Who is eligible to birth with Licensed Midwives either at the Birth Center or at home?
Who is considered low risk?
When should I begin midwifery care?
What is the difference between Birth Center Birth and Homebirth?
Do you take insurance?
Is there a discount in your fee if I start later in my pregnancy?
When can I birth with my midwife?
What happens if I need to transfer?
If I transfer do you come with me?
Why doesn’t my midwife come with me for a non-emergent transfer?
If I transfer are you still my midwife?
If I transfer do I get a discount/reimbursement?
What if I don’t want labs or ultrasounds?
Do you still recommend hiring a doula if I have a midwife?
Any pregnant person who is low risk is eligible to birth with a Licensed Midwife.
Licensed Midwifery care is ideal for people who wish to allow their bodies to birth as undisturbed as possible, while having skilled midwives present to monitor safety and well-being, as well as guide the birthing process as needed to ensure the best and safest outcomes.
Out-of-Hospital Births are ideal for those who desire to birth without medical pain management, as midwives’ skills and portable, waterproof equipment ensure safety and monitoring benefits without compromising your options for continued movement, positions, and access to water in labor.
These options, along with the emotional and mental support provided by midwives enable to you more easily cope and move through the intensity of labor than in a traditional hospital setting.
This question can be somewhat confusing because risk is assessed in different ways by different providers who practice in different birthing settings.
Common risk factors given in obstetrical care – including advanced maternal age, reoccurring miscarriages, or vaginal birth after cesarean, can almost always be mitigated and classified as low risk with in-depth midwifery care. In the same way, some things that obstetrics does not consider high-risk, including certain lab values or ultrasound results, will risk you out of midwifery care.
The best thing to do is schedule a consultation with our midwives in order to discuss your personal health and pregnancy history to see if you are a good candidate for an out-of-hospital birth. We often work with people who have complicated health and birthing histories to help them realign their body in a healthy way so that they can be qualified as low risk.
Choosing midwifery care also means you are choosing to be an active participant in your prenatal care through more conscious nutrition and hydration, daily supplements, and overall body health and movement in order to qualify as low risk for out-of-hospital birth.
As your midwives, we take your health and wellbeing seriously, and our entire focus during prenatal care is to help you become the healthiest version of yourself.
We often have people inquiring about care later in pregnancy, stating that they were waiting “to make sure everything was low risk”. This is NOT ideal for midwifery care. The best time to begin care with a Licensed Midwife is as EARLY as possible, for two reasons.
1. Obstetrical care views low risk differently, and many people have been told they were low risk by their OB, only to find out that under midwifery care they have multiple high risk factors and now have very little time to correct these issues before delivering.
2. Midwives limit how many clients we take per month in order to ensure our availability. If you wait too long to hire a midwife, we could easily be full and not able to take any more clients during your “due window”.
Many of our clients begin care with us even prior to conceiving – and this is ideal. Midwives are able to do hormonal testing, all early pregnancy genetic testing, as well as order all the same ultrasounds as obstetrical care providers. We also tailor our care to each client, so we review all the options for labs, tests, ultrasounds and more and you choose the ones that feel right for you, your situation and your pregnancy.
Often when we have clients come into care later in pregnancy, it is very difficult for us to get everything into range for midwifery care, and clients can often feel overwhelmed. Obstetrical “low risk” care and lab ranges are not the same as Licensed Midwifery care ideals. Being told you are low risk by your OB does not mean you will automatically qualify for an out of hospital birth, so the sooner you start with your midwife, the better.
We see many more transfers in labor with clients who begin care later in pregnancy, simply because their physical and mental preparation are not always able to be as ready and ideal for labor when they begin care later in pregnancy.
However – even if you are already later in your pregnancy now, don’t hesitate to give us a call. It can still be well worth coming into care with a midwife even if you are later on. From time to time we are able to take late-transfer clients – if we still have space – and we will work tirelessly with you to quickly get everything in place in order for you to have your best and safest out-of-hospital birth experience.
Essentially birthing at our center or at your home are the same. The birthing equipment and emergency options are the same – including water labor/water birth pool, emergency equipment and medications, birth stool, rebozo, and more.
Pros of birthing at the birth center are: Lower cost, as midwife team does not having to transport, set up and take down the extensive birth kit equipment and pool, as well as less drive time for the team enables us to provide services at a lower cost. You also do not have to buy the birth kit, prepare your home or gather the list of additional supplies required for a home birth.
For some of our clients it is also better because the hospitals close to the birth center are ideal hospitals in the event of a transfer, verses some people’s home location which may not have good hospitals in the area, or even can be further from a hospital in general.
Pros of a home birth are: Not having to drive to the birth center in labor and not having to transition back home several hours after delivery; and being in your own space.
We work with insurance as much as possible to mitigate cost for all our clients. For most of our clients with PPO insurance as well as most MediCal plans, we are able to have you lab work and ultrasound visits covered up front with no out of pocket costs.
For private PPO insurance plans, we also partner with a billing company, EarthSide Billing, in order for clients to be reimbursed for as much of their midwifery fee as possible. Unfortunately for HMO or MediCal insurance plans, no reimbursement options are possible, which is why we offer several discounts and payment plan options.
Typically your midwifery fee is paid through monthly payments that are calculated by dividing your total between the month you begin care until the month you are due.
We offer scholarships for our BIPOC and LGBTQ+ families. We also work with a financing partner, United Credit, who can cover your midwifery cost with a long-term, affordable payment plan.
We understand that midwifery care can be a huge sacrifice and our goal is to help you find ways to cover your cost in order for you to be able to receive the care you deserve.
The later in your pregnancy that you start care, the more difficult and time consuming it is for our team to care for you and ensure you are safe for an out-of-hospital birth. Also, the vast majority of the care and time is invested at the end of pregnancy. So no, there is no price discount for starting care later in pregnancy.
Starting care later in pregnancy requires that our team request all of your previous records, upload many pages of records by hand into your account, give you months of education and recommendations in a short amount of time, review all of your current and past health history in depth to ensure you are safe to birth out of the hospital, and more.
Often to get someone qualified and prepped for their birth when they are already late in pregnancy can also require many hours of admin work over the weekend to ensure everything is ready in time.
The goal is for everything to be in range and up to date by 37 weeks, as that is when you are legally able to birth outside of the hospital. In order for your midwives to go on-call for you at 37 weeks, your chart and values must be complete and in-range. Otherwise, if you go into labor before we have all of your previous records, or before all your current lab values in range, you would be transfered to the hospital to give birth.
There are different types of transfers – either non-emergent, or emergent transfers, which can both happen before, during or after labor.
The most common time to transfer is a non-emergent labor transfer. This typically happens because someone has a long labor, become exhausted and stops making progress.
Occasionally we have a prenatal problem that risks someone out including genetic condition of baby, preterm labor, hypertension or lab values that can slowly, or suddenly, become high risk.
Even more uncommon is to have a transfer that is emergent and happens by ambulance. Your midwife will typically stabilize everything as much as possible while waiting for the ambulance, and almost always transfer with you in the ambulance during an urgent or emergent transfer.
Typically, with any emergent or urgent reason for transfer, your midwife WILL accompany you to the hospital and stay with you until the situation is stabilized.
For non-emergent transfers your midwife does NOT typically accompany you. Your midwife DOES arrange and facilitate the transfer with you, recommending and organizing which hospital to transfer to, based on your wishes, personal factors, and current situation.
Your midwife will call the hospital and speak directly to the staff who will be receiving you, giving them a full report of your situation and reasons for transfer and fax over all your records. This way they are expecting you, prepared to receive you and have your prenatal history for reference.
Throughout your hospital experience, your midwife is available for virtual support as needed, available for input, support and recommendations.
Because non-emergent transfers typically happen for exhaustion of the birthing person during very long labors (multiple days), your midwife has generally been up without sleep for many hours as well.
Most often in the situation you are transferring to the hospital to receive pain relief (Epidural) in order to sleep and recover strength to continue laboring.
Non-emergent types of transfers usually take many more hours of labor in the hospital before delivery, and it is not safe or practical for your midwife to be up for such an extended period of time without proper sleep or food, especially since she is also on call for other families who may go into labor at any time.
Your midwife IS available for virtual support while you are at the hospital, and you can call or message her at any time for advice and input.
We want to be kept updated on everything you are experiencing, especially any hospital recommendations that seem invasive or unnecessary.
Even if you transfer, your midwife is still your primary care provider. However, we do not have hospital privileges, so while you are at the hospital we provide virtual counsel and support as needed, and then our active, in-person medical care resumes immediately when you are discharged back home.
No matter what type of transfer you experience, once being discharged from the hospital your midwife provides your complete postpartum care, beginning with your postpartum home visit, followed by three in-office postpartum visits scheduled through 6 weeks postpartum.
Transfers do not qualify clients for a discount. Transfers are almost always difficult situations that take more time investment and experience from your midwives than low-risk birth, and so require payment for your midwives’ time, skills and services rendered. Also, when you hire your midwife team, you are reserving one of the limited spaces in your due month, as midwives can only take a certain number of clients per month in order to ensure our availability – and so in essence, you are also “purchasing your space”.
Very rarely, we may have a client who needs to transfer care very early on in pregnancy (before 33 weeks) because of a rare, high-risk situation. Those clients do have the choice to either continue co-care and keep their midwife team for supportive and emotional care throughout their experience, or transfer completely out of care and discontinue midwifery services.
If clients choose co-care, they pay in full, as we give complete care including prenatal, birth and postpartum support in conjunction with your hospital team. If clients (who are transferring before 33 weeks) choose to discontinue care, then we do not continue to follow you through your pregnancy, birth or postpartum experience and you would only pay for services rendered.
Midwifery care is safe for low-risk people, and in order for us to ensure that you are low-risk, we must have certain labs and ultrasound results to confirm that you and your baby are healthy, and that it is indeed safe for you to birth outside of the hospital setting.
There are various lab and ultrasound options and schedules, and we go through all of the possibilities in detail with you throughout your care. For certain healthy people without any risk factors or symptoms, you can at times choose to waive some of the labs and ultrasounds if you would prefer.
However, we do require certain basic lab panels, and at least one full anatomy scan ultrasound, as well as additional ultrasounds and tests if you go overdue.
Yes! Doulas are amazing and we highly recommend hiring a doula to be part of your birth team. Your midwives are your medical care providers, and as such, we must always prioritize your medical health before emotional and mental support. Kindness, informed consent and shared decision making are built into our care, so we are never “checked out”, and always give care with informed consent, gentleness and love.
However, it is still so helpful to have a doula there who’s dedicated role is for emotional and mental support – not only for you, but for your partner, and even your other children and family members. It is also within the doula’s role to accompany you in transfer situations. This can be a huge support for clients that may need to transfer non-emergently to the hospital, as having your doula by your side throughout is so supportive and reassuring.
Doulas also offer postpartum care and visits, which is beyond helpful to families in the first few weeks of adjusting and surviving with a newborn. There are some scholarship options for doulas here in LA, as well as a new MediCal bill covering doula care as well. We will discuss all the options together and partner you with the support you deserve.