Where to start?

That’s the first question, right? There are so many questions. Scroll through here, and hopefully you’ll find your question – and your answer. If not, do not hesitate to e-mail us at katiecnm@gmail.com.

What is a CNM?

A CNM is a “certified nurse-midwife.” She is a woman (usually) who earned a masters-level nursing degree and is licensed to practice as a midwife in her state. CNMs are specialists in normal, physiologic pregnancy and childbirth and also are trained to offer basic well-woman care. Some CNMs continue with additional, specialized training and education to offer services such as working with basic ultrasound or assisting with breech births. A certified nurse-midwife is different from a certified professional midwife (CPM), a lay midwife and a direct-entry midwife in that she is first a registered nurse. For more information about CNMs, visit the American College of Nurse Midwives. For more information about CPMs, visit the North American Registry of Midwives.

What’s the difference between a midwife and an obstetrician?

A midwife is an advanced-practice nurse, not a doctor. An obstetrician is a doctor who specializes in women’s reproductive medicine and higher-risk pregnancy and childbirth.  A midwife will refer clients to obstetricians when necessary.

Is home birth safe?

Kate listens to a baby’s heartbeat during labor.

Scientific studies about home birth have produced varied analyses and conclusions from different groups with different agendas. Clearly, CNMs like Kate believe home birth is safe, or they wouldn’t offer to attend them. The safety of home birth does require certain conditions, however. First, the home birth should be a planned home birth. Mother and baby both should be screened for health risks, and the birth itself should be attended by a trained professional. Home-birth clients also should have an emergency and non-emergency plan for transfer to a hospital should that become necessary. Here’s what the American College of Nurse-Midwives says about home birth: ACNM Policy on Home Birth

What about the mess?

This question garners smiles from birth attendants because the truth is: Home birth is not, usually, very messy at all. Home-birth clients purchase disposable underpads and other items to collect birth “mess,” and attendants work carefully to handle laundry and trash efficiently and thoroughly. Kate and her staff always purpose to leave a home as nice as or nicer than they found it.

What if something goes wrong?

There is no setting, no health care provider and no set of circumstances that guarantees nothing will “go wrong” in childbirth. However, certain conditions help provide an atmosphere where problems are less likely. Home-birth midwifery, with its careful screening and one-on-one care, enjoys good outcomes with few instances of morbidity and mortality to mother or baby.  But when there is a complication that requires more care than can be given at home, the midwife will work with the family to facilitate a transfer to a hospital. Most complications leave time for assessment and decision-making, meaning true “emergencies” are few and far between. There is good reason to believe things are less likely to “go wrong” when the midwifery model of minimal intervention is in place.

What does Kate bring to a birth?

For the birth, the midwife brings several bags of supplies, including all medical items, like hemostats and scissors to cut the cord, devices to listen to fetal heart tones, medications for nausea and bleeding, IV therapy supplies, a baby scale and newborn assessment tools, and a host of other items. Home-birth families are asked to supply about $75 worth of supplies, items which can be purchased in stores or as a package put together by an assistant. Here’s the list of supply kits available: Supply Kits

Who else comes to the birth?

The birth team works together.

Because she values the extra head, hands and heart, Kate usually brings a trained birth assistant to the birth. The midwife’s assistant is either a licensed nurse, a student nurse or a doula trained by Kate specifically to assist the midwife at home. The birth assistant’s primary role is to help the midwife do her job, though the assistant often works closely with the laboring woman as well. The midwife’s assistant might check fetal heart tones, monitor vitals on mother and baby, help set up supplies for the birth, offer labor support, make coffee, soak laundry, weigh the baby and keep paperwork up to date. Kate tries to honor client requests for specific assistants when she can. Kate occasionally brings a second assistant in training. Families are welcome to have whomever they like at their home births – helpers such as doulas, for example, family members or their older children – which is one of the beauties of home birth.

Does insurance cover midwifery services? Home birth?

Some insurance companies cover both midwifery care and home birth. Generally, however, it takes some work to jump through the right hoops – phone calls, paperwork , etc. – to get coverage when it’s possible. Many people determine it’s easier or more cost-efficient to pay cash thanks to deductibles and/or administrative hassle. If clients want to use insurance for coverage, Kate puts them in touch with a billing service and charges additional administrative fees for the extra office work. In short: Your insurance might cover our services, but you’ll probably have to work at it to get Kate paid.

Is home birth legal?

Any *place* of birth where she’s welcome to be is a “legal” place for a woman to have a baby, her home certainly included. Home birth, then, is *definitely legal*. Questions of legalities come up, however, when considering the birth attendant – the midwife. (Families don’t face questions of legality; midwives do.) In Indiana, only *certified nurse-midwives* are licensed to attend home births, or to “practice midwifery.” Certified professional midwives (CPMs), who might be as well or even better trained, are not offered licensure in Indiana, and thus risk prosecution for practicing midwifery without a license if they attend a woman at home. It should be noted that lay midwives – or CPMs at least – can obtain licenses and/or attend home births without fear of prosecution in some 27 other states, Michigan included. Kate maintains three licenses – her RN, her CNM, and a license to prescribe medications – and is by-the-book *legal*. Read the Indiana General Assembly’s administrative code about CNMs here: Indiana General Assembly


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