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Tuesday, October 17, 2017

Midwife Resource Guide

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Every woman experiences pregnancy and anticipates birth in her own way.  When it comes to pregnancy and childbirth, there is no right or wrong way to go about it. We each have our own set of needs, desires, and expectations. Once the decision has been made to try to conceive, you will want to search for a healthcare provider to care for you during the pregnancy and the birth of your child. The type of provider that you may choose would depend on numerous factors such as accessibility, type of experience desired, cost/insurance, whether the pregnancy is high risk, relationship with the current healthcare provider, and the environment that you would like to give birth in. While ob-gyns and family physicians have been considered the norm, more women are choosing to use certified nurse-midwives and direct-entry midwives.

Main sections of this article:
Things to consider when choosing a healthcare provider
What is a midwife?
What does a midwife do?
Why choose a midwife?
Why not choose a midwife?
Midwifery myths
What you need to know about your midwife
How to find a midwife in your area
Richmond area midwifery resources

 

Midwife Resource Guide

Things to Consider When Choosing a Healthcare Provider

Accessibility
One of the main factors in choosing a provider would be their accessibility. Not everyone lives in a location where all the different types of providers are available. Research to determine which providers are close to you. If providers are too far away, it may deter you from getting the necessary care that you and your baby need.

Type of Experience Desired
Everyone has a different approach to pregnancy and birth. You need to consider what is important to you and determine which provider will be able to meet your expectations. For example, you may desire a holistic approach to your pregnancy and birth with minimal interventions like continuous electronic fetal monitoring, epidurals, and etc. A midwife might meet your needs.

Cost/Insurance
Many people do not know that most health insurance companies cover Certified Nurse Midwife (CNM) services. Believe it or not, Medicaid reimbursements for CNM services are mandatory in every state. Even still, please check with your insurance company to verify coverage and reimbursements.

Pregnancy is High Risk
If you have any medical conditions that place your pregnancy in the high-risk category, it is recommended that you consider medical professionals such as ob-gyns and family physicians instead of a midwife. A midwife most likely would not have the resources available to handle possible scenarios associated with a high-risk pregnancy.

Current Medical Provider
Relationships and trust are crucial when it comes to pregnancy and birth. If you have a good relationship with your current medical provider and feel comfortable that he/she would respect your wishes, you may want to consider not switching. However, if you have any doubts that your current provider may not honor your wishes when it comes to the pregnancy and birth, it may be time to switch.

Environment
The environment can play a large role in the birth of your child. If you have a low-risk pregnancy and desire to give birth in a birthing center, at home, or other locations outside of a hospital, you may want to consider a midwife that works in these environments. Birthing centers are very receptive to natural births and are usually staffed by CNMs. For home births, you may either consider a CNM or a Direct-Entry Midwife. Direct-Entry Midwives are individuals that have been educated in midwifery through formal education, self-study or an apprenticeship.

What is a Midwife?

Midwives are trained professionals focused on providing expert care before, during and after childbirth. They may deliver babies at home, birthing centers, or even hospitals. There are two main categories of midwives practicing in the United States: Certified Nurse-Midwives (CNM), who hold advanced degrees and certifications in nursing and midwifery; and Direct-Entry Midwives, who have been educated in midwifery through formal education, self-study or an apprenticeship.

It is important to note that state laws and licensing requirements for midwifery vary. In Virginia, only two types of midwives are legally recognized:

Certified Nurse-Midwife (CNM): CNMs are professionals with a degree in nursing and midwifery from a school accredited by the Accreditation Commission for Midwifery Education (ACME) and certified by the American Midwifery Certification Board (AMCB). CNMs can practice legally in all 50 states and the District of Columbia. Most midwives in the United States fall under this category and can work in any setting, including private homes, hospitals, and birthing centers.

Certified Professional Midwife (CPM): As direct-entry midwives, CPMs are certified by the North American Registry of Midwives (NARM). CPMs receive their training through apprenticeship programs or through an accredited formal training program. Like CNMs, CPMs can work as independent practitioners both in private homes or formal settings; however, CPMs are the only midwives required to have specific training outside of medical/hospital environments. CPMs can provide prenatal, birth and postpartum care. Currently, CPMs are legally allowed to practice in 30 states.

Other types of Direct-Entry Midwives include:

Certified Midwife (CM): CMs typically have undergraduate degrees in fields other than nursing, but have completed a graduate-level midwifery program accredited by the ACME and have been certified by the AMCB. Currently, only five states recognize CMs: Delaware, Missouri, New Jersey, New York and Rhode Island. CMs are highly trained and have received education in health-related skills and midwifery identical to that of CNMs. Likewise, they can practice in the same variety of settings and, in New York and Rhode Island, are able to prescribe a number of medications and treatments.

Traditional Midwife: Also known as “lay midwives,” these practitioners have obtained a detailed knowledge of midwifery through self-study, an apprenticeship or formal training, but for religious, social or philosophical reasons, choose not to become certified or licensed. Traditional midwives are found at private home births or other out-of-hospital environments and provide a high level of personal care. However, it is important to note that in states like Virginia, only CNMs and CPMs are legally allowed to attend a home birth.

Licensed Midwife (LM): LMs have been trained, formally or informally, in the practice of midwifery and have passed requirements and testing set forth by the state’s medical board licensing division, but do not necessarily have national certifications. While some states, like Oregon, require no licensing, others, including Virginia, do not allow LMs to practice without national certifications.

The majority of midwives attending both home and in-hospital births are CNMs, as they account for the largest population of midwives.

What Does a Midwife Do?

Every individual will have her own experience – even when using a midwife. However, most midwives provide extensive care throughout the childbearing cycle. Whether you choose a home birth or a more formal birthing center or hospital, you can expect both prenatal and postpartum care that includes regular prenatal visits; comprehensive labor and delivery care; and newborn health and wellness care.

Since Virginia only allows CNMs (Certified Nurse-Midwives) and CPMs (Certified Professional Midwives) to practice, it helps to know some of the differences between these types of providers.  For more midwifery laws in each state, click here.

Because of their high levels of medical training, CNMs can provide women’s health care far beyond just childbirth. They also provide check-ups, annual gynecologic exams, fertility programs, pre- and post-conception care, newborn care and menopausal management; as well as prescribing medications and treatments.

Like CNMs, CPMs are also highly trained, although less formally. CPMs most commonly work in private homes or birthing centers and tend to carry a smaller case load, allowing for very personal and comprehensive care throughout pregnancy and childbirth. While they cannot prescribe medicine, they are trained to help healthy women throughout the birthing process based on the Midwives Model of Care.

Here are some additional services that a midwife can provide:

  • Family planning and preconception care
  • Perform prenatal exams and order tests
  • Monitor physical and mental health
  • Admit and discharge you from hospital

Why Choose a Midwife?

Women may want to consider a midwife if they desire to have a more natural form of childbirth with minimal medical intervention such as fetal monitoring, episiotomy, epidurals, labor inductions, and etc.  Midwives are also flexible in the location where the childbirth will occur.  They perform deliveries in the home, birthing centers, and hospitals (most common).  In addition to a more natural childbirth, midwives also provide emotional, mental, and practical support for a more personalized experience.  Although many obstetricians provide high levels of emotional, as well as medical support, for most women, the benefits of working with a midwife include greater control of the birthing process, having a care provider that is more personally connected and a more interactive birthing experience from start to finish.

Whatever your personal reasons, knowing your options and choosing the path that is right for you and your family will make all the difference as you go through your pregnancy, delivery and postpartum experience.

Why Not Choose a Midwife?

A midwife is not recommend in all situations.  If a woman is classified to have a high-risk pregnancy due to health conditions, a medical professional such as an obstetrician or a specialist is needed to ensure the safety of the mom and the baby.  A midwife will not have all of the resources and training to handle complex medical difficulties that may arise from a high-risk pregnancy.  Also if you have a good relationship with an ob-gyn or family physician, you may want to consider continue using them for your pregnancy and childbirth.  You would already have an established level of comfort with them and they have a better understanding of your medical history.

Midwifery Myths

For a long time, people assumed that midwives were only for those off-the-grid types who chose home births – you know – hippies. And while the 60’s and 70’s certainly brought an increase in traditional midwife services and home births, times have changed. Not only are more women from every walk of life choosing midwife-assisted birth, today’s professional midwives are found working side-by-side with doctors and other medical professionals at hospitals, as well as in private homes and birthing centers.

Another common misconception about midwifery is that, while midwives might be gentle, soothing souls, they may not be qualified to provide healthcare comparable to that of a trained physician. But, in certain cases, midwives have been shown to provide increased safety for healthy women and babies.

The American College of Nurse-Midwives reports that midwives provide benefits including:

  • Decreased rate of Cesarean births
  • Reduced risk of induction or intervention
  • Increased rates of natural pain management
  • Lower infant mortality rates
  • Fewer preterm births
  • Lower costs for clients and insurance companies
  • Higher breastfeeding success rates

Of course, complications can arise in any pregnancy, which is why most midwives have relationships with physicians and hospitals should a woman need to be transferred in an emergency situation.

What You Need to Know About Your Midwife

As with any healthcare provider, verifying your choice of midwife is important. Knowing the type of care you desire, as well as the services your midwife provides, is essential to a positive birthing experience. When deciding on a midwife, here are a few questions you might want to ask:

  1. What is your education and training?
  2. Do you work with birthing assistants? What is their background?
  3. What happens if you are sick or on vacation when I go into labor?
  4. Do you do prenatal screenings, such gestational diabetes testing?
  5. Do you offer post-partum care? What type?
  6. What are your fees and what services do they include?
  7. Do you accept insurance?
  8. What are your policies for handling complications? (e.g., breech, pre-term labor, pre-eclampsia, etc.)
  9. Are you trained in neo-natal resuscitation?
  10. At what point would you consider referring me to a physician or transferring me to a hospital during pregnancy and/or labor?
  11. Do you have a relationship with a physician or hospital in the event of an emergency or complications beyond your comfort/skill level?
  12. If I have to go to the hospital during labor, would you go with me?

You may also want to try BabyCenter.com’s printable Midwife Interview Sheet to help keep your thoughts organized when meeting with your midwife for the first time.

How to Find a Midwife in Your Area

There are several ways to find a midwife for your pregnancy and childbirth.  You can ask friends and family who have used a midwife for a recommendation.  Since they know you, they will be able to have better insight into which midwife would be best.  You can also ask a trusted medical provider who supports your decision to have a midwife-attended birth.  This may be your family doctor or ob-gyn.  Finally, you can also search for midwives online.  Please make sure to interview the midwives to determine fit.  Here are a couple of national sites to help you in your search:

American College of Nurse-Midwives
Mothers Naturally

For local resources, please see next section.

Regardless of how you start your search, establishing trust and a personal rapport with your chosen provider is essential to ensuring the best possible outcome for you and your baby.

Richmond Area Midwifery Resources

Below, you’ll find some of Richmond’s top midwives, including those in private practice, as well as hospitals and birthing centers offering midwifery.

PRIVATE PRACTIONERS AND BIRTHING CENTERS 

Mary Callendar, CPM, LM
Richmond Virginia Home Birth

Services:
In-home prenatal, birth and postpartum care; herbal and homeopathic remedies; water birth; VBACs at home; serves as a monitrice, midwives assistant, or primary midwife; acupressure and/or acupuncture in labor; antepartum doula; baby-led weaning; birth pool rental; parenting consulting; placenta encapsulation; and TENS unit rentals.

Offers experience with bilingual families (Spanish speaking), LGBTQP families, single parents, clients on bed rest, families conceiving with ART and IVF, postpartum mood disorders, multiples and more.

Contact:
(804) 382-8222
Email: Click here for online email form.
Website: www.richmondvirginiahomebirth.com

Payment:
Fees are based on a sliding scale determined by total family income. Call (804) 382-8222 for details. Does not accept Medicaid, but does accept some insurances. Can work with families to obtain small loans to cover home birth and care through www.MedLoanFinance.com.

 

Nancy Giglio, CNM 
Richmond Birth Services, Inc.

Services:
Home-based office, lab work and ultrasounds through consulting physician’s office, labor and delivery, prenatal and postpartum care, water birth.

Contact:
(804) 282-8471
Email: ngmidwife@aol.com
Website: www.richmondbirthservices.com

Address:
220 Roslyn Hills Drive
Richmond, VA 23229

Payment:
Accepts many insurances and Medicaid. Call for more information.

 

Corina Hossle, CPM
Embrace Midwifery Care and Birth Center
Clinical Director and Midwife

Services:
Complete on-site birthing center, preconception counseling, full prenatal care, labor and delivery, water birth, postpartum care, newborn assessment and care up to 6 weeks, newborn metabolic screening, newborn Vitamin K injections (optional), eye medication prophylaxis (optional), ordering of standard prenatal lab tests and/or ultrasound (optional).

Contact:
(804) 596-BABY (2229)
Click here for online email form.
Website: www.embracebirthva.org

Address:
130 Buford Road
Richmond, VA 23235

Payment:
Accepts some insurance plans. Verify your coverage here. Embrace also accepts payment by cash, check, debit card, credit card (with a 3% service fee), FSA and HSA accounts, and www.medloan.com financing. Call (804) 596-2229 for more detailed fee and payment information.

 

Glenda Turner, CPM, LM
With Woman Midwifery Care

Services:
Prenatal care, breastfeeding support, home birth, water birth, VBAC, preconception counseling, newborn and postpartum care, and childbirth education.

Contact:
(804) 937-6517
Email: glenda@withwomanmidwifery.com
Website: www.withwomanmidwiferycare.com

Address:
8710 Choctaw Rd, Ste A6
Richmond, Virginia, VA 23235

Payment:
Not an in network provider with any insurance carrier, however, offer contracting with Essential Maternity Billing (EMB) for insurance billing for those clients whose plan covers homebirth with an out of network provider. Accepts Medicaid. Medicaid clients should call the office to speak with the midwife about filing claims. Self-pay clients can pay by cash, check, credit card or health savings accounts. Will tailor payment plans to your budget and open to barter arrangements.

 

West End Midwifery
Kathryn Beaton, CNM
5-Star Rating on Healthgrades
Top Ten Midwives in Richmond on RateMDs

Rebecca Franco, CNM, WHNP

Services:
Prenatal visits, childbirth education, labor support, post-partum care and breastfeeding assistance. Doula services available upon request. Backup obstetrician provides skill in breech delivery, birthing of twins, VBACs and support for the midwifery model of care.

Contact:
Main Office: (804) 523-3712
For more information about the midwifery practice, call (804) 543-9795 or email Rebecca@westendmidwifery.com.
Website: www.westendmidwifery.com

Address:
Henrico Doctor’s Hospital – Forest Campus
7603 Forest Avenue
Courtyard Office Building
Suite 207
Richmond, VA 23229

 

HOSPITALS AND MEDICAL CENTERS

HENRICO DOCTOR’S HOSPITAL – Midwifery

Meghann Batten, CNM, MS
3-Star Rating at Healthgrades
Top Ten Midwives in Richmond on RateMDs

Lois Hancock, CNM

Rhonda Johnson, CNM

Dr. Amber Price, CNM, DNP
Vice President of Women’s & Children’s Services
5-Star Rating on Healthgrades
Top Ten Midwives in Richmond on RateMDs

Services:
General obstetrics and gynecology, midwifery care, personalized support, hydrotherapy, wireless monitoring, aromatherapy, alternative labor and birthing positions, skin-to-skin after birth, delayed cord clamping.

Contact:
(804) 381-7946
midwives@hcahealthcare.com

Address:
1602 Skipwith Rd
Richmond, VA 23229

 

VCU HEALTH – Department of Obstetrics and Gynecology, Midwifery

Leslie Fehan, MS, CNM, WHNP-BC
5-Star Rating at Healthgrades

Melanie Hartman, RN, CNM
5-Star Rating from Healthgrades

Holly McGroary, CNM

Ashley Mirmak, CNM

Services:
Prenatal care (individually or through the CenteringPregnancy® program), 24/7 labor support, emotional support and encouragement during labor, hydrotherapy, women’s health before and after birth, and breastfeeding support.

All midwives collaborate with VCU Health physicians and have immediate access to their support should complications arise during labor or birth.

Patient offices are at Stony Point and The Nelson Clinic.

Contact:
Main Office: 1-800-762-6161
Nelson Clinic: (804) 828-4409
Stony Point: (804) 560-7343
Request an appointment online.
Website: www.vcumom.com/Team-and-Capabilities/Midwives

Address(es):
VCU Medical Center
1250 E. Marshall St
Richmond, VA 23298

Women’s Health at Nelson Clinic
401 North 11th Street, Suite 600 (corner of 11th and Marshall)
Richmond, Virginia 23298

Women’s HealthCare at Stony Point
9000 Stony Point Parkway
Richmond, VA 23235

Payment:
Accepts many major insurance carriers. Call the Financial Counseling Call Center at (804) 828-0966 to verify or learn about VCU Health Financial Assistance.

 

VIRGINIA COMPLETE CARE CENTER FOR WOMEN
Affiliate of Chippenham Hospital

Ashlie W. Buell, CNM, WHNP

Jennifer P. Walker, CNM, WHNP
5-Star Rating on Healthgrades

Services:
Prenatal care, midwifery services for labor and delivery, postpartum care, family planning, well woman care (general gynecology).

Contact:
(804) 320-4967
Website: www.vacompletecare.com

Address(es):
Virginia Complete Care Center for Women – Richmond
7101 Jahnke Road, Suite 1054
Richmond, VA 23225

Virginia Complete Care for Women- Colonial Heights
930 South Avenue, Suite C
Colonial Heights, VA 23834

Virginia Complete Care for Women – Manchester
101 Cowardin Ave, Suite 208
Richmond, VA 23224
(804) 231-9691

Virginia Complete Care for Women – Chester
12220 Ironbridge Rd
Chester, VA 23831
(804) 706-5827

Payment:
Accepts most major insurance carriers. Check with your insurance company first to verify or call (804) 320-4967.

 

VIRGINIA WOMEN’S CENTER

Wendy A. Dotson, CNM, MSN
Head of Midwifery
5-Star Rating on Healthgrades

Services:
Pre-conception counseling, natural childbirth, midwifery, family planning, gynecological care, homeopathic remedies.

Contact:
(804) 288-4084
Schedule an appointment

Address:
Forest Medical Plaza
7611 Forest Avenue, Suite 200
Richmond, VA 23229

Payment:
Accepts most major insurance carriers. For general questions about insurance plan acceptance, call (804) 288-4084. To find out if a particular physician or clinician participates in your plan, call (804) 282-1095. Some insurance plans require you to obtain authorization before visits, so it is best to determine the extent of your benefits before initiating treatment.

 

THE WOMAN’S CENTER (ST. FRANCIS MEDICAL CENTER)

Laura Alberg, CNM, WHNP-BC

Kimberly Caylor, CNM

Jean Curtacci, CNM
5-Star Rating on Healthgrades

Brenda Radford, CNM

Services:
Pre-conception care, complete prenatal and postnatal care (including high-risk pregnancy)postpartum support; referrals for mammography; osteoporosis screening and other diagnostic tests;  bladder health and continencemenopausal medicine and hormone replacement therapy; and complete gynecology (including adolescent care and yearly exams).

Contact:
(804) 423-8462
Website: www.virginiawomenscenter.com

Address:
13700 St Francis Blvd, Ste 510
Midlothian, VA 23114

Payment:
Accepts most major insurance carriers. For general questions about insurance plan acceptance, call 804.288.4084. To find out if a particular physician or clinician participates in your plan, call 804.282.1095. The Woman’s Center also accepts checks, VISA, Mastercard, Discover, FSA and HSA cards.

 

Glossary of Certifications:
CNM – Certified Nurse-Midwife
CPM – Certified Professional Midwife
DNP – Doctor of Nursing Practice
IBCLC – International Board Certified Lactation Consultant
LM – Licensed Midwife
MSN – Master of Science in Nursing
WHNP – Women’s Health Nurse Practitioner
WHNP-BC – Women’s Health Nurse Practitioner – Board Certified

 

Additional resources:

American College of Nurse Midwives
North American Registry of Midwives
Midwives Alliance North America
Our Moment of Truth (by ACNM)
The American Midwifery Certification Board (includes a link for verifying midwife certifications)

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