Frequently Asked Questions:
We realize there are many important questions you have about South Coast Midwifery, so we’ve compiled a list of commonly asked questions for you to see in advance so that your consultation time can be maximized. If you don’t see your question here, please feel free to ask it during your consultation.
What is a Certified Nurse Midwife?
A Certified Nurse-Midwife (CNM) is a highly-trained professional who provides primary health care for all phases of a woman’s life: maternity, post-partum, and gynecology. A CNM is a licensed nurse who has completed a graduate level midwifery program, fulfilled extensive clinical requirements and passed a stringent national certification exam. Not all midwives are CNMs. Lay midwives may not be licensed, and Direct Entry Midwives do not hold Nursing degrees. Both may lack some of the special and extensive education and training of a CNM.
Is CNM care right for me?
Most likely, yes. Most women are excellent candidates for nurse-midwifery care. The vast majority of pregnancies proceed normally and result in childbirth without complications, especially when women take an active role in maintaining their health. Even when moderate risk factors- miscarriages or maternal age- are present, CNM care is often the best option. In the rare case of a high-risk pregnancy or complications beyond the scope of nurse-midwifery, we will refer you to the best qualified physician close to your home. We provide personalized attention, helping you select a physician, making the referral and briefing them on your situation.
What can I expect during my pregnancy, birth and beyond?
During all phases of your life, you can expect personal support and continuity. We encourage you to be well informed and help you grow more in tune with your body, its cycles and needs. During pregnancy, we regularly monitor the health of you and your baby, answer your questions and make recommendations about proper diet, personal hygiene, exercise, sleep, travel, and maintaining a healthy lifestyle. We foster a trust in your body’s ability to deliver a healthy baby, naturally. During labor, we evaluate your progress and provide emotional and physical support. We keep your baby’s birth as natural and uncomplicated as possible, and involve your family and friends as you desire. If a problem arises, we assist you in making decisions that protect you and your baby to the fullest extent. Follow-up care begins immediately after birth as we examine your baby, provide assistance with breast feeding and infant care, and rejoice with you and your family in a wonderful and healthy new beginning. In non-pregnancy, we advise you about family planning, reproductive health, preconception, personal hygiene and general health care. We also provide regular gynecological services, like annual pelvis, breast exams, and Pap smears.
What are the overall advantages of CNM care in pregnancy and childbirth?
Women and their families are given control over their own childbirth experience. Working with a CNM, you’ll enjoy longer prenatal visits, a greater emphasis on education and birth preparation, and greater emotional support. CNM’s are trained to recognize pregnancy and childbirth problems and will recommend consultation with or transfer to a physician or hospital whenever necessary.
Nurse-midwifery care results in better birth outcomes- with less intervention in the birth process- than those achieved under physician care. Women benefit when they avoid the risks, discomfort, and disruption of medical intervention during labor and birth. Clients of CNMs report feeling more comfortable asking questions and feel that CNMs instill a greater sense of trust in their own ability to give birth. With nurse-midwifery, each woman receives the personal care she deserves. A CNM gives you more choice in birth options, including where you give birth.
What are your fees? What do they include? When is payment expected? Does insurance or Medicaid cover your services? Are prenatal and postpartum visits included in the price?
South Coast Midwifery’s fees are approximately 50%-75% less than the average uncomplicated hospital delivery. We provide reasonable payment terms for all services not covered by insurance as well.
We feel the quality of personalized care and attention received at South Coast Midwifery is worth investing in. Midwives and Birth Centers enjoy better health outcomes for mothers and babies than hospital care. There is no comparison!
We offer a wide variety of payment plans and discount options. Among others, an additional benefit of our complimentary consultations is that our financial/insurance staff will investigate your insurance plan and provide you several options. We will certainly find the plan that works best for you and your financial situation!
Most third-party insurers cover care with a CNM. At your complimentary consultation we will verify your exact benefits. Most states, including California, mandate third-party reimbursement for nurse-midwifery. Private insurance companies in these states must pay for CNM services. The following is a partial list of Insurance companies we work with frequently as out-of-network providers:
- Blue Shield
- Aetna (may have exclusions for Home Birth)
- Great-West Healthcare
- United Health Care
- Health Net
- PacifiCare (may have exclusions for Home Birth)
The following is a summarized list of services included in our fees:
- Routine prenatal visits (once a month until 32 weeks, every other week until 36 weeks, weekly until delivery).
- On call Nurse Midwife 24 hours
- Comprehensive health physical and pap smear
- Out of Hospital Birth Details Class
- Breastfeeding Class
- Baby Care Basics Class
- Labor support
- Birth services
- Water birth
- Postpartum care (Immediate, 3-5 days & 6 weeks)
- Postpartum home visit (for birth center clients)
- Immediate newborn physical
- Newborn assessment at the 3-5 day visit.
- 35 Week Conference (1 hour Birth Plan)
- Birth Kit and supplies
- Facility fees
- Parent Educational Binder
- Lending book and video library
- Breastfeeding support and counseling
- Nutritional counseling
- Emergency equipment and transportation as needed
- Insurance claim submission
How long have you been practicing and how many births have you been the primary responsible midwife? How did you receive your training?
The first baby Lorri “caught” was in 1985 while attending a direct-entry midwifery school in El Paso, Texas. After finishing that program, she decided to pursue more advanced midwifery training. She obtained a nursing degree, registry as a licensed Nurse Practitioner, along with certification as a Nurse-Midwife. A midwife since 1993, Lorri has been the primary midwife at over 1200 births and hundreds more as a student or assistant. As a complementary practice, she has received training in homeopathy from the British Institute of Homeopathy. Lorri is also a Certified Khalsa Way Pregnancy Yoga instructor through Golden Bridge Kundalini Yoga. Between all the midwives at SCM, they have combined attended over 1600 births!
Why did you become a midwife?
It was through Lorri’s own experiences that she became professionally interested in pregnancy and alternative childbirth. She often refers to herself as a “homebirth wannabe”. She never had the chance to give birth at home or in a birth center, so she takes great joy in helping women have their choices honored. For each midwife’s personal story, please read more on our “Midwives” page.
What is your philosophy about childbirth
See our “About Us” page for an overview.
Are you certified or licensed?
The midwives at SCM are either Certified Nurse-Midwives, licensed by the California Board of Nursing and accredited by the American College of Nurse-Midwives or they are Licensed Midwives, licensed by the California Medical Board and accredited by the North American Registry of Midwives. Most of our midwives are also registered nurses. In addition, Lorri is a Women’s Health Nurse-Practitioner licensed by the state of California. The Birth Center is nationally accredited by the Commission for Accreditation of Birth Centers.
What happens if two people are in labor at once?
It has happened before! We have a unique practice in that we have two midwives on call and a back up midwife to ensure that any woman in labor will receive the attention she requires.
What if I need to see a doctor?
We have the privilege of working with several area doctors with a variety of hospitals in which they have admitting privileges and will consult with or refer to them accordingly depending on the situation at hand.
Do I need to see him/her prenatally?
It is not necessary, as we practice independently of physicians. However, if you are a HMO insurance subscriber, it is advisable to remain in contact with your assigned doctor in the case of a non-emergency transfer or a transfer out of care.
What situations do you consult him/her for?
We may speak with a consulting physician for reasons ranging from labs to results to treatment recommendations to discussions of risk assessment for any developing problems. For example, we will consult with the physician for some of our mothers who are being managed for hypothyroid or those who have a threatened miscarriage and are in need of hormonal treatment to support the pregnancy.
We also consult with an herbalist and homeopath for natural remedies and support.
What’s your hospital transfer rate? What’s your Cesarean rate?
Following you will find the average statistic rate for some of the most commonly asked categories.
- Non-Emergency Transportation to Hospital: 14.5%
- Emergency Transportation to hospital: <.005%
- Cesarean Sections (2012): 5%
- Episiotomy: <0.5%
Approximately 95% of those who required non-emergency transportation to the hospital were for some form of failure to progress.
How many families do you accept per month into your care?
To ensure we can continue to offer our personalized and attentive care, it’s important that we do not exceed a certain number of clients per month. Because some go early, some go late, and some right on time, the exact number of mommas and babies we help per month can truly vary. We do fill up each month, so we encourage you to call today for your complimentary consultation and tour!
Can you do Vaginal Birth After Cesarean? (VBAC’s)
Yes! Call today for your complimentary consultation! If you have not had a vaginal birth since your cesarean, there may be eligibility requirements that must be met first. During your consultation, we will discuss these with you further. We may also need to review your medical records at a later appointment. If you have had 2 or more cesarean sections, you will be ineligible for a VBAC with South Coast Midwifery. Inquire within for more details. 949.654.2727
How do I contact you?
For general questions and inquiries, you can call us at the office during business hours. Our voicemail is available 24 hours a day. For our midwifery clients (during pregnancy and up to six weeks postpartum), a paging system is in place if you should need us for emergencies or labor in the off-clinic hours.
How do I get my lab work done?
We will collect your lab work in the office. It will then be sent and processed by the lab for testing and results. We will review the results with you at the office.
What routine prenatal tests do you require?
We will offer to you all tests recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM), as well as those of the State of California. We will offer education on the screening, so that you can make an informed choice.
Some of those screens are:
- “OB Panel” to show complete blood count (CBC), blood type, Rh factor, antibodies, rubella, hepatitis B, and syphilis status, and a random glucose result.
- HIV screening
- Hepatitis C screening
- Pap smear is offered if indicated or requested
- Gonorrhea and Chlamydia screening
- Prenatal Screening (Quad Marker, Serum & Full Integrated Screenings)
- Diabetes Screening Test and Anemia screening at 28 weeks
- Group B Strep (GBS) screening at 36 weeks
- Ultrasound* (indications may be suspected twins, unknown date of last menstrual period or conception)
- Urinalysis with culture & sensitivity
- Non-stress test (NST)*
- Biophysical Profile (BPP)*
* indicates test is not routinely performed
What method of childbirth preparation is recommended or taught?
Childbirth classes are taught by independent teachers; we will offer you referrals to the Bradley Method, HypnoBabies or Birthing From Within. Most classes are also taught in the birth center. Visit our “Classes & Events” page for more info!
How long are prenatals? Who does them? Where do you conduct prenatal examinations?
Your first visit with us is approximately 1 hour long. We will conduct your history review, take care of lab work, and physical examination. Each visit after that will be 30 minutes, with the exception of your 35 week visit. At that time, we’ll spend an hour with you for your prenatal exam and birth plan conference. The visits are conducted at the birth center with one midwife and one assistant.
Do you use a Doppler or fetoscope? Why?
During prenatal visits we can use a Doppler or fetoscope to assess fetal heart tones. At birth, a Doppler is preferable as it is quick, audible by speaker, can be submersed underwater without having mom get out for fetoscope use, and doesn’t require mom to be repositioned.
In what situations, should they occur, would I be too high risk for homebirth?
Due to ACOG guidelines, local standard of care, and politics, 2 Cesarean births, and breech presentations can not be offered at this time. Some of the other common exclusions from our care would be multiple gestations, insulin dependent diabetics, epilepsy, preterm pregnancy, substance abusers and hypertension.
In what situations will you transport?
If a woman should opt for analgesia or anesthesia, a transport becomes necessary as we do not have these medications available at home or in our birth center. Such medications increase risk and must be monitored in the hospital. A woman may have become exhausted and in need of compassionate use of medication to help her rest and progress before complications arise due to her fatigue. If a non-emergency transport is recommended, it will be because we have exhausted all resources available (i.e. homeopathy, herbs, etc.).
What complications have you handled? How did you handle them?
Briefly, many complications can be and are handled at home or in the birth center without further incident. For instance, a cord around the neck, GBS + mother, shoulder dystocia, fetal distress, maternal exhaustion, dehydration, retained placenta, postpartum hemorrhage, and newborn respiratory distress. If the situation cannot be stabilized, we will not hesitate to call for emergency assistance and guidance.
What emergency equipment and medicine do you bring?
Basically, we carry more emergency equipment for a mother and newborn than what is found on an ambulance (paramedics provide the safe ride). Our birthing suites have supplies and medications equivalent to a Level I labor and delivery room in a hospital. The difference between us and them is, we only use them if absolutely necessary. We carry the same equipment to our home births. We have all of the equipment necessary for resuscitation (includes oxygen and suction) and postpartum hemorrhage (includes IV fluids and medication), among many other things. Because our supply list is so extensive, we can provide you with a list at your consultation upon request.
When will we meet during labor?
This is based on each woman individually. Mother will be instructed on how and when to call the midwife (at the 35 Week Conference and Birth Details Class). Instructions for first time mothers are different from those who have had previous births. Adjustments will be made according to previous labors and distance from midwife or birth center. Occasionally a woman may need to be evaluated in early labor (about 1-4 centimeters dilated) and offered recommendations of homeopathy, herbs, rest, etc. Once a mother is in established active labor (about 6 centimeters dilated), the midwife and team will join the family.
At what point after the birth will I or you leave?
Certain safety criteria must be evaluated before the client is discharged or the midwife leaves the home. The newborn must be stable (we will assign Apgar scores) and physical exam within normal limits, with no signs of respiratory distress. Mother must also be stable, including her vital signs, postpartum bleeding to a normal amount, and breastfeeding established.
After your baby is born, we will ensure everyone is happy and healthy, then leave the new family alone for a chance to get to know each other and nurse. After a time we will return and offer to help mom up to the bathroom, assist her with a shower or bath to refresh herself (if sutures are needed, we will do this before the shower), then back to bed (or wherever mom is most comfortable). We will provide a complete newborn physical to the baby (assessing heart, lungs, weight, and measurements), dress him or her, and once again leave the family alone, while we do clean up and charting. Then we will say good bye after approximately 3-4 hours. The midwife will then be in touch with the family in the day following birth. This is an approximation for a normal, uncomplicated delivery. We have stayed up to 14 hours postpartum before and will not leave until a level or “normalcy” has been met. We will see mom and baby at the birth center for the beginning of her postpartum visits (3-5 days, 1 week and 6 weeks).
This is subject to change of course, if there are any complications following the delivery.
What procedures do you require on the newborn?
We are required by the state of California to offer antibiotic eye ointment (erythromycin in a vaseline-like carrier) to prevent infection caused by undetected or untreated gonorrhea and/or chlamydia infection (we can screen mom, at her request, for these infections at a prenatal visit). Also offered is a one-time injection of Vitamin K (0.5mL) or 3 doses of oral Vitamin K to prevent Hemorrhagic Disease of the Newborn. We encourage mothers and their partners to educate themselves and make an informed decision as to whether or not they would like to proceed. You have the option of refusing treatment with a signed waiver.
A Newborn Screening Test, a heel stick for blood collection, will be offered between 2 and 6 days after birth. It is required of the state of California that you have proof of the test or a signed waiver for it in order to apply for a birth certificate for an out of hospital birth. We can administer the test at the birth center or have you sign a waiver if you decline the collection
Who may I have with me at the birth?
You may have anyone you like at your birth and who is supportive and inspiring to your choices. We strongly urge our clients to surround themselves with positive, helpful people. We will help maintain your vision of birth. Please remember that this time is all about you and your family. When choosing who to have present, please consider “How will this person aid in this process?”, “Do they provide loving energy?”, “Can they help with my children or prepare food?”. Remember, you need to be able to let go during birth, with absolutely no inhibitions. We offer a Birth Details Class and welcome you to bring anyone you may be thinking of inviting to your birth. We will also serve as your guardian and see to it that unwanted guests do not find their way in uninvited. We hope the class will give everyone a sense of what to expect at the birth and what should be expected of everyone: A prepared birth team and family with love and support make for a wonderful birth!
What happens if my labor goes on for days?
Herbs help to decrease the time of labor, but pre-labor might last days! As long as mother and baby are doing well, there is no need to intervene. We encourage you to continue to eat, drink, and rest for the long haul. Women who aren’t able to do these things often become dehydrated and exhausted, which increases the possibility for unwanted interventions or transfer to hospital. We encourage you to go about your every day activities in early labor and enjoy the beginning of the final journey to meet your baby!
What happens if it’s so fast you miss the birth? Have you ever missed a birth? Why?
From the time you contact us and we determine it is time for us to be with you, we will be in constant contact as we make our way to your home or you to the birth center. There have been times when the baby has come as we were en route, but never en route to the birth center. In those very few times, we will be on the phone with the partners of the mothers and coaching them through the birth of the baby. Reasons why the baby comes faster than we can arrive are between the baby and Mother Nature! Once a mother was unsure if it was time to call me, while another time the baby surprised his mother with a 20 minute labor after her older child was born after 18 hours of labor. You will be briefed on Rapid Childbirth at our Birth Details Class.
What pharmaceutical drugs, homeopathics and/or herbs do you use prenatally and at births?
This is individual. While one woman may prefer pharmaceutical remedies, the next will prefer homeopathy or herbs. We are flexible and will work with you to see that you are using the most effective remedy or medicine to fit your situation. That is a unique and beneficial component to our practice; you have the best of both worlds when it comes to treatment options. That said, we do recommend an herbal combination in the last four weeks of pregnancy, along with prenatal vitamins for use throughout. We carry herbs and homeopathy for a variety of uses to every birth. They may or may not be used depending on what the mother needs as well as her preferences.
For labor and birth, we are proud to announce we are the first birth center in California to offer Nitrous Oxide. For information on Nitrous, visit our Resources page.
Whether it’s herbs, homeopathy, essential oils, prenatal vitamins, minerals, personal care items, we have most of them in stock and available for purchase at the birth center.
When will you use the following: Pitocin or Methergine, newborn resuscitation equipment, oxygen, suturing materials, IVs?
Pitocin and Methergine will only be used in the case of excessive bleeding after the placenta has been delivered. In the case Pitocin becomes a necessary intervention in labor, a transfer to the hospital is necessary for fetal monitoring and IV administration of the medication.
Newborn resuscitation equipment is always set up and ready at every birth. While many midwives only set it up as needed, we feel it is important to have it available on a second’s notice.
Oxygen is also standing by in the case that mother needs to bring more oxygen to her baby as she labors or in the case of a baby who is slow to transition after birth. Suturing materials (including anesthetic to numb the area) is available if necessary.
IV supplies are available for a variety of reasons, which might include the administration of antibiotics in labor (for treatment of group B strep for example), replenishing fluids due to dehydration, administering medication due to excessive bleeding, and to replace excessive fluids lost with bleeding. Starting an IV line is not routine.
Do you do a postpartum home visit? When?
Postpartum visits are included in our package of care for birth center clients! For those who prefer a home visit versus a visit in our office, we offer them at discounted rates.
Do you have birthing tubs? Do you do deliveries in water?
We love water labor and births! We have luxurious oversized soaker tubs at the birth center, as well as birthing pools available for rental. You really don’t need anything fancy, even a kiddie pool will do (60″ diameter and 22″ height) just fine. The pain relief and relaxation offered by a simple pool of warm water is amazing! See Barbara Harper’s (author of Gentle Birth Choices) website for more information on water birth.
How do I become a midwife or get more information about becoming a midwife?
The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives and certified midwives in the United States. They provide a plethora of information relating to the midwifery career and how to become a midwife, including details specific to high school students, college students, nurses, career-changers and foreign educated nurse midwives. Please visit their website for detailed information. For 25 years, the American Association of Birth Centers has been the nation’s most comprehensive resource on birth centers. They provide comprehensive information and workshops relating to opening a birth center. Finally, Midwifery Today offers educational materials and packages on becoming a midwife.