Q: What is a Midwife?

A: Midwife literally means “with woman.” The care provided by midwives reflects a deep understanding of the needs of women and newborns and the intricate process of labor, birth, mothering and breastfeeding. Midwives are the main caregivers to childbearing women worldwide.

 

Q. What kind of education do midwives receive?

A: Three types of midwives receive extensive education and provide a range of care to women and their families:

• Certified Nurse-Midwives (CNMs) are educated in both nursing and midwifery and hold a Master’s Degree. They must pass a national certification exam and meet criteria set by the American College of Nurse-Midwives. CNMs are licensed in all 50 states. They provide hospital, birth center and home birth services and are recognized within the health care system as experts in normal childbirth and well-woman care.

• Certified Midwives (CMs) are educated in midwifery, including the unique aspects of nursing education pertaining to midwifery. CMs must pass a national certification exam and meet the criteria set by the American College of Nurse-Midwives. CMs are not currently licensed in Hawaii.

• Certified Professional Midwives (CPMs) are educated in midwifery and must pass a national certification exam and meet the criteria set by the Midwives Alliance of North America.  CPMs are also experts in normal childbirth and provide home birth and in some states birth center care. CPMs are newly licensed in Hawaii

 

Q: What is midwifery care?

A: Dedicated to the belief that pregnancy and birth are normal processes in a woman’s life, midwives provide personalized, compassionate, and thorough maternity care. This includes comprehensive physical and emotional care for a mother and her baby through pregnancy, labor, birth and continuing after the baby is born. Our midwives are present during the labor and birth, which is often not the case with other care providers who “check-in” periodically during labor and are present for the delivery itself.

Midwives specialize in primary health care for women of all ages, including pap smears, breast exams, physicals, fertility counseling, and family planning.

 

Midwives spend more time with their patients during prenatal visits, making certain that all questions and concerns of the mother and her family are answered and addressed.

​

Midwives are specialists in normal pregnancy and focus on maximizing prenatal wellness. Obstetricians are specialists in complicated pregnancy and surgery. More than 80% of women have normal pregnancies and labors.

​

Midwives are well trained to recognize any complications that may affect the health and safety of a mother and/or her infant and will consult with physicians as needed for complications. They provide ongoing support if a family needs more technological care.

​

Q: Why should I see a Nurse-Midwife?

A: Nurse-midwifery care is woman-centered and based on the philosophy that health care should be safe and satisfying. CNMs make every effort to respect the human dignity and cultural diversity of their clients. They are committed to promoting self-determination, the right to obtain complete information about the care, and enhancing the normal process of pregnancy and birth through education and supportive intervention.

Women who are healthy typically do not need extensive medical technology to conceive, birth, or feed their babies. Midwives provide information and support to allow them to care for themselves and their babies in a natural, peaceful way.

 

Q: How safe is midwifery care?

A: Numerous studies have uniformly concluded that Nurse-midwifery care has outcomes that are equal and in some ways better to those of physicians with the same types of patients. CNMs are particularly adept at providing care and increased communication that helps women prevent complications. A standard of Nurse-Midwifery care is that CNMs have a mechanism for obtaining medical consultation, collaboration, and referral when questions or problems arise. If a woman needs care beyond the midwifery scope of care, the East Hawaii Midwife Service midwives assist in accessing and implementing the appropriate level of care for the client’s particular needs.

 

Q: Where should I give birth?

A: Environment can play a crucial role in having a safe and satisfying experience during labor and birth. At East Hawaii Midwife Service we consider a woman’s health status, her desires and potential for complications. Together the midwives and the family determine together what will be the most comfortable and safe place to give birth. The East Hawaii Midwife Service midwives attend births in the home environment exclusively.

 

Q: If I am planning on a hospital birth can I still receive care with East Hawaii Midwife Service midwives?

A: We accept two clients per month who are planning a hospital birth.  Our midwives do not attend hospital births therefore our prenatal patients will need to be attended the on call obstetrician or midwife in labor at the hospital of choice. We provide a complete copy of your medical records to present to the hospital staff in labor. We understand this is not ideal however it is still a good option to receive midwifery care during your pregnancy. We understand the rural populations of Hawaii and travel distances to other maternal health care providers. It is our mission to provide care to our community.

 

Q: What can I expect for my initial visit?

A:  This first visit is a good time to learn more about our practice and for the midwives to get to know you. A midwife will talk with you about your plans for the birth, the schedule of care in the office and testing options for genetic screening, ultrasounds and blood work. She will take a thorough history about you and your family including a paternal history. This visit is also a good time to discuss things you can do to improve your health and the health of your baby: changes in diet, exercise habits, medications, stress reduction, etc. You will also receive a physical examination to assess your health. This may include a pap smear if you have not had one recently.

Feel free to ask any questions that you have! The midwives at East Hawaii Midwife Service are knowledgeable and can help you find resources to help you have the optimal birth experience.

 

Q: What can I expect for subsequent routine visits?

A: After the initial visit, appointments are 30-60 minutes long. The routine course of visits is once a month until 28 weeks, then every two weeks until 35 weeks and then weekly until 40 weeks. This schedule can be adjusted depending on your needs.

When you arrive, you will be welcomed and encouraged to use the rest room. While in the rest room, you can use the scale to weigh yourself. During the exam, a midwife will check your blood pressure, measure your abdomen, feel the position of the baby and listen to the baby’s heartbeat. This is a fun task in which older siblings can help the midwife.

Then there is ample time to ask questions and discuss various aspects of your health. The midwife will review any prior lab or ultrasound testing with you. You can feel free to talk about any thoughts or feelings that have come up; we want to make sure your emotional and educational needs are met as well as your physical needs.

​

Q: What Tests will be done during my pregnancy? Are they required?

A: If you are considering home birth it is important to make sure that you and your pregnancy are low risk and continue to be low risk throughout the pregnancy. During the first trimester initial blood work is done to assess for anemia, immunity to Rubella, and any for exposure to Syphilis, Hepatitis B, or HIV. We will also determine your blood type.

At the beginning of the seventh month we will re-check for anemia and assess how your body in managing glucose metabolism in pregnancy. In our office we perform the “glucose tolerance test” with organic grape juice or jelly beans rather than the neon-orange glucose drink usually used in the labs.

At approximately 35 weeks gestation, a GBS culture is performed to check for any presence of Group B Strep bacteria.

Genetic testing is optional and you can discuss with a midwife whether or not you desire it. Options include CVS, First Trimester Screening, Amniocentesis and AFP testing.

Ultrasounds are also optional and are used for dating, fetal position and/or fluid checks. These are done by referral to a facility of your choice.

​

Q: Can I have a water birth?

A: Water birth is a great option for relieving discomfort during labor and providing a relaxing environment to labor and give birth. It can help lower the blood pressure, dilate the cervix, and ease strain on the perineum.

​

Q: What pain management options are available to me?

A: Aside from using water for laboring and/or birth, cold compresses, massage, changing positions, eating and wearing comfortable clothes, aromatherapy and other environmental changes such as dimming the lights or playing soft music, and having emotional support all help to make pain more manageable.

 

Q: What if I need antibiotics for Group B Strep?

A: If you test positive for GBS the East Hawaii Midwives can administer the IV antibiotics recommended by the Center for Disease Control (CDC) guidelines. You can still have a home birth if you have a positive GBS status.

 

Q: If I have risk factors, can I still choose to have midwifery care?

A: Although most pregnancies progress normally, some pregnancies may present with risk factors that make a Home Birth less than optimal. We have guidelines for what conditions may risk you out of using our home birth services. These include labor before 37 weeks gestation, labor after 42 weeks gestation, and certain medical conditions including insulin dependent diabetes, thyroid disorders, hypertension, etc. We evaluate each woman individually however some risk factors are best cared for in a hospital setting with your midwives collaborating in care with physicians. Risk factors may also come up during labor that will necessitate being brought to a hospital for care. If you have any questions, we can discuss this with you personally at any of your visits throughout your pregnancy.

 

Q: How is the baby’s heartbeat monitored during labor?

A: The baby’s heartbeat is monitored throughout labor using a hand-held ultrasound device called a doppler. A midwife will listen intermittently depending on what stage of the labor you are in and how the baby is tolerating labor. The doppler can be used underwater during water births. We follow accepted national guidelines on prescribed intervals for listening to the heartbeat that are proven to be safe and efficient. If at any time we hear a heart rate that is non-reassuring, we would transfer to the hospital for continuous fetal monitoring.

​

Q: Who examines my baby after birth?

A: The East Hawaii Midwife Service midwives will provide care for healthy newborns for the first two weeks of life. At the birth, your midwife will perform a complete newborn exam and there will also be baby exams during your two follow-up home visits (day 1 and day 3).  At two weeks we provide a mother-baby exam in the office. After that visit a copy of the newborn exams and a summary of the labor and birth will be sent to the pediatric office. If the newborn exam reveals any abnormalities or if your baby needs additional medical care or support, we will contact your pediatrician and facilitate a transfer of care.

​

Q: Are there tests for my baby after birth?

A: Soon after birth, your baby will have a physical examination in your presence. We will weigh and measure your baby at this time. At your first or third day home visit we perform the cystic fibrosis and “PKU” metabolic-screening tests. At the two week office visit the midwife will perform a simple hearing screening test. The results from this test and the PKU test are recorded in the state’s system as well as being available to you and your pediatrician.

 

Q: What if I want my son circumcised?

A: If you elect to circumcise your son, we can refer you to a licensed professional who can perform the circumcision.

 

Q: Can I transfer into your practice if I am far along in my pregnancy?

A: While we appreciate being able to get to know you and your family early on and have time to establish a relationship, it is possible to transfer to us in the third trimester as long as you have had regular, routine, low risk prenatal care. You must supply us with a copy of your complete prenatal records including lab work and ultrasound reports.

​

Q: Can my children attend my appointments and the birth?

A: Families with children are always welcome in our offices and during the birth! We have toys and books to entertain children and there are fun opportunities for children to be helpers during belly checks in the exam room. We can also help you to prepare your older children for the birth and being an older sibling.

​

Q: How do I obtain the birth certificate and social security number for my baby?

A: After the birth, the our staff will assist you to complete the forms required for the birth certificate at bedside. After you receive the baby’s Social Security card you will need to order the hard copy of the birth certificate which will cost $10.00.  Applications to order the hard copy can be picked up at the department of health or found on-line. If you are not married to your partner, you will need to fill paternity papers or civil union documents if you are in a same sex relationship.

​

Q: What happens if I need to go to a hospital during labor?

A: We will work to provide options for needed hospital based services. East Hawaii Midwife Service midwives assist you to the hospital in labor if an urgent situation presents in labor and try to stay with you until the baby is in your arms.

​

Q: Do I receive a refund of monies paid if I have to be transferred to the hospital in labor? Will my insurance pay for hospital services?

A: If East Hawaii Midwife Service midwives attend your birth and a complication arises that necessitates transfer to the appropriate hospital then the midwives have performed their job and have safely transferred you to the hospital, therefore all fees are due.  However if a complication arises during your pregnancy before 37 weeks and you need to be transferred to a higher level of care then we will discuss reimbursement, minus your nonrefundable deposit and any fees that your insurance provider does not cover. Yes, your insurance will pay for hospital services; the amount depends on your policy coverage.

 

Q: How many clients do you accept per month?

A: East Hawaii Midwife Service accepts 2-5 home birth clients per month.

 

Q: Does your service provide backup midwife services if the case of over lapping births or personal emergencies?

A: We make every effect to be present for the birth of all our clients.  We understand the intimate relationship that develops between a midwife and a client. We do however collaborate, consult and have relationships with several other qualified island midwives that offer coverage should we need it. It is rare in our practice that we have other midwives cover for us.