Sierra is not taking new clients in order to more fully enjoy motherhood.  If you are a returning client, you can contact her to check her availability.

What is a midwife and how many midwives are in Flagstaff, Arizona?

 A midwife is a trained health care provider who assists women through pregnancy, labor and birth.  In Arizona, a midwife is licensed through the state’s Department of Health.   A certified professional midwife (CPM) is a nationally certified midwife who assists women in giving birth safely at home.  A certified nurse midwife (CNM) is also a nationally certified midwife who can assist women in giving birth at home, a birth center or a hospital.  There are at least 5 CPM's and 2 CNM's working in the Flagstaff area.  I encourage you to find the midwife who best meets your needs and you feel comfortable with, as birth is such an intimate and life changing experience.

How long have you been a midwife?

I have been working in the field of midwifery since 2000.  In 2004 I earned my license in Arizona (LM) by taking an 8 hour written exam, an oral exam with a physician, and a lengthy practical exam.  Following this I also became a nationally certified professional midwife (CPM).  I have also held a license in Colorado in order to legally assist my niece with the delivery of her baby in 2009.   Over this time in working with midwives and as a midwife, I have attended about 260 births and have caught about 100 babies.   I love my job!

What happens at a home birth?

It will be your responsibility to prepare your supplies for your birth, but they are very simple items to gather, such as extra towels and sheets and even some pots and pans.   I will bring many more medical supplies to the birth, some that are routinely used like a Doppler to listen to the baby’s heartbeat, as well as some that are only occasionally used, such as oxygen and resuscitation equipment for emergencies.  When you go into labor and need the presence of a midwife, I will come and stay with you for the duration of your labor and birth.  Sometimes my role is to help you breathe, massage you, and give lots of support.  Other times I may just be needed for the medical role that I must do and your partner or coach may be all you need for your comfort needs.  When you get closer to pushing, I have other midwives and/or assistants whom I can call to come help at your birth.  Having a second midwife or skilled assistant present increases your safety.  When the baby is born, he or she will be placed on your chest to begin bonding right away.  I will help you with breastfeeding and stay at your home for approximately 3 hours after your birth.  I will also do your laundry and clean up any “mess” from the birth.

Are there any advantages to homebirth?  Is it safe?

Yes and Yes!  For healthy, low-risk women, homebirth is a great option.  In most other developed nations, midwives deliver the majority of the babies and the maternal mortality rate is lower in many of those countries.  The CPM study of 2005 showed no differences in outcomes for moms and babies when a CPM was present with the mother in labor.  Some of the advantages that many women enjoy about a homebirth are:

• The ability to eat and drink in labor
• The ability to move around and change positions
• The ability to labor and birth in the water if desired
• Having only the people they have chosen to be at their birth
• Not being subjected to so many interventions
• The decreased risk of Cesarean section
• The financial cost is significantly less than a hospital delivery
• There are many, many more reasons that women come up with!

Homebirth is a great option for many women.  I feel strongly that homebirth is the best option for any woman who feels comfortable with it.  If a woman feels scared about being at home to have her baby, she may have a better labor in the hospital where she is not afraid, as fear impedes the labor process.  I would highly recommend hiring a doula to help you in labor if you are planning a hospital birth. 

Are there any pain medications I can take in labor?

There are no pain medications to take in labor at home.  Midwives support you by using other techniques that have been proven to help a woman in labor.  We will give you massages, allow you to labor in the water, give you food and drink, and help you with your breathing.  If the need for pain relief arises, you have the option to go to the hospital, though this is rare in my experiences.

What if there are any complications?

Midwives generally spend lots of time with their clients during their pregnancies and are able to rule out many complications prenatally.  When a complication occurs in labor, you would be transferred to the hospital for a higher level of care.  In general, I like to see the transfer to the hospital occur before there is an actual emergency, which means that sometimes we get to the hospital and not much is done differently with the exception of an IV and lots more people to meet.  Most transfers are done by private auto, not ambulance, and most are non-emergent.  According to a study completed in 2005 the percentage of transfers to the hospital completed by CPM’s is about 13%.  This is approximately what I have seen in my experiences as a midwife as well.  The other important statistic about midwifery services is that by having a homebirth, you significantly decrease your risk for Cesarean section from the national average in 2007 of 31.8% to about 8% in my experiences, which is also less than the World Health Organization recommendation of less than 15%.  When complications do arise, I will go with you to the hospital and stay with you to support you in your birth experience, though a physician or CNM will become your primary provider. 

Do insurance companies cover homebirth?

Yes and no.  Many insurance companies will cover homebirth at an out-of-network rate and depending on your specific plan.  Some of these companies are Blue Cross Blue Shield, Aetna, and United Healthcare, though BCBS has recently been more reluctant to pay than ever.  There are a few companies that never have covered homebirth, such as Arizona Foundation for Medical Care and RAN + AMN.  The state Medicaid plans (AHCCCS) also do not cover homebirth.  If you desire to find out more information about your insurance, please contact me to have a preauthorization done.  I also will do a sliding fee scale for those who qualify financially.

What are typical fees for a homebirth?

The package fee for a homebirth could be anywhere from about $2000-$5000.00, depending on your circumstances, insurance eligibility, and where you live.  The package includes all of your prenatal care, your birth, and all of your postpartum care in addition to some labwork, supplies, and more.  There are other additional expenses that will be added to that fee, such as additional labwork, ultrasounds, possible physician visits, and a few more.  We can discuss the exact fees for you at your free consultation visit and make a payment plan.