Frequently Asked Questions about Midwifery Services

 
Do you accept Medicaid or Insurance?
At this time, Texas Medicaid  does not cover homebirth midwifery services.  Many people with Medicaid coverage who want to have a homebirth work out a payment plan with MotherBloom Midwifery.  There is legislation and work in progress to create change in the current Medicaid reimbursement system to allow homebirth midwives to bill Medicaid, but there is much negotiating still to be done.

MotherBloom Midwifery does accept payment from private insurance companies.  I am affiliated with A&E and SLB Medical Billing Specialists, insurance billing agencies that advocate with the insurance companies on behalf of midwives and their clients. If you have health insurance with maternity benefits, you will be reimbursed accordingly once your insurance company pays the claim. I cannot bill for any services until after the birth and it can take several months for the claim to be paid.  Due to the low volume of my practice, I cannot accommodate this long delay in payment for my service. So, while I am willing to do insurance billing you should have a realistic view on how the system works and what will actually be paid back to you.

If you have insurance coverage, I can connect you with the billing agency at your first visit and they can explain the process for billing. It is necessary for MotherBloom to collect payment before the birth, and the billing agency has a fee also.

While I can provide insurance billing for clients, it is important to know up front that the current insurance system does not work well for midwifery care. The main reason is that medical billing is procedure driven, not time driven. In the medical insurance system there are technical fees and facility fees that are paid along with procedure codes and ultimately the whole reimbursement system is based on volume (most providers see a lot of patients and spend very little time with you). In the midwifery model of care we don’t do any procedures, we take a very small caseload and we spend a lot of time with our clients. So no matter what I do, even if I am an approved provider and you have no deductible to pay, the reimbursement for my care is very low. Another problem with the insurance comes up if we transfer care in labor to the hospital. If the baby is born in the hospital then we can no longer bill the global code (the maximum amount billable) for maternity care. At best, I can bill for prenatal visits and postpartum visits but the reimbursement for these visits is low. Typically, this comes to between $600-$800, minus any deductible you have. Sometimes insurance companies will not pay for the prenatal care as a separate charge at all or may have an exclusion for home birth. Please discuss this with me in more detail at your initial consultation.

Is routine ultrasound part of the care I will receive?
Routine ultrasound has become an expected component of prenatal care that many women desire. Ultrasound is like ordinary sound except it has a frequency (or pitch) higher than humans can hear. When sent into your body from a transducer (probe) resting on your skin, the sound is reflected off internal structures. The returning echoes are received by the transducer and converted by an electronic instrument into an image on a monitor, similar to a television screen. These continually changing images can be recorded on videotape or film. Diagnostic ultrasound imaging is commonly called sonography or ultrasonography.

Common uses for ultrasound in most medical practices would be:

  • Confirming the pregnancy
  • Dating the pregnancy
  • Genetic screening (1st trimester)
  • Targeted screening- looking for physical anomalies and gender (2nd trimester)
  • Locating the placenta-especially relevant for women considering VBAC
  • Bio Physical Profile (BPP)-evaluates the well being of the baby (post-dates or by clinical indication)
  • Hand held or bed side fetal monitoring in labor

I will discuss with you the schedule for routine ultrasound and the risks and benefits of an ultrasound exam. Though it is not a requirement, many women in my care decide to have an ultrasound, usually around 20 weeks.  There are several different locations that I can refer clients to for ultrasounds.  A physician or ultrasound technician will evaluate the ultrasound findings and send a detailed report to my office.  Sometimes there is a medical indication for an ultrasound exam. In this situation, I will describe the concern and how ultrasound could be helpful.  I will help arrange for the ultrasound and review the results with you, as well as follow-up on any further testing you might need.

Is Ultrasound Safe?
Ultrasound safety is still being studied. There are known effects associated with the medical use of sonography such as temperature and cellular changes, but they are not considered “harmful”. Widespread clinical use of diagnostic ultrasound for many years has not revealed any conclusive harmful effects and studies in humans have revealed no direct link between the use of diagnostic ultrasound and any adverse outcome.
Ultrasound use in pregnancy is considered safe in the medical model and is controversial in the midwifery community. There is research to support strong caution against routine ultrasound use, especially in the first trimester of pregnancy.

What the FDA has to say:

A United States Food and Drug Administration (FDA) report 1 states that ultrasound has been used for many years with no obvious detrimental effects. Nevertheless, current evidence is considered insufficient to justify an unqualified acceptance of ultrasound safety. The FDA report recommends that ultrasound be used only when a diagnostic benefit is likely, and that exposure should be limited to that required to produce the needed information.

The World Health Organization (WHO) of the United Nations, in its report on ultrasound 2, recommends prudence in ultrasound exposure to human subjects but agrees that benefits outweigh any presumed risks. The WHO report states that patients should be examined with ultrasound only for valid clinical reasons.

With regard to ultrasound scanning during pregnancy, the FDA states that “ultrasonic fetal scanning is generally considered safe and is properly used when medical information on a pregnancy is needed. But ultrasound energy delivered to the fetus cannot be regarded as completely innocuous. Laboratory studies have shown that diagnostic levels of ultrasound can produce physical effects in tissue, such as mechanical vibrations and rise in temperature. Although there is no evidence that these physical effects can harm the fetus, public health experts, clinicians, and industry agree that casual exposure to ultrasound, especially during pregnancy, should be avoided. Viewed in this light, exposing the fetus to ultrasound with no anticipation of medical benefit is not justified.”3

In conclusion, based on experimental and epidemiological data, there is presently no identified risk associated with diagnostic ultrasound. However, a prudent and conservative approach is recommended in which diagnostic ultrasound should be used only for medical benefit and with minimal exposure.

1 US Department of Health and Human Services, Public Health Service, Food and Drug Administration: An Overview of Ultrasound: Theory, Measurement, Medical Applications, and Biological Effects. Publication # FDA 82-8190. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1995002
2 Environmental Health Criteria 22: Ultrasound. World Health Organization: Geneva, 1982, p 19.

3 US Food and Drug Administration, Center for Devices and Radiological Health, Diagnostic Devices Branch. Fetal Keepsake Videos. Available at: http://www.fda.gov/cdrh/consumer/fetalvideos.html  

What prenatal tests do you routinely recommend and/or require?

The full fee for your care includes the cost of initial prenatal lab testing, including a complete blood count, blood type and antibody screen, and testing for viruses such as HIV and Rubella. As with everything during your care, you can make an informed choice about testing throughout your pregnancy. There will be additional costs for other blood tests, vaginal cultures, and any genetic screening you choose to do, as well as ultrasounds arranged at private doctor or radiology offices. These fees are frequently covered by private insurance and Medicaid.

What if I transfer care in labour?

If it becomes necessary to transfer to the hospital in labour due to prolonged or a situation that becomes unsafe in the home environment, I will accompany you to the hospital.  The midwives in Austin have a collaborative, usually seamless transport situation to an area hospital.  We call the hospital’s labour and delivery unit and they have a space waiting when we arrive, there is no need to go through the emergency room.  At the hospital I help liaise between the hospital staff and clients, staying with my families until after the birth of the baby.  I continue postpartum care as usual, assisting with breastfeeding and transitioning to parenthood.  Transporting to the hospital is usually not a “scary” or “dramatic” event in an emergency situation.  Often we just need more help for the baby to come out.  Transporting for more birth assistance with a first time labour does not make in necessary for second babies to be born in the hospital.

How many women are due within a month of my due date?

MotherBloom Midwifery strives to have 2-4 clients due each month.

What happens if two women go into labour on the same day?

While this happens rarely, it is usually not a problem to get help from my fellow Austin midwives.  We have a practice for backing each other up when necessary.

Do you ever induce labour? Do you use pharmaceutical products to do so?

Induction with drugs (pitocin or cytotec) is not part of my practice. If a medical induction is needed then I would make arrangements for that to happen in a hospital. Sometimes I recommend natural remedies; such as herbs, homeopathics, acupuncture or castor oil to try and stimulate labour or to make it stronger.

How comfortable are you with delivering babies of first-time mothers?

I am very comfortable attending first-time mothers at home. Typically, one third to one half of the women in my practice any given year are first time mothers.  It is a common misconception that it may be easier to have a first baby in the hospital with medical model care and then have the second or subsequent babies at home.

What kinds of pain relief can you offer at a home birth?
Many factors contribute to a woman’s perception of pain in labour. I find that with the continual support of skilled and familiar attendants, in a relaxed environment where a woman is at ease with her surroundings, a natural birth can be accomplished, often leaving a woman in awe of the power of birth. Midwives are able to offer a variety of methods to help women cope with the discomforts of labour including massage, hydrotherapy (including waterbirth), changes of position, bodywork and other methods all without associated risks of drug use to mother and baby.
What is your experience with pregnancy loss?
Anyone who has gone through pregnancy and birth has experienced the very real fear of a bad outcome, whether this is miscarriage or stillbirth.  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 someone who has chosen non-conventional birthing options, I am aware of the additional questioning and scrutiny that can accompany a bad outcome at home.

In my many years attending home births, I have experienced helping many women through miscarriages, difficult births, and one newborn death.

It is my desire to have complete transparency regarding my experience with birth at home. I welcome questions and discussion in order to help you decide where and with whom you would like to have your baby.

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