Do we take insurance? You bet!

Oh, the world of insurance and insurance billing!  It can be overwhelming to be pregnant but then also trying to figure out how much your birth will cost your family can be downright exhausting!

We are here to help you wade through this whole process- from finding out you are pregnant, to getting scheduled for your first prenatal appointment to figuring out how much your insurance will pay!

At Portland Natural Birth, we happily bill your insurance for you for your midwifery care and homebirth.  Mirra worked at a birth center for many years where she learned all the ins and outs of insurance billing.  It was enlightening;) She’s not afraid to get her hands dirty calling up the insurance companies if needed.  We are out-of-network with all insurance companies.

So what does that mean?  Most insurance plans have two pathways- in network and out of network.  In network providers are contracted with your insurance plan and you are given a list of who these providers are.  Often, in network benefits have low deductibles and low member co-insurance.  Out of network providers are not contracted with insurance plans and thus, out of network benefits often bring higher deductibles and less coverage.  Sometimes, these deductibles are shared, which is beneficial for you.

Although we are out of network and you may have a higher deductible, our lower-than-the hospital costs usually make a big difference.

Our fees are all inclusive, called a Global Maternity fee– it’s prenatal, birth, and postpartum care all rolled into one fee.  We collect your co-insurance during your pregnancy and then after your birth we bill your insurance company this global maternity fee.

There aren’t any extra fees for us to bill your insurance company, so if you do have private insurance, out of network benefits, and homebirth coverage come schedule an interview so we can chat about what a homebirth with Portland Natural Birth could look like!

Condoms in my birth bag?!

I’ve been asked many times what’s the weirdest thing in my homebirth bag… Well, I’d have to say condoms now!  Yes, you read that correctly.  I’m now carrying latex-free condoms.  Yes, they work well for preventing pregnancies and STIs, so why would a midwife, delivering babies, be carrying them?

Well, I recently attended a great workshop put on by the Oregon Midwifery Council who brought in a local OB-GYN from the area.  I had been hearing about this interesting method for controlling postpartum hemorrhage but hadn’t yet been taught how to use it (or even seen it used).

In Oregon, as a Licensed Midwife, I carry specific medications in case of a postpartum hemorrhage (when the birthing person heavily bleeds after the birth).  I sometimes start with certain anti-hemorrhagic herbs such as Shepherd’s Purse, Angelica, or cinnamon.  It really depends on the situation and how the birthing person is handling the bleeding.  Sometimes the herbs work wonderfully well and we can all focus back on the normal immediate postpartum (you know, cooing over the cute baby, helping mama nurse, doing a full newborn exam on the baby, cleaning up our supplies…).  But sometimes, we need more help.  Occasionally I’ll go right for the pharmaceutical medication if that’s what indicated instead of herbs and other times, I’ll try the herbs first and then use the meds.  I carry Pitocin, Methergine, and Misoprostol- all have their specific indications for use.  All but rarely, these medications stop the bleeding and we can, again focus on the more-normal parts of the immediate postpartum and replenish the mama as needed (an IV can really help in this situation and then iron building supplements soon after).

So what happens in those rare cases that all our herbs and medications don’t work and bleeding continues?  This is an instance where, as midwives, we go into emergency mode, place our hands on the mama in specific positions (it’s called bimanual compression) to limit anymore bleeding and transport to a hospital immediately for more tools.

But wait, here come the condoms!  So, a devise had first been described in 1951 as a balloon tamponade and then in 1999 a more specific uterine balloon tamponade came in to play.  The FDA approved this devise, called the Bakri balloon in 2006. It’s basically a balloon that you inflate in the uterus to put pressure from the inside to stop uterine bleeding.  Great, right?!  Well, it gets better… that devise is very expensive BUT you can use a condom and some supplies from our own homebirth kits to make a homemade uterine tamponade! And, according to studies it works just as well as the expensive Bakri balloon.  With the insertion of this devise, it gives us time and breathing room to get to a hospital safely for further help without the birthing person losing more blood.  It’s also amazing to have for rural home births or in other countries where hospitals are far away and transporting to the hospital with someone bleeding could be a very scary situation.

I’ve dealt with my fair share of bleeding as a midwife, but I’m excited to have learned a new method for those more intense bleeding situations.  It’s cheap and easy to make and now I get to say I carry not only cool instruments, lots of gauze, some herbs and meds, but also condoms now!   Honestly, I’d be OK with not having the need for this devise but I’m ready if we do need it!

Here’s to continually learning, updating our midwifery practices and condoms for the win!

Birthing Choices in Portland

Portland is great, for a number of reasons, right?  It is a great place to bike, be close to nature, shop at farmer’s markets, go paddling, take the bus, run into your friends at the grocery store, AND give birth!  We have a lot of different options in the Portland area, which means all families get to chose what works best for them.

Portland is home to numerous hospitals, a couple free standing birth centers, and many midwives.  So, what is the difference between all these options and what does each options look like for your birth?

Hospital

Well, the first option is the standard one that most Americans still go to for giving birth, and the majority of Portlanders do too- the hospital.  We have some great hospitals and each one has its own flair.  You could go down the standard American route and see an OB doctor for all your prenatal appointments.  This is a good option for someone who has some high risk factors, like diabetes needing insulin treatment, among other risk factors.  Often the doctor works in a group practice and takes turns being on-call fonewborn in hospital r deliveries.  Some doctors have multiple hospitals they deliver at while other doctors only work at specific hospitals.  Make sure to get to know the doctors in your group practice as well as taking a tour at the hospital that they deliver at.

Another option in the hospital is to work with Certified Nurse-Midwives (CNMs).   Like an OB practice, CNMs work in a group and you get to see different CNMs in that practice during your pregnancy.  Whoever is on-call during your delivery is the one you’ll get!  CNMs practicing in the hospital setting work under different protocols than homebirth midwives, as they are under the direct supervision of the hospital OBs and their protocols.  Hospital based CNMs are perfect for low risk clients who are most comfortable delivering in a hospital but want a natural birth and/or trying for a lower intervention birth.  The Portland hospitals currently that have CNMs on staff are Providence Portland, OHSU and Legacy Emanuel.  Some of the hospitals allow for laboring in the birthing tubs with the midwives and provide telemetry units that allow movement while still being monitored.  Providence Portland also has a doula program that works with the families that are under the CNM care.

Birth Center

For families that are unsure where they want to give birth, but leaning towards out of hospital, a free standing birth center could be an option.  In Portland there are now 4 birth centers that are not in the hospitals and are staffed by a combination of midwives.   Most of the birth centers are staffed by midwives on rotation, like the hospital CNMs, so you don’t have continuity of care (like with home birth midwives), but many practice differently than the stricter protocols from the hospital.  There are CPMs/LDMs, CNMS, and ND midwives at the area birth centers.  The birth centers are made to resemble more of a home like setting than a sterile hospital environment.  All of them have birthing tubs that you can labor in and at least two of the centers you can stay and birth in them.  This middle ground is great for families that want a natural birth (no epidurals here!) but aren’t ready to commit to a home birth.

Homebirth

And then there are homebirths!  We, of course, love homebirths but completely acknowledge that it’s not the place for all families.  And that is OK!  It’s important to give birth where you are comfortable and where is the safest for your pregnancy, birth, baby, and set of risks.  Homebirths are not for women who are high risk.  But, if a woman is low risk and wanting a natural birth with her loved ones, pets, candles, pillows,  and kids around her then this is her best option!  A home birth is nice because you don’t have to leave your house in labor or get in the car with a tiny, new human being.  You have all your own things and can eat out of your own refrigerator (yes, we want you to eat in labor!).  There aren’t strangers coming into your room while you are in labor.  It also provides the best option for homebirth baby continuity of care and individualized care with midwives.  We bring all the emergency equipment to homebirths along with a whole bag of other supplies.  You also have the option to have an inflatable birthing tub which some women use just for laboring in and others give birth in it.  You have more options in your movement and birthing positions if you are at home.  We also come back to you three times in the first week postpartum, another great reason for a homebirth!  There are a lot of homebirth midwives in Portland so go ahead and interview a couple to find the right fit for you and your family if this is the option that best suits you.

It is important to know there are multiple birthing options and find the best match for you.  Just because your best friend had a homebirth doesn’t mean that’s right for you if you are worried to be out of the hospital.  Or just because your mother in law thinks all babies are born in the hospital doesn’t mean you shouldn’t look into a birth center or homebirth like you’ve been wanting to.  Go ahead, do some research, visit a couple places and talk to a couple providers and the right choice will present itself.

Happy birthing!

 

Do we take OHP for home births?

Oregon was one of many states that expanded their Medicaid program under the Affordable Care Act.  Regardless of your political views about the ACA, many more people have been able to get health insurance now under Oregon Health Plan (OHP).  And, it is also directed towards pregnant women to make sure they have health insurance to get adequate prenatal care.  So this is a step in the right direction!  Its vital to our families and communities to make sure that all pregnant women have health insurance and have safe and adequate prenatal care to help avoid and/or manage any issues that come up during pregnancy.  Its also important that with health insurance they have choices as to where they want to give birth and how they give birth.

So, at Portland Natural Birth, we feel its crucial to make sure ALL families get the care they want and need.  This means that yes, we do now accept OHP insurance!  But, unfortunately, OHP comes with many more strings attached than any of us would like.  It doesn’t stop us from accepting it and billing it, but it does come with a bigger conversation about what it means for our OHP families and what our care looks like under OHP.

The Oregon Health Plan (OHP) has their own guidelines for out of hospital births.  As a Licensed Professional Midwife in the state of Oregon, I have a certain set of criteria, guidelines and protocols that I practice under.  OHP has taken some of these rules and regulations and added some of their own, most often stricter.  Sometimes it is clear as to what their rules governing prenatal care, birth, and postpartum and their risk factors are and sometimes it can get a little murky.  We practice and strongly believe in individualized care and informed choice which means our families get to make their own educated decisions about their care after we’ve talked about all the pros/cons and benefits/risks of any testing/screening/procedure.

However, for our clients with OHP some informed decisions aren’t as optional as they usually are.  This is really disappointing but for now, its a hoop our clients have to jump through if they have OHP and want their homebirth covered.  For most, OHP assumes that the standard screening for Gestational Diabetes and Group Beta Strep, among initial and mid-pregnancy blood work need to be done.  OHP also requires monthly chart notes and updates to prove our clients still remain low-risk and good candidates for homebirths in Portland.  As it stands right now, OHP will not approve someone for a home birth if they transfer into midwifery care after 28 weeks.

So, where does that leave us?  Well, Portland Natural Birth still remains committed to serving clients, regardless of their financial constraints and will continue fighting to get our OHP clients approved for a home birth.  I have also written letters to the Oregon Health Authority (they oversee OHP and the approval process for homebirths) in support of changing their prior-approval process.  OHP pays half of my midwifery fees yet requires more than double the paperwork and headache than any other insurance company does.  But, rest assured Portland families, while we are fighting for a more equitable process for midwife and pregnant homebirth client, we are taking OHP clients and happily giving them our love and support.  Its what we believe in and your insurance company doesn’t change that fact!

So, What’s the Difference between a Midwife and Doula?

As midwives and doulas, we get this question asked a LOT!

  “What does a midwife do that’s different than a doula anyways?”  “Do I need both?” “Do I need either?!”

Midwives and Doulas are very different but both work with pregnant families.  It can be confusing, especially when you turn towards the dictionary…

Definition of doula  

: a person trained to provide advice, information, emotional support, and physical

comfort to a mother before, during, and just after childbirth

Definition of midwife 

: a person who assists women in childbirth

So, really, what’s the difference you still ask?  That definition didn’t help at all!  Well, doulas do an amazing job at supporting pregnant and laboring families through physical comfort measures as well as emotional support.  They provide emotional and physical tools (calming visualizations, massage, breathing reminders, a calm presence, etc) that can help laboring people through the intense contractions and have support for their birth plan.  PNB doulas are trained through different teachings and have years of experience attending births.  They bring a lot of skill and compassion to all their doula families.  Our Portland Natural Birth doulas meet families in their homes at the end of their pregnancy to get to know them and help understand what the families’ needs and desires are for their upcoming birth.  Then, the doula is on-call for whenever the birth happens and goes with the birthing family to their pre-chosen birth place (home, hospital, birthing center) to continue supporting them.  Doulas are not medical professionals and support the families while their medical providers do the rest of the stuff…

Which brings us to midwives!  Midwives are medical providers that support birthing families wanting a more natural birth.  At Portland Natural Birth, we provide all your medical care for pregnancy, birth, and postpartum (through 6 weeks) for families wanting a homebirth.  There are some midwives that work in the hospital as well.  Midwives are trained in everything pregnancy and birth related and understand what a normal birth looks like.  Homebirth midwives are trained for those normal vaginal births as well as any emergencies that may arise and are either trained to take care of it at home (manage a hemorrhage, resuscitate a baby, give IV fluids in labor, etc) or know when to transport to a hospital swiftly.  For low risk people who want a homebirth, midwives can be their only medical provider they see their whole pregnancy.

“So, do I need a doula if I have a midwife?”

Maybe!  Now that you know the different responsibilities and jobs that midwives and doulas do, you know that homebirth midwives provide the medical care for birthing families and because they only work with one birthing person at a time they give their undivided attention to them.  But, it can still be nice to have a support person that is just there for your physical and emotional comfort.  Doulas are awesome at being with laboring families in that early labor time before a midwife comes to their home.  PNB midwives love working with our doulas and vice versa!

 

 

Homebirth Transports

pregnant womanWhen you come into our care your hopes for a natural birth at home are on the forefront of your mind.  Maybe it’s something you’ve wanted since before you were even pregnant or maybe you didn’t even know about home births until you were into your second trimester.  At Portland Natural Birth, we work really hard to provide you and your baby the best, comprehensive but holistic care possible.  We spend an hour at each prenatal appointment going over your physical and emotional health, all while making sure you continue to be low risk and safe for a homebirth.

At interviews, transport questions are always asked by either the birthing person or their partner.  Rarely, I’m the one to bring up the “what ifs”.  But, we always talk about what we do in an emergency, what kind of equipment and training we have, what it would be like to transport to the hospital, what we as the midwives do during the transport, and what clients can do to best prepare themselves for any possibility.  Then, as your pregnancy progresses, we bring up the transport discussion again.  At the 36 week home visit we fill out a hospital transport plan which includes what hospital clients prefer to go to and which one is the closest in an emergency.  We also talk about any fears the family may have surrounding emergencies or hospitals or just about the birth itself.  And we are always open to having some or all of this discussion before and after this 36 week visit.  Some clients need to talk about it more than others to process the “what ifs” while others feel ok with just the planned discussion.  Either way is entirely ok and that’s why we provide individualized care- every person needs something a little different to feel comfortable!

So, what does a transport from a homebirth look like?  Well, it depends on the reason for transport.  Most hospital transports from home are for non-emergent reasons.  The most likely scenario is when a laboring mom asks for additional tools that we don’t have at home.  She may have been in labor for multiple days, exhausted and possibly dehydrated and desires and epidural or maybe needs a little pitocin to meet her baby.  While no one goes into a homebirth with this desire, sometimes families get there… and that’s ok!  We have a lot of resources, tools and tricks as experienced midwives to encourage babies to be born at home but sometimes they have different plans.

If we transport for maternal request in this non-emergency then we go by our own cars.  I always call the preferred hospital and A) make sure they have room and will accept our transport and B) give them all the pertinent information so they can best help us.  Then, after a bag is packed and mom is ready we caravan over to the hospital.  At least one of the midwives always stays with our clients in the hospital.  Especially if we have been there for a long time, we may rotate through the birth team so we can also get little sleep so we can come back and provide the best support… but always one midwife is with the mom!  We become ah-mazing doulas in the hospital!  We are no longer your medical care provider but help you navigate through the new surroundings and requests of the hospital.  Also, we know most of the Portland area hospital providers so we seamlessly work with them to continue providing our clients great care that they can still feel like they made their own decisions, even though the place of birth was different.  We stay with you until baby is born and help with the initial breastfeeding session.  And of course, we continue all of our normal postpartum care visits- we’ll come to you 3 times in the first week, wherever you are!

Very rarely but it does happen, a transport is for an emergency.  And then we go by ambulance.  I still call ahead to the closest hospital to let them know we are coming and we continue all our supportive care like we do in a non-emergency situation.  It can be scary when we move fast but we always communicate to our clients as to what is going on and what we think needs to happen.

Sometimes, I get the question/comment: but if we transport to the hospital then we are stuck with both midwifery bill and the hospital bill and don’t get our homebirth.  Yes, unfortunately birth costs do go up if we end up at the hospital from a homebirth.  But, the care we continue to provide is unmatched and our clients feel that.  Providing midwifery care through pregnancy is a different experience to begin with- one that you are met with caring providers who take the time to listen to you and help problem solve as any issues come up.  Midwives provide a safe and nurturing environment that empowers our families into taking the next step to becoming first time parents or seasoned parents.  We are able to walk beside you and gently guide you through harder decisions if a homebirth transport becomes desired or necessary.  To still be able to make your own decisions and come out feeling empowered from a birth that didn’t go exactly how you thought is pretty remarkable and worth every penny!

We want to help all our clients have beautiful homebirths but sometimes that’s not in the cards and that’s ok. That’s why we continue putting all our energy into our clients’ care, regardless of where they end up giving birth and how they give birth.  Though it can be a hard transition and hard to acknowledge that birth doesn’t always go according to plan, we do work with clients so they feel supported and empowered through their pregnancy, birth, and postpartum and I think we do a pretty darn good job at that!

 

 

What does prenatal care look like with PNB midwives?

When I meet clients for the first time during our consultation I tell them that yes, we follow the normal obstetric visit schedule but the similarities stop there. Portland Natural Birth dedicates a whole hour to every prenatal (and postpartum) appointment with all our clients. So, what exactly happens in the hour?

Well, first off, here’s a peek into our cozy office room in the sweet Awakening Wellness Center…  The love seat is perfect for our clients to come in, relax, have some tea or water, and start telling us about how their past month (or week) has been.

We talk about any new experiences in this pregnancy they’ve encountered since our last visit or any continual issues they are having.  We do a lot of listening and then, when they are ready we dive into some great remedies from herbal and homeopathic recommendations to body work to physical exercise, nutrition, or mental health stability, along with any western treatments that are needed.

We continue talking about what is normal during this part of their pregnancy and any expectations or fun new things that may pop up in the coming months.  We make recommendations on additional educational classes, depending on how far along they are.  And we discuss, at length about any upcoming medical decisions or tests they may have at their next appointment.

At Portland Natural Birth, anyone you feel comfortable with is invited to your appointments.  We love having partners at appointments and getting to know them and making sure they are comfortable with us and the current plan.  We also love having children present at appointments if that feels right to you.  Or sometimes parents are visiting and want to check out their child’s care provider or maybe they’ll be part of the birth so they can come to your appointment and discuss any questions or concerns they may have.  Your appointment is really all about YOU.  Its about making you feel comfortable.

We still do the normal vitals: blood pressure, pulse, urine analysis (good ol’ peeing in a cup), palpating and listening to the baby and measuring your fundal height (how big your uterus is growing to accommodate your baby).  We also draw all labs in our office.  This allows you to feel comfortable getting all these vitals taken care of but in the comfort of our office and by people you trust.

Lactation News!

Well friends, the time came to step up my game as a midwife!  I love attending births and providing care to all our sweet families in those precious days during the postpartum period. I already spent time with all families making sure they had a good latch, gave them pointers on different nursing positions and gave them a quick run down of how their milk was made and why their breasts seemed fuller at different parts of the day.  I’ve always loved helping with nursing.  Not only is breastmilk AMAZING but it provides such an untouchable bond when families have the right support.  postpartum breastfeeding baby

So, I decided to further my education and learn more about breastfeeding.  After many months studying and learning more than I thought possible, I sat and passed the IBLCE (the international exam for certified lactation consultants) in October 2016!  I am now an IBCLC which means I am certified as an international lactation consultant which is the highest certification for this specialty.

What does this mean for Portland Natural Birth now?  Well, its an additional service, as needed for clients that may not have birthed with us or used other services but need some lactation support.  But, honestly, more than an extra service, its more help I can give to my own midwifery clients.  I’m really excited about spending a little extra time on prenatal education during our visits.  I’m happy to provide additional information and problem solve during the prenatal period on any possible problems or issues we may face.  And I’m happy knowing that I can save my clients an extra trip to another care provider while we snuggle in at home during their normal postpartum visit and troubleshoot whats going on.  Another perk as an IBCLC is that I can make direct referrals if necessary (specifically for a frenotomy, or tongue tie revision).

So, sit back and relax Portland families:  your homebirth midwife is now your lactation consultant as well!

Pregnancy Support Group

Come join your very own Portland Natural Birth midwife, Mirra, in connecting with other pregnant mamas once a month!

Pregnancy is such an exciting time but also can have its own challenges along with tons of questions.  “Is this normal?  Am I the only one that thinks that?  What will life be like once the baby is born?  Do I have all the essentials?  What do I need?  Was that the baby kicking or something else?!”

You aren’t the only one with all those questions!  Come to Doula Love to be supported by other pregnant mamas and meet a couple friends along the way!

When: The fourth Saturday of every month from 1:00pm to 2:30pm
Location: 5433 NE 30th Ave Portland, OR 97211

http://www.portlanddoulalove.com/pregnancy-support-group-ne-portland/

Upcoming Pelvic Floor Workshop with Kelley!

kelley burke pelvic floor specialistHey mamas! In light of my pelvic floor workshop coming up this month, I’m sharing a little article with you about pain and sex today. There are a couple decent suggestions here (my advice is to NOT do #3!). But really, I just want to open the conversation about sex after baby. Many mamas are really surprised after they leave midwifery or OB care at 6-8 weeks that they still don’t feel ready to connect with their partner sexually. Regardless of what kind of birth you had (or even if you’ve never been pregnant) your pelvic floor can have a range of sensations from heavy, bruised, stingy, too tight, lacking tone, pulling pain, dull pain, sharp pain or even a lack of sensation at all. Yes, these are all normal to feel after what your body has gone through but this is NOT your “New Normal”.
What IS your new normal is the self care practices you build into your day that lead to your recovery, and long term pelvic floor health and connection.

My monthly pelvic floor workshop is on Monday, December 14th. I want to hear what you are all going through and share some ways you cpelvis pregnantan move towards recovery, comfort and care for yourself while you take care of your baby.

The class is from 10 am to 12 pm at Doula Love (5433 NE 30th Ave) and babies are most welcome.

 

Register Here!