How long have you been involved in midwifery?

I have been attending births since 1999, when I became a midwife’s assistant.

How many births have you been the responsible primary midwife?

In November 2004 I was promoted to the responsibility of primary midwife under supervision. I received my Colorado Midwife Registration (license) in May 2006. I have been the primary midwife more than 50 women and primary for 20 additional women who were under contract with my supervisor. I have attended over 200 births in homes and hospitals, and in a freestanding birth center as either a 1st Assistant, Co-Midwife, or Primary Midwife in Colorado and California. My license to practice midwifery in California was issued in March 2007.

What is your philosophy about childbirth?

My basic philosophy is that pregnancy, childbirth, and breastfeeding are a normal part of a woman’s life cycle. I am confident that birth is inherently safe and that women possess the wisdom to give birth without specific instruction. As a midwife, I believe my job to be that of lifeguard, facilitator, and privileged witness.

Why did you become a midwife?

As a youngster, I was a gymnast and had a few injuries that required hospitalization for surgery. I was lucky to receive excellent care from my nurses and they sparked my interest in the profession. My career choices took me in a different direction and I didn’t give it much thought for several years, until I became pregnant with my first daughter. I was under the care of the “best doctor in the city” of Albuquerque, who also employed a couple of Certified Nurse-Midwives in his practice. When he left for a vacation and me in the charge of his midwives, I realized what I’d been missing with him: woman- and family-centered care. I was amazed at the difference between obstetrical care and midwifery care. Suddenly I was included in my own care plan and asked for my opinions on different birth options– before then, I had no idea there were so many options in pregnancy and childbirth! The midwives would actually sit in the chair and have conversations with me until I was the one to get up and leave! I had no idea that I could have such a practical relationship with my caregiver! Later during my next pregnancy, when we’d moved to another city, I met another midwife who was even more gracious with her expertise. By then I’d been exposed to the idea of doulas, various philosophies of childbirth education, and my interest in midwifery as a profession was increasing. My midwife picked up on that, provided me with support, resources, and endless opportunities including helping to integrate me back into the community of midwives and families of Orange County.

I believe one of the most important components of being a midwife is sharing our knowledge with women, not simply attending their births. My favorite part of being a midwife is being a witness to the transforming effect childbirth has on us.

Do you practice with a partner or assistants?

I attend births with a maximum of two trained assistants. My birth assistants are trained to assist me with everything from set up of our birth setting upon my arrival at your home to assisting in complications and emergencies, to clean up following birth. They hold current training as providers of cardio-pulmonary and neonatal resuscitation. They are also trained doulas and are happy to provide that extra help if you request it.

When will I meet them?

I hope you will have many opportunities to meet them during your prenatal care. At the minimum you will meet them at your 36 week home visit. Due to their schedules with me, other midwives, and their own client and class schedules, it is hard to predict who will be at your birth. For this reason, my assistants do their best to be invisible and out of your sight until necessary or as requested.

Can I have a doula at my birth?

YES! While some home birth attendants discourage the use of doulas, I wholeheartedly support and welcome their involvement at your birth. I invite you to visit the Doulas Association of Southern California website and search for a doula who suits your needs.

How many people can I have at my birth?

The answer for every woman will be different. You should have only those people at your birth whom you trust implicitly, support your choice to have your baby at home, and will be helpful for up to 4 hours following the birth. It is important for women to be selective with their attendants because birth requires the ability to get naked in every sense of the word: physically, spiritually, mentally without regard for their attendants’ judgement.

What happens if two people are in labor at once?

My practice is small and at this time, it is very unlikely that I will have two clients laboring.  In the event it does happen that two women are in labor at once, I belong to a wonderful network of licensed midwives who are willing to provide back-up to each other.

Do you have a back up doctor?

In California it is written into the law Licensed Midwives that have physician supervision, but this is not the same as physical presence. I do not have a physician “on paper” to direct my practice as the physician’s liability insurance prohibits such a relationship with Licensed Midwives, but I do have a friendly physician who is willing to make consultations for women in pregnancy and accept our transfer if that need should arise.

What situations should they occur, would I be too high risk for homebirth?

In California, criteria for initial selection of clients for community-based midwifery care assumes the mother is healthy and without serious pre-existing medical or mental conditions. Her medical history, physical assessment and laboratory results must be considered within limits commonly accepted as normal with no clinically significant evidence of the following:

• cardiac disease
• pulmonary disease
• renal disease
• hepatic disease
• endocrine disease
• neurological disease
• malignant disease in an active phase
• significant hematological disorders or coagulopathies
• essential hypertension (BP >140/90 on two or more occasions, six hours apart)
• insulin-dependent diabetes mellitus
• serious congenital abnormalities affecting childbirth
• family history of serious genetic disorders or hereditary diseases that may impact on the current pregnancy
• adverse obstetrical history that may impact on the current pregnancy
• significant pelvic or uterine abnormalities, including tumors, malformations, or invasive uterine surgery that may impact on the current pregnancy
• isoimmunization
• alcoholism or abuse
• drug addiction or abuse
• positive HIV status or AIDS
• current serious psychiatric illness
• social or familiar conditions unsatisfactory for domiciliary birth services
• other significant physical abnormality, social or mental functioning that affects pregnancy, parturition and/or the ability to safely care for a newborn
• other as defined by the Midwife

For what situations do you transport to the hospital?

The following conditions require physician consultation and may require transfer of care according to the state standards of care. Consultation does not preclude the possibility of an out-of-hospital labor and birth if, following the consultation, the client does not have any of the conditions set out in this section.

Intrapartum Conditions: Serious medical/obstetrical or perinatal conditions, including but not limited to:

Maternal:

• active genital herpes in labor
• prolonged lack of progress in labor
• abnormal bleeding, with or without abdominal pain; evidence of placental abruption
• rise in blood pressure above woman’s baseline (more than 30/15 points or greater than 140/90) with proteinuria
• signs or symptoms of maternal infection
• signs or symptoms of maternal shock
• client’s request for transfer to obstetrical care

Fetus:

• abnormal fetal heart tones (FHT)
• signs or symptoms of fetal distress
• thick meconium or frank bleeding with birth not imminent
• lie not compatible with spontaneous vaginal delivery or unstable fetal lie

Emergencies requiring immediate transfer:

• prolapsed umbilical cord
• uncontrolled hemorrhage
• preeclampsia or eclampsia
• severe abdominal pain inconsistent with normal labor
• chorioamnionitis
• ominous fetal heart rate pattern or other manifestation of fetal distress
• seizures or unconsciousness in the mother
• evidence of maternal shock
• presentation not compatible with spontaneous vaginal delivery
• laceration requiring repair outside the scope of practice or practice policies of the individual midwife
• retained placenta or placental fragments
• neonate with unstable vital signs
• any other condition or symptom which could threaten the life of the mother, fetus, or neonate as assessed by the midwife exercising ordinary skill and knowledge.

What complications have you handled?

Midwives define complications differently depending on where they practice, their comfort levels, and experience. Common complications I have handled include umbilical cords wrapped around the necks or other parts of babies, shoulder dystocia, neonatal resuscitation, and maternal bleeding. I have assisted at other births with complications such as undiagnosed breech and misdiagnosed diaphragmatic hernia.

What emergency equipment and medicinals do you bring?

I carry herbs and homeopathics that aid in a number of conditions, oxygen with the accompanying equipment, IV fluids, anti-hemorrhagic drugs, and local anesthetic for lacerations incurred during the birthing process.

When will you come during labor?

My goal is that we keep in touch by phone during the early hours of labor when my presence is not required and you are able to go about your regular daily life. I intend to arrive at your house when labor is well established and progress is under way. This usually means for first time mothers that your contractions are every 3 minutes, lasting at least 1 minute and have been that way for at least an hour. For second time mothers and later, your contractions will be every 5 minutes, at least 45 seconds and have been that way for an hour. In each instance you will likely be approaching the transitional phase of labor and really in need of extra support. Of course, that is the general idea, your situation may warrant something different if your history or desires are different.

What happens if it’s so fast you miss the birth?

I hope you will have kept me apprised of your labor so I am prepared to hit the road when you call, but if your baby has other ideas, I will be on the phone with you providing instruction. It is not necessary to call for emergency back up, since I am likely on my cell phone in my car racing to you. Midwives carry all the equipment necessary for a maternal and newborn emergency, paramedics do not. It may relieve you to know that a baby coming fast usually has no barriers and will do just fine.  During one of your prenatal visits, we will discuss how to handle birth if the baby is likely to be born before the midwife arrives.

How do I get my lab work done?

I draw your labs myself and submit them to the lab for processing.

Where do you conduct prenatal and postpartum examinations?

At this time your care will take place in the privacy of your own home.

Do you use a doppler or a fetoscope? Why?

I can use either one you prefer during pregnancy. I use a doppler in labor and birth because it is portable, doesn’t require the mother to lay down, be still, and quiet. It can be used in the water and in any position. I like to provide all in attendance with the proof of baby’s wellness. When I am using a fetoscope, only I can hear.

How long do you give each woman? What is discussed? What is done?

Prenatal visits are typically an hour long. We discuss nutrition, childbirth education, health tips, family life, work life, spiritual life, and anything else that is relevant. At each visit we will measure the baby’s growth as evidenced by the uterus growing, palpate the belly as baby gets bigger, listen to heart tones, do a urine dipstick, and check mom’s weight gain.

How many births do you attend per month?

I typically have 2 a month, though may assist other midwives with their clients.

Do you do a postpartum home visit? When?

Yes, I return to your home approximately 24 hours after birth and again at 3, 7, and 14 days. This schedule is flexible depending on your needs and health status following birth.