Frequently Asked Questions


1. What exactly is a Licensed Midwife? What's a Certified Professional Midwife? Is it the same profession as a Nurse Midwife? If not, what's the difference?

A Licensed Midwife (LM) is a direct-entry midwife. This means that we receive specialized training and education specific to midwifery practice, without first needing education in another healthcare field, such as nursing. I obtained my first license to practice midwifery from the state of Florida. Florida Licensed Midwives must graduate from a 3-year state-approved MEAC-accredited midwifery school, which includes both academic and clinical components, before taking the NARM exam and applying for state licensure from the Florida Department of Health. Florida LMs usually practice in the home setting or in free-standing birth centers. For more information about Florida Licensed Midwives, please click here.

I am also a nationally accredited Certified Professional Midwife. A Certified Professional Midwife has obtained the national CPM credential from the North American Registry of Midwives (NARM). Many Licensed Midwives are also CPMs, however, a CPM credential alone does not allow a Midwife to become licensed in the state of Florida.

A Certified Nurse Midwife (CNM) has training and education in both nursing and midwifery. A CNM's training is hospital-based, and most CNMs practice in hospitals, though many also practice in birth centers and/or provide homebirth services.

Please read the Midwives Alliance of North America Core Competencies for more information about the Midwives Model of Care.

2. How do I pay you? Do you take Medicaid and/or private health insurance?

I offer an all-inclusive “global” fee for my midwifery services. My financial contract is up front with no hidden charges. I offer flexible payment plans with payment in full due by 36 weeks of your pregnancy, and I accept cash, personal checks, money orders, and most major credit cards. I also offer a 5% discount if the total fee is paid in full by your second visit.

Additionally, I offer a reduced sliding scale fee for families who meet the Poverty Guidelines for their family size (contact me for more information).

I do not accept insurance as a form of payment, however, I do assist with billing and client reimbursement. If you have maternity insurance coverage, I encourage you to verify your benefits as soon as you find out that you are pregnant; this allows plenty of time to request any authorizations or Gap Exceptions as applicable. You will be responsible for paying the full fee for my midwifery services by 36 weeks of pregnancy, and then after your birth and postpartum care, I will bill your insurance company and reimburse you any recovered fees as soon as I receive them. I can verify your benefits and request a Gap Exception for you, as well.

I do not accept Medicaid. If you choose me as your midwife and are eligible for Medicaid, I do recommend that you still apply for Medicaid so that any bloodwork and labs, ultrasounds, and/or appointments with any other providers (chiropractors, pediatricians, obstetricians, etc.) may be covered.

Additional expenses not included in the comprehensive package fee are billed separately and include your birth kit (including birth tub and waterbirth supplies, if desired), lab and ultrasound fees, Rhogam injection for Rh negative clients, and any fees incurred by consulting physicians or hospitals in the event of a transfer.

3. Do you offer a discount for self-pay clients?

I offer a 5% discount for self-pay clients if the total fee is paid by your second visit.

4. What about bartering?

I will consider bartering on a case-by-case basis for equal exchange of professional services (such as chiropractic care, holistic dentistry, yoga classes, massage therapy, etc.), homegrown organic produce, baby plants, fruit trees, etc. Try me! I’m always looking for practical supplies for our little urban (and one day rural) homestead.

5. I would love to work with a midwife, but I simply cannot afford the cost. Do you offer discounts for low-income families?

Yes, I offer a reduced sliding scale fee for families who meet the Poverty Guidelines for their family size (contact me for more information).

6. Do I need to see an obstetrician, too? Do I need to register with a hospital just in case I transfer?

No. Licensed Midwives offer comprehensive prenatal care and laboratory testing so you will not need to see an obstetrician unless you develop any complications that are outside of my scope of practice.

You will not need to register with a hospital. In the event of a transfer during labor, I will call the hospital to make them aware of the situation, and will then accompany you to the hospital and furnish a copy of your records to the hospital staff. The transfer process is usually pretty smooth.

7. Will I have to go to a lab to get my bloodwork done?

All routine labs are drawn in the comfort of your own home. The only time I would send you to the lab would be in the rare event of the need for specialized testing after an abnormal routine lab result.

8. Do you do ultrasounds?

No, I do not perform ultrasounds. If you desire an ultrasound, I will refer you to an ultrasound technician for a routine anatomical ultrasound at around 18-20 weeks of pregnancy.

9. When should I call you and begin prenatal care?

Please call me as soon as you find out you are pregnant so we can have our initial consultation and make sure we are a good match for one another. After that, your first official prenatal visit should be scheduled around 10 – 12 weeks of pregnancy or earlier. Early prenatal care allows us to evaluate your nutritional status and daily diet, and find natural remedies for common pregnancy discomforts.

10. Can my family or friends be at my prenatals?

Yes, your family and friends can be present at your prenatals, as long as you are comfortable with them being there. Older children especially love assisting your midwife with measuring your belly and listening to baby’s heartbeat.

11. How many people can be at my homebirth?

There is no limit to the number of people who you choose to be present at your birth. Some birthing people need solitude during labor and birth and choose only one or two people to support them through the birth process. Some birthing people are very social and want a lot of people at their births. Keep in mind that many birthing people also change their mind in labor and either ask for more privacy or call more support people to be with them. As long as you are 100% comfortable with your support team during your labor, you can have as many or as few people as you desire there with you. 

Please note that I do bring a birth assistant to all births, and you will meet her during your 36-week prenatal appointment.

12. Do you do VBACs?

If your most recent birth was a cesarean section, you will need to obtain a consultation with a physician who has obstetrical hospital privileges, and as long as you are expected to have a normal pregnancy, labor, and birth, I can accept you as my client and provide homebirth midwifery services. If your first birth was a cesarean, and your second birth was a vaginal birth, this consultation may not be necessary unless you have additional risk factors.

For more information on VBAC, recent studies, risks and benefits of both VBAC and elective repeat cesarean, please visit International Cesarean Awareness Network (ICAN) and VBAC Facts

13. Can I videotape the birth or have someone take photos?

Yes, you are more than welcome to videotape or photograph your birth. I do recommend that whoever is filming or taking photos be someone other than your main support person. For example, if your mother is going to be one of your main support people, you will not want her to have the responsibility of taking photos because you may need her physical or emotional support very suddenly, and then you may be disappointed later when there are no photos. For this reason, I recommend a tripod for filming and/or a birth photographer (or a random friend or family member who you feel very comfortable with but will not need their one-on-one support during labor) if you wish to film or photograph your labor, birth, and postpartum.

14. Do you do waterbirths? What about outdoor births?

Many of my clients choose to labor and/or give birth in the water.  Even if you are not sure if you would like to birth your baby into the water, I recommend having a birth pool available to labor in. Check out Waterbirth International for great information, articles, and waterbirth stories.

Some women and birthing people choose to labor and/or birth outdoors. My birth supplies are all portable and can be used outdoors. If you plan to labor and/or birth outside, I recommend researching outdoor births and setting up a private birthing area, such as a tent or canopy with blankets, mosquito netting, towels, a couple gallons of fresh water, etc. Keep in mind that insects and animals do live outside and may share your birthing space with you!

15. Do you routinely attend births in the hospital?

No. Licensed Midwives attend low-risk, healthy women and birthing people either at independent birth centers or their homes. Certified Nurse Midwives and obstetricians routinely attend births in hospitals.

16. I live pretty far from you. How far will you travel for my homebirth?

I generally accept clients within a one hour driving radius of Coventry, Rhode Island. This includes Providence, Cranston, Johnston, Warwick, etc., along with parts of Massachusetts and Connecticut.

17. What equipment do you bring to births?

I will bring general monitoring equipment such as blood pressure cuff and stethoscope, thermometer, along with my fetoscope and doppler for assessing baby’s heart rate. I also bring sterile instruments, oxygen and resuscitation equipment, maternal and fetal pulse oximeter, herbs and pharmaceutical medications to control hemorrhage, IV supplies, antibiotics for GBS+ clients, supplies for suturing, supplies for the newborn exam including vitamin K and antibiotic eye ointment, baby scale, and other miscellaneous supplies.

18. What birth supplies will I need?

I have created a customized homebirth kit for you available for purchase for $50.25 from Precious Arrows here. You will also need a few other miscellaneous supplies that you will usually already have in your home, such as a plastic shower curtain liner, two sets of clean sheets, baby clothes and diapers, wash cloths, towels, healthy snacks for labor, comfortable clothes to nurse your baby in, etc.

19. Do you offer pain medication during labor?

Epidurals and other pharmaceutical pain medications come with risks of side-effects, and because of this, they are not safe to administer outside of the hospital. However, there are many natural and safe techniques to help with the intensity of labor and birth. Pregnant people birthing at home use movement & position changes, vocalization, water (shower, birth pool/tub, or both), relaxation techniques and breath awareness, an exercise/yoga ball, massage, heat, a doula, acupuncture/acupressure, aromatherapy, music, visualization, hypnosis (Hypnobabies or Hypnobirthing), herbal and/or homeopathic remedies, and more.

20. What happens if I change my mind during labor and I want to go to the hospital?

I will always honor your birth journey, knowing that it is yours and yours alone. If you change your mind at any time during labor and ask to transfer to the hospital, I will first make sure there is nothing else your support team and/or I could do to assist you in having your baby at home, and if you are then still certain that you would like to transfer, I will assist with facilitating a smooth transfer to the hospital.

21. What if something goes wrong?

Healthy, low-risk clients generally stay healthy during pregnancy and have normal births. If a complication does develop during pregnancy or labor, there are usually clear warning signs well ahead of time that alert us and give us plenty of time to correct the issue and avert any potential problem or make a plan to calmly transfer to the hospital before the situation becomes emergent.

Certified Professional Midwives are experienced and trained to recognize and manage abnormal situations that may occur during pregnancy, labor, birth, or postpartum. I bring emergency equipment such as anti-hemorrhagic drugs to manage excessive bleeding, oxygen and resuscitation equipment for both mother and baby, and IV supplies to all births. I also bring a skilled birth assistant trained in both neonatal resuscitation (NRP) and cardio-pulmonary resuscitation (CPR) to every birth.

In your third trimester, we will create an emergency care plan that we will implement if an issue arises during labor that warrants a transfer to the hospital.

22. What if I tear? Can you suture or will I have to go to the hospital to get stitches?

A healthy diet rich in fresh, raw fruits and vegetables, an active lifestyle, adequate vitamin D from sunshine and/or supplements, waiting for the urge to push and gently assisting with pushing urges, perineal support, warm perineal compresses, and laboring and pushing in warm water can all minimize your risk of severe tears. Most tears that do occur in healthy clients are minor and may need few or no stitches at all. I am trained and experienced in the repair of 1st and 2nd degree tears, and bring all suture instruments and supplies (including lidocaine local anesthesia to numb your perineum and vagina) to every birth. In the rare event of a 3rd or 4th degree tear, I will accompany you to the hospital where you will be sutured by an obstetrician experienced in the repair of these more complicated tears.

23. Isn’t homebirth really messy? Who will clean up after the birth?

This is a common misconception. Homebirth really isn’t all that messy. Most pregnant clients do not lose their waters in a huge gush like we see on the television, and instead have a slow, steady leak that can be contained by heavy-flow menstrual pads or adult protective underwear. When pushing your baby out, there is usually more amniotic fluid that comes out with and after the baby, and this fluid is usually caught and absorbed by chux pads under your bottom. Postpartum lochia (blood) is also caught and absorbed by chux pads. You don’t have to worry about any mess, though. My assistant and I clean up all the mess, including disinfecting the birth area, taking out the trash, and washing the birth laundry. By the time we leave, no one will be able to tell that you gave birth at home.

24. Should I hire a doula, too?

A doula is a professional labor support person. The doula offers information, support, and tips for coping with labor, and helps your partner to be the best labor support person he/she can be. Assisting a laboring mother can absolutely be a team event. Unlike the midwife and birth assistant who are responsible for monitoring the health of the birthing client and their baby, the doula's sole responsibility is to support and encourage you during labor and birth. There are also postpartum doulas who help support you emotionally and physically after your baby is born. I greatly enjoy working with doulas and encourage you to research if hiring a doula is right for you and your family.

25. Will you take care of the birth certificate and social security card paperwork?

Yes. Within 5 days after the birth, I will file the necessary paperwork to obtain your child’s birth certificate and social security number. When it is ready, you will be able to pick up a copy of your child’s birth certificate from your local vital statistics office (for a fee of around $12 or so), and your child’s social security card will be sent to you in the mail within 4 to 8 weeks.

26. Do you examine my baby when he is born, or will I have to go immediately to a pediatrician’s office?

I perform a comprehensive head-to-toe newborn examination after your baby is born, including weighing and measuring your baby, and administering antibiotic eye ointment and the vitamin K injection if you choose. I will then fax a copy of the newborn exam form to your pediatrician.

At your 48 hour visit, I use the pulse oximeter to screen your baby for critical congential heart defects (CCHD) and perform the newborn metabolic screening (aka PKU or “heel poke test”).

It is your responsibility to contact your pediatrician and schedule an appointment for him/her to see your baby within the first 48 hours after baby’s birth.

27. I have been seeing an obstetrician for this pregnancy and am due soon. Is it too late to switch care providers and have a homebirth?

As long as you have been receiving regular prenatal care and are considered healthy and low-risk, there shouldn’t be a problem with switching into my care. I will request your medical records from your previous care provider, and we will continue your care right where you left off.


QUESTIONS?

Please don't hesitate to contact me today at 904-547-0760 or send me an email at midwifemelissamarks@gmail.com.