Questions about midwifery Care?
Do you have lots of questions about your birth options? Maybe you aren't even sure where to start. Our Frequently Asked Questions page is a great way to begin the process of discovering which services we offer and what the experience of community-based birth might look like for you.
If you have read through this page but still want to know more, we would love to chat in person or by phone about any other questions you might have. You can schedule a free consult before you make any final decisions. We want you to find the right fit for you and your family.
We can't wait to meet you!
Neva and Tiffani
MIDWIFERY CARE 101
Licensed Midwives are experts in low risk pregnancy and childbirth. We know that you are more than just a pregnant body and we can guide you through the mental and emotional aspects of the process as well as the clinical or medical parts.
Our training is based on a holistic approach to the entire childbearing year. This includes your pregnancy, your birth, and postpartum recovery as well as newborn care and breastfeeding. This means that you do not need an obstetrician or other hospital-based provider when you are in our care.
What does this mean for you day to day? When you have a concern or question about pregnancy symptoms or discomforts, our recommendations start with supplements, herbs, and lifestyle changes. Our methods are meant to help you get low-risk and stay there. But just in case our natural remedies don’t work for you, we also know the medical treatments that are the next best thing. Our care is customizable for your needs and the needs of your family based on your own philosophy and beliefs.
Chances are….YOU are a great candidate! Nearly everyone is low risk until there is proof otherwise.
You are a fantastic candidate if you are planning an unmedicated birth with minimal intervention. And last, but not least, if you want to give birth within your own community, such as at home or in a free-standing birth center.
Midwifery care creates a relationship that helps to prepare you for birth and early parenting. This can be one of the most vulnerable times in your life and we work with you to create that safe space where you can feel empowered to make the choices that are right for you and your new baby.
The cornerstone of our practice as your midwives is well-informed healthcare choices added to very high-quality, personalized care. We use a teaching checklist to cover what you need to know. We introduce you to the decisions you will have to make and offer you evidence-based information well in advance of the time you will be asked to make the final choice. This way you have time to research and ask more questions if you would like without feeling pressured to make a rushed choice.
MIDWIFERY CARE: Prenatal Care
Start with a free consult. This is 30 minutes in person or by phone to ask any and all questions about midwifery care and our practice in particular. We want you to be sure that we are the right practice for you and your family.
Once you know you are ready to start care with us, we will send you an email invite to Maternity Neighborhood. This is your online pregnancy medical record. We ask that you complete your health history before your first visit so that we can focus on the current you when we meet in person.
Your first official visit is usually between 10-12 weeks. This appointment will include initial labs and lots of paperwork to get started. We will listen to baby’s heart beat and give you a quick physical exam to make sure all is well. We start with an annual exam or PAP smear unless that is something you want to do.
We see you at least every month until 36 weeks. If this is your first pregnancy or if you have lots of questions, we switch to seeing you every two weeks in the third trimester. After 36 weeks we see you every week until your baby is born. We start each visit with your questions or concerns. We want to make sure you have plenty of time to ask your questions. Then we look at our teaching checklist to see what midwifery topics we need to cover for that visit. Next is the belly check where we feel and measure your belly, listen to baby’s heartbeat and take your vital signs.
POSTPARTUM AND NEWBORN CARE:
We will come see you and baby in your home between 18-48 hours after you give birth. We spend this visit working on breastfeeding and offering your baby all of the regular screening. We offer WA State Newborn screening, Cardiac Heart Defect Screening, and another newborn exam. We can see you as often as you’d like for breastfeeding help, but the next scheduled visit is in our office between day 7-14. We want to check on baby’s feeding as well as your postpartum healing. After day 14, baby’s transition to pediatric care and we schedule at least one more visit for 6-8 weeks postpartum with you.
You will be offered all of the same routine testing for maternity care that is available with hospital-based providers. This includes lab work and ultrasounds as well as optional genetic screening of you and your newborn.
Blood draws and urine samples are taken during your regular visits and sent off to Laboratories Northwest. If you choose to screen your own genetics or the genetics of your newborn we offer non-invasive prenatal testing with Natera.
Ultrasounds can be a very exciting part of the pregnancy experience. We have a small ultrasound machine in our office to help see very tiny babies and to help confirm which way your baby is positioned if we need to. But for diagnostic ultrasounds, we refer you to one of the following: TRA, Diagnostic Imaging, Multicare Radiology, or Multicare Maternal-Fetal Medicine.
As an active client with Laoch Midwifery, you have access to our on-call services 24 hours a day, 7 days a week for urgent concerns and labor questions. This is different from other practices because it's your actual midwives that pick up the phone!
Urgent calls are forwarded directly to Neva and Tiffani. There is no call service where you have to leave a message or go through a triage nurse. When you have an urgent concern, you have direct access to your midwives!
The short answer is yes, absolutely. The longer answer is more complicated and involves the rules and policies of insurance companies and the State of Washington.
Each pregnancy is different and the only way to know if you are a candidate for VBAC is to review your records and learn about what happened to cause the first c-section. We can generally get an idea if you are a candidate at your free consult visit.
THINKING ABOUT COST:
Insurance companies will not pay for Home VBACs. When you have a VBAC with Laoch, we bill your insurance for all of your prenatal and postpartum care and newborn care. But they will not cover the actual birth. Our rate for a home VBAC is $2500 in addition to the $500 home birth fee.
WHAT ABOUT TBI?:
The Department of Health has an agency that governs birth centers and the rules that are currently on the books state that you can not have a previous scar on your uterus and have a baby in a birth center. There are advocates working to get this rule changed every day (it’s stilly that it’s ok at home but not in a birth center). But for now, it’s not allowed.
ALTERNATIVES TO MIDWIFERY CARE:
If for any reason you are not able to have a home VBAC with us but you have your heart set on really great midwifery care, we can create a customized care package for you. We have obstetrician friends that are happy to help manage your hospital VBAC while we manage your prenatal and postpartum care. In some cases, you may want or need to schedule a c-section for your next baby but also really want to have awesome midwifery care. We are very happy to offer custom packages in this case as well.
MIDWIFERY CARE: Birth & Postpartum Care
Your birth location is a personal choice and there are many things to consider. When choosing your birth space you may factor in things such as: Do you anticipate having a long labor, or do you have a history of very fast births? How much available space and hot water you have at home? Fees and insurance coverage, childcare, proximity to emergency services, etc. We can help guide you through all the pros and cons of both the home birth and birth center options.
When you are planning to birth at home, we have your 36th-week prenatal visit right there inside your home. This serves a few purposes. We all get to make sure we know how to find your home address in the daylight. And, we deliver your birth kit with many of the supplies that we will use when your baby is born. When providing birth care to you at home we charge an additional $500. This fee is not covered by insurance and helps to cover additional costs for supplies and travel expenses.
Laoch Midwives also have privileges at The Birthing Inn in Tacoma, WA. If this is your choice of birth place, we will start the registration process in the third trimester. More details about having your baby at TBI can be found on their website or by contacting them directly at 253-761-8939.
Birth plans are awesome, especially to help remind you what your options are. Lucky for us, most things you will “fight for” on your birth plan are just a regular day for us. Every baby gets skin to skin time. Delayed cord clamping is the only way to go. And we never separate babies from parents. We don’t have opioid pain relief to give you in the first place and yes, we want you to eat and drink and move about in labor. Have plans for your placenta…how can we help?
You can most definitely have a water birth! In fact about 60-70% of our babies are born in the water. Nearly everyone labors in water of some sort. The shower is great for the early hours of labor. And what better reason for going to The Birthing Inn than those amazing giant tubs?! If you are planning a home birth we have a limited number of rental tubs or resources for other birth workers that are happy to help you out.
Doulas are also great and can be very helpful especially at home before it’s time for midwives. Need a recommendation We have some favorites we love to work with. Or you can search for the right fit here: www.doulamatch.net
You are welcome to bring guests to your regular visits and your birth. We just ask that anyone that is sick or feeling like they might be sick, stay home. We can also offer advice about who you might want to have with you and who you might want to stay rested and at home so that you have a support system ready to help you when you return.
If you have specific desires and plans for your birth, we are here to help. As long as your baby stays happy and healthy, we want to support your master plan!
As previously mentioned, most pregnancies are low risk. However if you have certain chronic illnesses, it's safer for you and baby to have birthing care in a medical setting.
These include but are not limited to:
- Type I or II diabetes
- Untreated thyroid disorders or other endocrine disorders
- Severe cardiovascular and pulmonary diseases including uncontrolled hypertension
- Rh sensitization or hemolytic diseases such as thrombocytopenia
- Uncontrolled neurological disorders
- HBV positive; HCV positive; HIV positive, active tuberculosis or any other communicable diseases
- Active smoking habit (this includes vaping and smokeless tobacco)
Reasons your risk status might change and require co-management or transfer of care:
- Hypertension of any kind
- Gestational Diabetes requiring medication
- Twins and other multiples
- Breech presentation
- Intrauterine Growth Restriction (IUGR)
- No prenatal care prior to 28 weeks
If you are in our care and require a transfer or co-management we are still here to help. We have transfer relationships with several local hospitals and great relationships with a variety of providers.
If you have your baby in the hospital, we still offer home visits postpartum and newborn care as appropriate.
Sometimes, even when you do everything exactly right, babies decide that they want to be born in the hospital. Sometimes the universe or your genetics decide that you and your baby need more than the routine midwife things. This is a time when western medicine is the best way to keep you both safe. When a transfer is necessary, we call it "doing the next best thing." In these cases, we have well-established transfer relationships with several obstetricians in the greater Tacoma area who are happy to help you out.
Sometimes you have something sudden and urgent happening and the nearest emergency room is the best place to be. For example, if you have a high fever or are unable to keep food or water down for more than 24 hours, we will give you instructions to go to the nearest ED.
If labor isn't following a normal pattern or if you change your mind and would like pain medication, we coordinate a transfer with a local hospital by phone. Most times it is safe to have a family member drive you to the hospital. In very rare cases, things become emergent and your midwife will go along with you and/or baby in an ambulance and transfer care in person with the hospital providers. We stay with you until we know you are safe and cared for.
If breastfeeding is a part of your parenting goals and plans, you are going to love midwifery care. If it isn't part of your plan, you will still love us! And we support you 100%.
Successful feeding starts with lots of education. You can read and watch lots of videos, but there is just no replacement for your own baby and your own full breasts to really learn how it will work between the two of you.
We strategically focus on getting your baby breastfeeding within an hour of birth. This gets both of you off to a great start and takes care of the vast majority of breastfeeding troubles. We revisit feeding at every visit once your baby is born. At your day-1 postpartum home visit, we check in and work through any questions or concerns. We want to make sure you get as much hands-on help as you need along with lots of reassurance when things are going well.
If things are difficult or if you feel like you need extra help we can schedule breastfeeding visits as often as you need. We are dedicated to getting you the support necessary to make breastfeeding a success for you. About 95% of breastfeeding concerns can be handled by your midwives alone, however, if things are extra difficult or if you want a second opinion, we are happy to refer you to lactation specialists, pediatric medical providers who can assess ties and feeding and/or pediatric dentists for tongue and lip tie revisions.