labor sounds like a good idea, but what if I want drugs? Some women, especially those having their first baby, are frightened at the idea that they will be forced to labor without the option of pain medication. None of us knows ahead of time what labor will be like or how we will cope. Many women tell us that they have a low pain tolerance. That may be true for certain things, but labor is unlike any other experience of pain that you will have in your life.
You will be thoroughly prepared through pre-natal visits with the midwife. Our required childbirth preparation class teaches you and your partner the HypnoBirthing® method. You will be thoroughly prepared to navigate labor in a relaxed state. The continued presence of the midwife during labor will reassure you that you and your baby are safe.
Learn more about HypnoBirthing® classes.
Should you desire some form of pain relief during labor, we have an injectable narcotic, Nubain, available. We use it very rarely, because our clients usually surpass their own expectations of what they are capable of, but some like to know it is there “just in case”.
Top Can I have an epidural at the birth center? Epidurals are not available outside of the hospital. While epidurals are commonly used and relatively safe, there are major risks to the mother and baby involved in epidurals. The mother’s blood pressure can drop dangerously low and the baby can have distress. Epidurals can only safely be used in a hospital, with an anesthesiologist and obgyn doctor available in the event of complications.
If you are sure you want the option of an epidural or other pain relief options, you might consider prenatal care at the birth center and planned hospital birth.
Read more about hospital birth.Top I like my doctor; can I have my delivery at the birth center with my doctor? You are welcome to invite your doctor to attend your birth at our center. We have a process to grant “guest privileges” to outside doctors and midwives. So far, none of the local doctors has taken us up on the offer, however.
It is pretty unlikely that your doctor will be open to the idea of you having your baby at the birth center, much less the idea of them actually attending a birth at the center. If you desire to have your baby at the center or, you will most likely have to transfer your pregnancy care to our midwives (see becoming a client during pregnancy)
Top What about tearing? Many women are concerned about vaginal tearing during birth. We take the health of your entire body seriously and work hard to prevent or minimize tearing. We use oil on the outside to ease the baby out and teach you how to push in a slow, controlled manner to minimize trauma to the tissues.
Water is a fabulous way to prevent tearing. We encourage you to at least spend some time soaking in the Jacuzzi tub in your birth suite, even if you don’t want to have a waterbirth. The water softens the tissue, allowing it to gently stretch during birth. Delivery underwater has been proven to dramatically reduce the risk of tearing, because the water not only softens the tissues, but the natural analgesic effect of the water makes it easier to deliver your baby slowly and gently.
Should you require stitches; the midwife will perform the repair after birth. We use local anesthetic for stitches.
The midwives are also trained to cut an episiotomy in emergency situations. It is done extremely rarely, but the ability to perform an episiotomy is an important component of the midwife’s management of birth complications.
Top Is underwater birth safe? Most people worry about the baby breathing under water and this is a very common question. Researchers into waterbirth have determined that the risk of the baby breathing under water during birth is a false fear.
The baby is protected by the “Dive Reflex." Don’t forget that the baby has been “under water” the entire time he or she was in the womb. Water is the most natural environment for a baby.
Babies are born with all kinds of “reflexes” – automatic behaviors; one of them is the “Dive Reflex”. A newborn immersed in water will close its mouth and open its eyes (do not try this at home!). This reflex persists for several months and is the basis for infant swim training.
When the baby is born in water, it is still attached to the umbilical cord and receiving oxygen exactly as it was in the womb. As a matter of fact, a baby born under water doesn’t even realize it is born until you take him or her to the surface. It is a very gentle way to welcome a new life.
The midwife brings the baby out of the water within a few seconds of birth, to minimize any risk.
Waterbirth has been proven through thousands of birth around the world to not only be safe, but perhaps safer for the mother and baby.
Read about waterbirths at
Baby Love Birth Center. Top I am only weeks away from my due date and have realized that my doctor or hospital isn’t meeting my needs. Can I become a client during pregnancy? Of course you can!
Women may transfer in to care to
Baby Love Birth Center at any point in their pregnancy. We get phone calls every week from women who have discovered that their hospital or doctor isn’t meeting their needs. Some women need some time to realize that their fears about birth are misplaced and that they want to follow their heart and have their baby in a private, relaxed setting, rather than in the hustle and bustle of the hospital “just in case”.
Becoming a client during pregnancy is a simple matter of coming for a tour and interview and if we agree that
Baby Love Birth Center is the place for you, we will fax a request for your pre-natal records to your current care provider and as simple as that, you are now our client!
Some women who are considering switching care providers worry about offending or disappointing their current provider. While this displays a great deal of thoughtfulness on your part, you should know that no doctor wants an unhappy patient. You have the right to exactly the care you desire and if you can’t get it with your current provider, no one will fault you for switching.
I would like to have a VBAC (Vaginal Birth after Cesarean), can I do that at the birth center? As much as we would love to support you in achieving a VBAC, Florida law prohibits VBAC in birth centers (see below). This is a sad situation, as cesareans become more and more common, yet many women realize the dangers of repeated cesareans.
The birth center would be the ideal place for a birth without the interventions that often lead to unnecessary cesareans (routine induction of labor, pitocin, epidural), but the concern regarding potential complications is making VBAC less available for women. The professional organization for obstetricians, ACOG (American College of Obstetricians & Gynecologists) has published guidelines for VBAC that impose severe restrictions on hospitals offering VBAC, including requirements that the obstetrician be standing-by during labor and that anesthesia services be readily available.
We can recommend our "back-up" ObGyn, Dr. George at Cape Women's Care, for VBAC. Dr. George is currently the only obstetrician in the area offering women the option of VBAC. Births take place at Cape Coral Hospital, which is also the only hospital in the area offering VBAC.
Dr. George enthusiastically supports VBAC and is willing to meet the strict hospital requirements that he be physically present on the labor unit while a woman with a prior cesarean is in active labor. Women who desire VBAC must be screened, but most healthy pregnant women have the option to avoid another cesarean.
Please contact Cape Women's Care to schedule an appointment for a consultation regarding VBAC. (239) 540-9111.
You will need to provide detailed medical records, including the operative report from your cesarean birth.
Notes:
Rule Chapter: 59A-11 (Florida Law)
Chapter Title: BIRTH CENTER STANDARDS AND LICENSURE
59A-11.009 Risk Status Criteria for the Acceptance of Clients and Continuation of Care.
Clients with any of the following risk factors shall be referred to a physician for continuing maternity care and hospital delivery ...
Previous uterine wall surgery including Caesarean section. An exception to this rule is permissible for all centers which are participating in the Vaginal Birth after a Caesarean (VBAC) Section study sponsored by the National Association of Childbearing Centers. Centers planning to participate in this study should notify the State Health Office. Every VBAC candidate shall be evaluated and approved for a birth center delivery by an obstetrician or physician with hospital obstetrical privileges. This evaluation and approval shall be documented in the client’s record;
(study inactive since 2000 - no active plans to restart study)
ACOG CLINICAL MANAGEMENT GUIDELINES FOR OBSTETRICIAN—GYNECOLOGISTS NUMBER 54, JULY 2004
Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care. |
Top I would like to have my baby born at home, do you offer home birth services? While we pride ourselves on offering a home-like setting for birth at the birth center, we cannot provide home birth services. This is due to new restrictions on out of hospital birth imposed by ACOG (American College of Obstetricians & Gynecologists) in November, 2006.
The staff midwife at
Baby Love Birth Center is a Certified Nurse Midwife and must maintain a collaborative relationship with an ObGyn physician; ACOG currently prohibits physicians from participating with planned home births.
We cannot legally attend births at home at this time.
Is Hospital Birth with a Midwife and option?
Yes! The midwives at Baby Love Birth Center have admitting privileges at Cape Coral Hospital, so if you either want to or have to have your baby in the hospital, you can get the same great prenatal care at the birth center and have your baby in the hospital with a midwife attending your birth.
You will still have relaxed and informative prenatal visits with the midwife, all lab work done at the birth center, access to the free classes and to Hypnobirthing Childbirth Preparation Classes.
Cape Coral Hospital has big, comfortable birth rooms and all the tools for natural birthing, including birth balls and jacuzzi tubs for labor (no waterbirth allowed, sorry). Rooming-in with baby is the rule at Cape Coral Hospital; even in the event of a cesarean birth you and baby are only separated briefly.