Frequently Asked Questions

I'm interested in homebirth, but just how safe is it?

 

Studies consistently show that planned homebirth with a skilled attendant is safe for low-risk clients. Up until recently the only studies available were studies using birth certificate data which included many births that were not planned to be at home or for which the family did not have adequate prenatal care. The Midwives Alliance of North America (MANA) has been collecting high-quality data on planned homebirth as part of the MANA stats project. Studies using this data are just emerging, but are demonstrating that planned homebirth is safe. The results of two of the biggest and most recent studies can be seen by clicking here.

Isn't homebirth super messy? 

 

Birth can get messy, but we have ways of handling that. We use chux pads, towels, and a cover for your mattress. We recommend an old set of sheets and towels that you don't mind getting messy. After the birth, we do all the clean up for you. We change your sheets, start the laundry, take out the garbage, as well as empty and take away the birth tub. We joke that your house is sometimes cleaner after we leave than when we arrive. 

I rent my home/apartment, or, my home/apartment is small. Can I still have a homebirth? 
 

Absolutely. However, in some situations when space is tight, we may not have room for a birth tub.

Do you offer waterbirth?


We sure do. Many of our families utilize water in one way or another during their births. This may be as simple as  showering during labor. Sometimes folks will use their own large bath tub in their bathrooms. Others will use a blow up birth tub with a liner filled by hose. Some only use the tub for relaxation and pain relief during labor. Others will actually give birth in the tub. The choice is entirely yours.  

Will you accept VBAC (vaginal birth after cesarean) clients?
 

Yes, if certain criteria qualify you as good candidate for an out of hospital VBAC.

What happens in an emergency?

 

Emergencies that require immediate medical attention at a homebirth are rare, but they do happen. Proper screening, risk assessment during pregnancy and birth, appropriate monitoring, and close personal care reduce the risk of encountering an emergency at home. I carry medications and equipment to stabilize client and/or baby while waiting for more advanced medical care to arrive or while in transit to a medical facility. I carry oxygen , medications to help control postpartum bleeding, IV fluids, and other life-saving equipment. I am certified in CPR and Neonatal Resuscitation.

 

While some emergencies require a call to 911 for medical transport, most hospital transports from homebirths involve a non-emergent need such as exhaustion during labor and the need for medications to relieve pain in order to get adequate rest, need for medications to augment a slow labor after trying everything we're comfortable trying at home, or early indications that client or baby could need more advanced care during labor and/or birth.

 

In the case of an emergency or non-emergency transfer to the hospital I will remain with you and/or your baby as long as necessary to provide support and help you navigate the situation.

Can you be my midwife for a hospital birth?

No. I am a homebirth midwife. I do not have hospital privileges. I do not have a back up obstetrician nor do I work under the supervision of a physician. In the event that a client needs to transfer to the hospital from a planned homebirth, their medical care is transferred to the on-call hospital doctor. In case of transfer to the hospital, I stay with my client even though I am no longer the medical care provider for her birth. I resume care after she leaves the hospital. 

Can you be my midwife at a birth center?

No. Currently there are no legal free standing birth centers in the state of Nevada.

What is your fee?

My fee is similar to the fees charged by other midwives in the area. It varies based on your payment schedule. Families who pay in full before their due date are extended a sizable discount. I offer a significant discount for Medicaid eligible families. Please contact me for an estimate based on your particular situation.

My fee includes all your prenatal care, on-call availability 24/7 for urgent issues or emergencies and labor for the duration of your pregnancy and postpartum period, my attendance at your birth with a trained assistant, the use of my equipment and medications at your birth, newborn care and examination, newborn screenings that you choose (hearing, metabolic, or CCHD), newborn eye prophylaxis and vitamin k administration if you choose, postpartum visits for you and baby on days 1, 3, and 7 in your home, and office visits at 2-3 weeks and 6 weeks.

 

A $500 non-refundable retainer is required to hold a spot on my calendar. I only take a limited number of clients each month. Full details will be covered as part of the financial agreement that we will sign before we start care.

My fee can be negotiable. I offer flexibility in payment plans, and I will even consider barter/trades if you have goods or services that would be valuable to my family. It is my hope that every family who wants a homebirth can find a way to have one. I also need to honor the fact that my time is valuable. I am open to creative options.

Are there additional costs outside of your fee?

There are a few expenses which are not included in my fee. Sage Springs clients are responsible for the cost of any labwork or ultrasounds. Additionally, you will need some supplies for the birth. I will provide you with a list of these items. I have created a premade kit for my clients to purchase. The cost of the kit is $50-135 depending on your needs.

Do I get a refund if we need to go to the hospital?

If your care needs to be transferred to a doctor or hospital in the last few weeks of pregnancy, during labor, or just after birth, we do not offer a refund. We will continue to provide support in the hospital and offer postpartum care as planned once you are back at home. 

If you need to transfer care before 34 weeks, we will bill for each prenatal and postpartum appointment individually instead of the full fee. I will provide postpartum care (if medically appropriate) for you and baby even if you have a hospital birth. If you choose to have me come to the hospital with you, my full fee applies.

Can you bill my insurance? 

 

Yes. We can contact your insurance company to get an idea of how much of your midwifery care they will cover. Coverage varies widely from company to company. Some may cover a good portion of the fee, others may not cover midwifery care at all. I use a professional billing company who knows the ropes and can help navigate the often complicated world of health insurance. We can provide you with an estimate of your financial responsibility. This is just an estimate and does not guarantee coverage amounts, even after speaking with your insurance company.

There is ALWAYS some financial responsibility for my clients. Even if you have 100% maternity coverage with no deductible, there will be certain charges/fees which are not covered by insurance.

 

Currently, Medicaid does not cover homebirth with a Certified Professional Midwife in Nevada.

I offer a significant discount for Medicaid families with proof of eligibility.

CLICK HERE TO LEARN MORE ABOUT INSURANCE

Amanda Macdonald, LM, CPM | 775-525-1669 nvmidwifeamanda@gmail.com

© 2019 Sage Springs Midwifery 

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Sage Springs Midwifery

12 W. Taylor Street

Reno NV 89509