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!

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!

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!

 

 

So, What’s it like to be an on-call midwife anyways?!

Have you wondered what it’s really like to be a homebirth midwife?  Every birth is so different but here’s a snippet of what an average night being call to a birth is like for your dear, midwife 🙂

9:45 pm  Make myself go to sleep early because I know a client has been having irregular mild contractions through the day.  She reported bloody show around dinnertime and we had a chat about what to do and what to look for.  So I make a pile of my birth clothes and grab her chart to lay on top of my prenatal bag and then crawl into bed.

12:05 am Reach over my sleeping husband to look at a new text on my phone and respond that they are doing great but that its still early and to try and rest as much as possible until they can’t!  I emphasize that although labor is exciting, it could still be many hours before active labor begins and its important to rest to conserve their energy.

I then roll back and try to fall back asleep as quickly as possible because even though I just told them to rest I know I’ll be awoken in the next two or three hours 😉

3:20 am Reach across in bed to read my new text and quietly get out of bed.  I call the laboring family so I can really hear what is going on.  Its so different reading a text that says a mom is contracting every 4 minutes.  Sometimes that means she’s in hard active labor and other times it might still mean early labor.  How do I know the difference?  I hear the difference in the mom’s tone of voice, her level of consciousness and I read between the lines.  I usually only need to hear her through half a contraction to know exactly what part of labor she’s in.   Except if she did hypnobirthing…. then that’s a different story!

I close the door to my bathroom, and talking softly I chat for less than a minute with the partner and then ask to speak to the mama.  Sorry partners- you are super important but I always ask to talk to the laboring person before I come over there! The mama is doing great and yes, she’s progressed to a nice active labor pattern. I ask questions to make sure baby is moving, that her bag of water hasn’t ruptured, that she rested a little, and that she’s eating and drinking well.  Mamas need energy to give birth so its vital to mom and baby to continue eating and drinking through labor.  I listen to how well she’s breathing through the contraction and find out what she’s doing during them. I make a plan to come over in an hour.

3:45 am I gather my clothes from my bedroom and go back into the bathroom. At first, I don’t want to turn on the light because then I can pretend I’m still sleeping but then my brain kicks in and I realize, yes in fact I need to fully wake up so I turn on the light, brush my teeth and get dressed.  I check my phone for the time and start collecting the meds from my fridge.  Its funny having a mom as a midwife for my kids.  They know there’s a container on the fridge door that stays there and they don’t touch it.  They also know sometimes they may open the fridge and find a bagged placenta waiting to be picked up by Kelley for encapsulation.  They also know that sometimes they wake up and only their papa is in bed and they may not see their mama for the day.   But they also get excited knowing a new baby is being welcomed into the world❤️

3:55 am I carry my homebirth bag, prenatal/postpartum bag, and the oxygen tank to my car.  Then lug the birth tub and bag (if they don’t already have it) outside as well.  And run back inside to grab my personal bag (I always bring an extra change of clothes because birth is messy!) and the client’s chart.

The client’s address is already preprogrammed and good-ol’ google maps gets me to where I need to go. I text the rest of the birth team to let them know I’ll update once I get to client’s house.Portland Home Birth

4:20 am I arrive to the homebirth to smiling faces, relieved to see me, knowing this is finally it!  As I comfort the family and take in the scene before me I start setting up all our equipment/supplies.  From here, birth happens!  Mama progresses and we lay witness to the raw, beautiful, intense energy of birth.  We clean up and tuck the sweet, happy, tired family in bed, promising to return the next day.

Being a homebirth midwife is a pretty crazy profession.  It is not for the faint of heart nor for those needing routine and order!  I have to be completely flexible yet 100% dependable.  My family knows I may not be with them for a holiday or I might miss that family hike we planned Saturday morning.  My friends know I may cancel plans 30 minutes before I’m supposed to be at their house- or they at my house!  My east coast family knows not to text/call me before 7 am PST because I sleep with my phone and will wake up to their texts.  I know I always need gas in my car, or at least know where the 24/7 gas stations are and that my phone always needs to be charged!  I always have to keep a log of all the medications I have to make sure they aren’t expired and that I have enough newborn screen kits for all my clients that want them.  I always make sure I have at least one clean outfit for a birth.  And yeah, I can’t go more than an hour from my house if I’m on-call.  And on-call is for all my clients that are between 36 and 43 weeks.  Crazy, huh?  It sounds crazy sometimes.  But… I wouldn’t trade it for the world!  I was called to midwifery at a younger age and knew that was what I was supposed to do.  I can’t imagine sitting behind a desk or computer all day.

Its neat to be coming and going through the night… I sometimes feel like a little birth elf that comes in and slips away unnoticed to help new life into this world while all the neighbors continue sleeping! Its pretty amazing to witness sheer strength and determination from the families that I work with.  Its humbling to support such strong empowered women!

So to all the families that I have had the chance to work with- thank you for including me in your intense and magical journey to parenthood ❤️❤️❤️

 

 

What is a Natural Birth?

Birth is more complex than a one-word label and our perspective encompasses all different aspects of what it can mean. We believe the term natural birth can take on many different meanings for different families.  At Portland Natural Birth, our goal is to include all Portland families desiring midwifery and home birth care, placenta encapsulation and prenatal and postpartum bodywork.

We support your right to:

Choose the kind of care that suits you best

Have full access to the information you need

Enjoy a team of supportive providers beside you

Feel a part of your care, empowered with choices

Above all, we believe natural birth means being supported, informed, empowered, and cared for in all of your options and throughout your entire process, no matter what your birth looks like.

Placentas and plants!

Placentas! They are amazing. This organ never ceases to amaze me. It’s beautiful in its circular shape with hues of red, purple and blue. It’s the only temporary organ that humans, ahem women, grow. How cool is it that we not only grow a little human being but also a temporary organ?!

Here at Portland Natural Birth, we are big believers in yup, you guessed it- placenta encapsulation! Ingesting your placenta replenishes your body in a way a regular supplement doesn’t. It’s formulated specifically for you, with your own blood and hormones. Cutting up small pieces for fresh smoothies is also an excellent way to get those nutrients but not everyone can stomach that idea. Hence, having someone amazing, like Kelley Burke, take your placenta away in the night and return it in lovely little pills is an easy way to get your reserves back after birth!

As homebirth midwives, we are also fully supportive of women knowing all their options.  So, wondering what others do with these amazing organs if they choose not to eat/ingest them?

Well, as much as I love placenta encapsulation for replenishing your body after the birth, personally I just had to plant mine! I know, I honestly believe in the power of ingesting your placenta. Its nutrients, formulated especially by your body, are something you just can’t get from a regular supplement. And having someone amazing like Kelley prepare it is hard to pass up!

lilac bush, placenta plantingBut, even so, I’m a gardener through and through. My husband and I had bought our first house months before my first kiddo was born. We spent hours after work taking out the grass, putting in garden beds, planting fruit trees and making the yard our own. By the end of April things were in bloom and my daughter had been born at home. A couple weeks later, at my request, my mother in-law dug up a baby shoot from her lilac bush and brought it to us. We planted my daughter’s placenta deep in the ground with that baby lilac bush on top. I knew I wanted something that would bloom around her birthday every year and what better plant for the northwest than a lilac!

Fast forward three years and two months to my son’s birth. I toyed with the idea of placenta encapsulation since I was tired as a mama to a kiddo and now newborn- I knew some nourishment like placenta pillshydrangea, placenta planting would do wonders! But… I had a beautiful, thriving plant with a sweet plaque a friend made for my daughter’s placenta. I had to keep on. This was our beloved house where both my kiddos were born. It took a little longer to get this placenta in the ground, we were suddenly busy with two kids! But we got there and so holding my not-so-new little guy and with our daughter doting a small shovel in her hand we dug a deep hole for my son’s placenta. Planted on top is a beautiful hydrangea which gets heavy with blooms in the summer, perfect for my summer solstice baby!

The point is, as much as I love seeing the effects on my clients when they have their placenta encapsulated, it’s also important to do what feels right for you. My heart wanted to see something beautiful continue to grow from this amazing organ that my body grew to nourish my kiddos- so that’s exactly what I did!

Now that my kids talk, they love showing new comers to our house their gardens where their own placentas feed the rich soil. ❤️

Come see us at Luna Chiropractic!

Your Portland Natural Birth Midwives have a new clinic space!  

We are so excited to start seeing clients in the wonderful Luna Chiropractic offices.  They are located on NE Russell and MLK, just above Russell Street BBQ and Goldrush Coffeeshop (333 NE Russell Street, Suite 200).

We will be seeing clients on Mondays in this clinic and continuing to offer homevisits for prenatal and postpartum appointments on our other appointment days throughout the week.

We are really happy about this collaboration with other healthcare providers.  Sharing clinic space with these wonderful practioners is not only great for us but wonderful for YOU!  Luna Chiropractic specializes in prenatal and postpartum chiropractic treatments and gladly treats your baby as well.  They are both knowledgable and very personable.  We have no doubt that if your body needs some work, you’ll love working with them as much as we do!

In addition to the chiropractors, a naturopath, acupuncturist and counselors are also sharing clinic space- most of whom are also providing support for mamas and families. Make sure to check out
Luna Chiropractic’s website if you want to learn more.  A new, comprehensive website with all the healthcare providers practicing in their clinic, including us, will be finalized soon.

A slightly different perspective on birth photos

Portland Home BirthI love birth photos.  I’m sure it comes as no surprise that a midwife wouldn’t tire of seeing babies being born.  But it’s true, I love seeing birth photos posted on Facebook, Pinterest and other websites and of course I love it when my clients send me pictures of their birth.

 

Last week a friend came to our house and noticed my daughter’s photo book on the shelf.  Neshamah happily shows it to anyone willing to sit for five minutes.  The day wasn’t any different as she snuggled up to our friend and opened to the first page of her book.  The first picture, very appropriately, is of me big and pregnant.  The following three pictures are of her birth.  Yes, I’m naked and she’s pale and bloody.  Its the most amazing photo: my face is ecstatic and relieved.  It’s a raw and authentic picture of birth.  She is literally a couple seconds old as I brought her to my chest in those pictures.  In the next picture, my husband is stunned in the background.  I adore these pictures.

Somehow my love of birth pictures started well before my midwifery education.  In fifth grade, I wrote an autobiography.  On the first page, I included a somewhat graphic (and bloody) picture.  I mean, what a better start to your autobiography then a picture of your first minute on earth!  I still remember being truly surprised when my teacher told me it was an inappropriate picture to show to strangers.  I was confused- it was a picture of my birth (and you could only see my mother’s leg)- why was that an inappropriate way to start a story about myself?

I’m not sure if my mother knew i was using that photo for my report before I turned it in.  But, it was in my own baby book, which wasn’t that private either.  I didn’t understand the need to hide it.  My mother has always been honest with me about my birth so as a young child I didn’t know others were not as open.

I laugh about that story now as an adult.  My naivety is sweet.  And yet, I’m raising my daughter in the same way: to view birth as completely normal and beautiful.  I love that she also thinks nothing of it showing off her birth pictures to her friends.  Of course, I feel bummed that many view birth photos as inappropriate media for their children and the public.  But for now I will continue looking at all the birth photos I can online because I love seeing that initial meeting between mama and baby with that raw edge where intensity meets beauty.

Why Choose Midwifery and a Home Birth?

Portland Midwife Jamie Burke homebirthMidwifery is near and dear to our hearts as we have studied countless hours to finish our training to become midwives, stayed up long nights with laboring mamas as midwives and collectively have had six home births with midwives.

Midwifery care far exceeds most families’ expectations.  We provide one-on-one care, dedicating an hour to every prenatal and postpartum visits.  We are available through email and phone to address any fears or concerns that arise outside of your appointments.  And we are knowledgable.  We know western obstetric treatments but we offer alternative treatments first.  Our goal is to always start with the least interventive treatment and work with you within what is comfortable and safe.

Midwifery care focuses on the individual.  Each mama is different.  Every labor progresses in its own time.  Every family brings a new story to us.  As midwives, we know what normal pregnancy, birth, and postpartum look like and we help you find your stride within it.

Every birth is different and that is why midwifery care is so important.