Do you accept insurance?
A simple question with a complex answer; as the insurance industry has complicated the health care system! I don’t carry malpractice insurance due to its high cost and an understanding of what is important in the provider-client relationship. Rather than see more clients to be able to pay the cost of malpractice insurance, I prefer to focus on a lower-volume, higher-quality practice that provides time for relationship building. Third party payors, such as your insurance company, require providers to have malpractice insurance before being willing to pay them as “in-network” providers.
Consider me an “out of network” provider, and remember that insurance will do it’s best not to pay the bill. As such, you will be expected to pay for services rendered, and I can provide information about getting reimbursed directly from your insurance company or refer you to someone who can help you be a squeaky wheel in your reimbursement attempt.
What are my out of pocket expenses?
You are responsible for paying the entire fee by 37 weeks, as detailed in the financial agreement. The fee does not change based on when you enter care, the number of prenatal visits, the time we spend with you in labor, whether or not you are transferred to hospital care at some point during labor, or the number of postpartum visits you have. In the case of home birth, you will also be responsible for providing a clean, private birthing environment with basic birth supplies.
What about lab work and ultrasound?
The good news is, your insurance will cover things like lab work, ultrasound, obstetrical consultation and hospital birth. For those with no insurance coverage, I can provide limited ultrasound exams in my office. When ultrasound or lab work is medically indicated, you will be referred appropriately.
What prenatal tests do you routinely recommend and or require?
Routine ultrasound has become an expected component of prenatal care that many women desire. We will discuss with you the schedule for routine ultrasound and the risks and benefits of each ultrasound exam. Though it is not a requirement, most women in our care decide to have at least one ultrasound, usually around 20 weeks.
We refer to the Prenatal Diagnosis Center at MJH or to the Fetal Care Center at UVA for ultrasound. Both of these facilities offer state-of-the-art comprehensive ultrasound screening. You will be seen by a physician who will evaluate the ultrasound findings and send a detailed report to our office.
Sometimes there is a medical indication for an ultrasound exam. In this situation we will describe the concern and how ultrasound could be helpful. Again, we would refer to MJH or UVA where the ultrasound will be interpreted by a physician. with special attention to the issue that necessitated the referral. The physician notes and recommendations are then sent to our office.
Do you ever induce labor?
Induction with drugs (pitocin or cytotec) is not part of our practice. If a medical induction is needed, we would make arrangements for that to happen in hospital. Sometimes we recommend natural remedies; such as massage, herbs, homeopathics, or acupuncture to try and stimulate labor or to make it stronger.
"How comfortable are you attending someone laboring for the first time?"
I have attended many first time mothers over the past 30 years. While it is difficult to fully prepare anyone for the experience of labor and birth, I know that birthing people are born with the blueprint in their brain of how to give birth.
How comfortable are you with attending VBAC’s?
Each potential VBAC is a unique situation with a unique decision making process. I have successfully attended many ‘VBAC’s including after multiple c-sections.
What kind of pain relief can you offer at a home birth?
Many factors contribute to perception of pain in labor. We find that with the continual support of skilled and familiar attendants, in a relaxed environment where you are at ease with the surroundings, a natural birth can be accomplished, often leaving a everyone in awe of the power of birth. We are able to offer a variety of methods to help cope with the discomforts of labor including massage, hydrotherapy (including waterbirth), changes of position, bodywork and other methods all without associated risks of drug use to parent and baby.
What is your experience with pregnancy/infant loss?
Anyone who has gone through pregnancy and birth has experienced the very real fear of a bad outcome. This fear is born out of both an intellectual and emotional awareness of inherent possibility of risk in birth, no matter where we are or what decisions we make. As families who have chosen non-conventional birthing options, we are all aware of the additional questioning and scrutiny that can accompany a bad outcome at home.
Although I have a deep trust for birth, I know that ultimately nature cares about the species rather than the individual. When that loss happens to you, it is 100% and statistics don’t matter. In the past 30 years of attending births, I have attended three stillbirths. After thorough peer review, I believe that all three were from causes that were unavoidable and unrelated to birth. I have also been involved in a miraculous resuscitation of a baby born with no heartbeat to a living, thriving, pink baby within 10 minutes. It was a sight to behold. That said, I understand and accept that there is no such thing as a 0% infant mortality rate and take responsibility for doing my best in any situation.