Birth Risks and Cause for Hospital Transfer  

Risks are involved in childbirth no matter where it occurs. I cannot offer any guarantees of outcomes. I will always do my absolute best with the knowledge and experience I have, to protect the birth space, be watchful for any signs of danger, and treat issues swiftly and as gently as possible if they arise. I expect parents to be well informed, take the initiative to read and educate themselves, and be willing to take full responsibility for the outcome of their birth. The decision to birth a baby at home must be made with the understanding that the location of the birth has inherent implications for access to medical care in emergencies and the availability of resources in the home. Homebirth is a decision families must be completely confident in and trust their inner knowing that their birth will unfold just as it should with or without a birth attendant.

The possibility of hospital transfer while rare is something we discuss so that there is clarity and transparency for both parties. Meeting nutritional needs is one of the best ways to prevent complications. In the event any issues arise during our journey together the decision to transfer care will always be made by you for your family.

During pregnancy, reasons for discussion of transfer of care may include, but are not limited to: uncontrolled hypertension (>140/90 prenatally), uncontrolled diabetes, persistent anemia that is unresponsive to treatment (<9.5g/dL), placenta previa (placenta partially or completely covering the cervix), known fetal congenital anomalies that require immediate care at birth, preterm labor (<36 weeks gestation), and diagnosed preeclampsia.

During birth complications that can occur with or without warning in any birth setting can include, but are not limited to: fetal distress, dehydration, infection, shoulder dystocia, placenta previa, placenta accreta, placental abruption, prolapsed cord, maternal hemorrhage, uterine rupture, stillbirth, birth defects, maternal embolism, newborn respiratory distress, and maternal or fetal death. While these are very rare in the homebirth setting, acknowledging the risk is important, again you and your family will always have the say when and if your plan for homebirth changes and you'd like to transport to the hospital to continue your birth journey, I will honor your wishes. All of these complications will be discussed during prenatal care to allow for your informed consent to plans for resolution. 

It is my belief and the belief of birth attendants around the world that these issues are much less likely to occur at home, with normal healthy mothers and babies. There are a small number of complications that are better dealt with if they occur in the hospital, due to their urgent nature (cord prolapse, placental abruption, and uterine rupture that most often occurs in women with compounding risk factors). These are important issues to consider when making this choice for you and your family.

In the event of a non-emergency transfer, we can drive to the hospital of your choice. In the event of an emergency transfer, we will call an ambulance or drive to the closest hospital. In the event of a hospital transfer, I will do my best to accompany you to the hospital and, if possible, will stay with you to offer support and encouragement as your birth companion. I will do my best to help you get the best care possible if a transfer becomes necessary.

Equipment and Medications

The equipment and medications that I carry include but are NOT LIMITED to: fetoscope, doppler, blood pressure cuff and stethoscope, essential oils, herbal tinctures to control excessive bleeding after birth, homeopathic remedies, neonatal resuscitation equipment and infant scale. I do not carry oxygen, however, the need for oxygen at a normal healthy home birth is very rare, and if a woman or baby needed basic oxygen therapy, they are most appropriately cared for in a hospital setting, and we would alert EMS promptly for higher level care. I do not carry suturing equipment routinely, since I rarely see any tears that require suturing. I do use natural ways for treating tearing such as Manuka honey and Nori, witch hazel, and herbal blends for 1st degree and 2nd degree tears with great success. If a tear does require suturing, a transport may be necessary, which will be fully discussed and prepared for before going in.

A complimentary birth pool will be provided for use during your birth. While this birth pool is in your possession it is your responsibility to care for it. In the event that the pool becomes damaged in your possession or during your birth you agree to pay a $150 pool replacement fee. If you fail to use the appropriate disposable liner to ensure preservation of sanitation of the pool you agree to pay a $150 pool replacement fee.

My Team

To provide the best care possible, it is my policy to attend each birth with at least one birth assistant or second midwife at no additional cost to you. However, this may not be possible in some circumstances, and following this policy remains at my discretion.

We will make every effort for you to meet anyone who may be at your birth ahead of time so that you can get to know them and make sure you are comfortable with them being part of your team. You are of course entitled to information about their training, experience, and knowledge. If you are ever uncomfortable with having a specific student or assistant at your appointments or your birth please let me know and we will make accommodations.

Expectations

Lifestyle - You agree to practice the healthiest lifestyle available to you within your means and circumstances. This includes (but not limited to): eating well, using recommended remedies and supplements, adequate hydration, stress management, physical movement as well as other alternative and conventional therapies when needed. These lifestyle practices are all essential in achieving a healthy birth. Minimizing or eliminating any hindrance to a healthy lifestyle gives us the best chance for a normal pregnancy, a healthy mother, baby, and birth. These are the things that are within our control when so many factors are not. I only work with clients who agree with these beliefs and are interested in making their self-care the top priority of their pregnancy.

Reasonable Expectations and Understanding of Risk - You understand that by working with me, you are not guaranteed a "perfect" birth. Birth is the same as life - unpredictable, but mostly wonderful. You are trusting me to advise you when necessary, and if at any point I feel that birth at home is not safe or in your best interest, I will communicate that to you. You alone can make the decision on how to proceed with your care. I agree to respect your personal wishes and boundaries and expect the same respect for my professional and personal boundaries in return. It is my practice, above and beyond, at all times, to respect and honor you, and I ask the same of you.

Honesty - You agree to be honest with me about social, physical, mental, and emotional issues or challenges that are relevant to their health and happiness as a pregnant and birthing woman. Examples include (but not limited to): relevant health history, sexual and emotional trauma, past hospital or birth trauma, etc. These situations can be disclosed to me however it feels best to you, but are important to talk about at least once in an effort to provide truly comprehensive care.

Client Autonomy/Your Own Choice - You have to choose home birth because you believe it is the best and safest choice for you and your baby. It should not be a choice made by anyone else (partner, family, friends) since it is ultimately your body and your physiology that has to birth your baby, and it cannot do so effectively if you feel excessively afraid or nervous about your birth plans.

Supportive Friends and Family - Supportive family members and partners can have strong positive implications for your brith outcomes. If you have people in your life who are unsupportive of your birth choices, it may influence your birth (especially if they are at the birth) and put me at risk regardless of birth outcome. We both must use our discretion and communicate openly about any potential disruptive relationship dynamics.

Keeping Appointments - I may be called to a birth at any time, because of this please be flexible with appointment times if they need to be rescheduled. I will try my best to keep you updated on schedule changes in a prompt manner.

Self-induction/ Interventions - Any attempt to induce yourself using natural remedies, including (but not limited to): blue or black cohosh, castor oil, cotton root bark, homeopathics, or any other substance taken for the purpose of inducing labor without my knowledge or direction constitutes a breach of contract, and more importantly signifies a lack of mutual trust and respect. All interventions may have risks and benefits. Making informed decisions and researching all options is vitally important for you and your birth team. To avoid potential hospital transfers and c-sections, please discuss any considerations you have for these methods with me beforehand. Failure to follow this policy may result in termination of care with no refund. 

Birth Certificate Filing
I will supply the birth certificate packet for you to fill out, it will be your responsibility to complete and file your birth certificate with vital records within one year of your child's birth. I will help you complete this at the 3 week postpartum visit if help is needed. 

Special Circumstances (Failure to Provide Service)

I will be on-call for your birth after 36 weeks of gestation according to your original due date agreed upon at the time of contract. If you go into labor before 36 completed weeks, I will do my best to make sure you are well cared for at the hospital, but I cannot attend your birth at home. Before active labor (active labor is defined as either 5-6cm dilation and/or contractions 4 minutes apart lasting one full minute), I am available to assist you over the phone or come to your home to confirm that everything is normal. I do not routinely offer continuous labor support (there are of course exceptions) since I need to be rested and energized to provide high quality care during active labor, birth, and the first several hours postpartum. If this is your first baby or you feel you will need more support during early labor, I highly recommend hiring a doula. I may have a student/apprentice who can provide some amount of doula support when there becomes a need.

In the unlikely event that I am not able to attend your birth due to unforeseeable circumstances or "acts of God" (such as another labor, inclement weather, personal  illness, injury, or a serious family emergency), I will provide a competent and reliable backup Midwife, at no additional cost to you, if at all possible.

Communication (How and when to contact me)

I am accessible to you on a 24-hour basis by phone call (not text) for labor or emergencies. If you keep in touch with me in early labor and call me when you are ready for me to come (do not text) it is unlikely that I will miss your birth. However, if your birth does happen quickly and I miss it, no refunds will be made regardless of the location and outcome of your birth, I will of course continue immediate postpartum care once I arrive. In the very unlikely case that you are unable to reach me in an emergency, you should go to the hospital or call 911.

All non-emergency communication can be email, text or voice messages. If I do not answer, leave a complete message, and I will return the message at my earliest convenience. It may take up to 24 hours depending on if I am at a birth or it is a prenatal day to return non-emergency calls or texts. Rest assured I will respond just as soon as I am able. 

All document requests have a 7 business day turnaround time.

Financial Agreement

1) All payments must be completed by 36 weeks gestation. 

2) Lab work and birth supplies are an additional costs to you outside of my fees.

3) There is a NO-REFUND policy due to the nature of the work, but consider refunds in the event of a FIRST TRIMESTER miscarriage.

Georgia currently does not recognize or license non-nurse midwives or birth attendants regardless of certification and therefore insurance does not provide coverage for services. I have had great success with submitting through Christian Health Shares and Samaritan Health Ministries.