Your Maternity Care |
Hospital Birth |
Non-Hospital Birth |
Insurance Coverage
Your Maternity Care
First Trimester Midwifery Care
The first pregnancy visit usually lasts 1-1/2 hours and includes a physical exam, review of the medical history, and an introduction to pregnancy care. Blood and urine specimens are collected. Genetic testing and infection screening are offered. Ultrasounds are ordered as medically needed. Clients learn ways to create a healthy environment for the developing embryo. Danger signs of pregnancy are reviewed.
Subsequent prenatal visits last about 30 minutes and are usually monthly, though may be more frequent as needed.
Second Trimester Midwifery Care
"I met Cindie when I attended my best friend's labor and delivery. I was 13 weeks pregnant and, after four previous miscarriages, scared to death. Given my history, I thought I had to choose an OB/GYN for my care. Four months later I realized I was still living in a place of fear and my doctor was doing nothing to sway that. I transferred my care to Cindie, who reassured me that my chances for having a nice birth were quite good. Throughout the rest of my pregnancy and 41 hours of labor, the care Cindie provided reminded me that the birthing experience is a natural, wonderful, and beautiful process."
- Heather MacMillan, Redmond
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Nutritional counseling continues to be a focus of Cindie's care during the second trimester. Genetic testing is routinely offered, and clients decide whether or not to accept this testing. An ultrasound is usually ordered at approximately 20 weeks gestation. Screening for anemia and gestational diabetes also occurs in the second trimester. At every visit from this point of pregnancy until the birth, there is an assessment of blood pressure, fetal growth and fetal heart rate.
Client questions and concerns top the discussions at these visits. However, Cindie also has an educational checklist that she flexibly applies to ensure all pertinent topics are addressed. These topics include nutrition, exercise, dealing with pregnancy discomforts, selecting appropriate childbirth classes, registering for your place of birth, and much more!
Third Trimester Midwifery Care
Preparation for labor, birth and parenting becomes a focus in the third trimester. Visits become more frequent. As before, they continue to monitor maternal blood pressure, fetal growth and fetal heart rate. Now the position of the baby is also noted. A vaginal culture for Group B Strep is collected in the last month.
Topics related to preventative health are discussed, including ways to facilitate a smooth labor and to decrease risk of perineal trauma. Early parenting issues are anticipated and discussed. If the pregnancy progresses a week past the due date, options for medical and nonmedical induction of labor are discussed.
Midwifery Care During Labor and Birth  Cindie typically provides phone support in early labor. She and the client decide together when to go to the hospital or birthing center. Cindie's presence is frequent during active labor. She monitors the safety and progress of labor, and offers her expertise in helping the labor to be as peaceful and productive as possible. Family, friends and doulas are welcome to participate according to the client’s wishes. In the hospital setting, this care is also complemented by the role of the labor nurse. If the baby is born in the hospital, usually Cindie and two labor nurses are the professionals present in your room. For higher-risk deliveries, obstetricians and/or pediatricians may also be present. If the baby is born at the birth center, Cindie and a trained assistant will be present at the birth. If complications arise, the client and/or baby may be transported to a hospital setting.
Enemas, IV access, food or fluid restriction, and continuous electronic fetal monitoring are not routinely used in low-risk births. The laboring woman and her partner play a large role in decision-making during labor and birth. All concerns are discussed together and the client's wishes are respected.
Postpartum Midwifery Care
If the birth takes place at the birth center, Cindie remains with her client during the early postpartum period. She provides early newborn care and breastfeeding assistance. Clients usually then go home a few hours after birth. Midwifery follow-up takes place through home visits and phone conversations during the first days after birth. Final office visits occur at 2 and 6 weeks postpartum.
If the birth takes place at Group Health Cooperative, Cindie remains with her client for at least one to two hours after birth. After this, the nursing staff is available to assist with maternal/newborn transitions. An on-call pediatrician evaluates the newborn before discharge to home. Most clients go home the day following a vaginal birth. Cindie makes daily visits to clients who are in the hospital. She then contacts her clients by phone the first days after birth. Final office visits occur at 2 and 6 weeks postpartum.
Hospital Birth
"I appreciate Cindie's knowledge and focus
on nutrition. I think this is very important and it is often lacking
in pregnancy care."
- Michelle Pearson, Seattle
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Cindie attends hospital births at Group Health Cooperative in Seattle, which is absolutely the best hospital in Seattle for midwifery births! (Many outside insurance plans cover this facility. Refer to Insurance Coverage.) Group Health's Family Beginnings unit, located on Capitol Hill in Seattle, is to be highly commended for having the lowest cesarean rate of hospitals in the state of Washington. It boasts a rate of 16 to 17 per cent, which is nearly half the rate of most Seattle-area hospitals. The rate of cesarean in 2003 in Washington State was 27 per cent.
CDC National Center for Health Statistics, Preliminary Data for 2003
Midwives attend the majority of births at Group Health, and hospital policies are developed with a keen eye toward the latest research. The consulting obstetricians are all board-certified and highly skilled to manage emergency situations. They are also respectful of the variations in normal labor and of the desires of the individual patient. An obstetrician is always present in the Group Health facility, so his or her expertise is immediately available if needed.
All birthing rooms are designed to support the family through labor, birth and postpartum. Each room has a labor tub, refrigerator, TV/VCR, CD player, soft-lighting options and a sleeping place for partners.
The nurses are experienced at supporting women through both medicated and non-medicated birth. They also have received training in breastfeeding so know how to help baby and mom make the most of first feedings.
While most babies remain in the room with their parents during their hospital stay, the nursery supports those needing more specialized care, with neonatologists on-call 24 hours daily.
For driving directions and more information about Group Health’s Family Beginnings unit, click here.
Non-Hospital Birth
If you have a low-risk pregnancy, you may choose to give birth at the Community Birth and Family Center. The birthing center has two beautifully-furnished birthing suites which are fully equipped with all the safety and emergency equipment required by the Washington State Department of Health. Each suite includes a queen-size bed, fresh linens and towels, a stereo, candles, windows that open for fresh air, a private bathroom and a large tub. Also available are a birth sling, birth stool, squatting bar, birth ball and hot and cold packs. The Arboretum is only a few blocks away, providing a lovely walking place if labor slows down. All the people present at your birth would be those who are familiar to you.
The birth center hosts several classes focusing on pregnancy and parenting. It also has a resource center with books and literature on topics of interest.
Most insurance plans cover the cost of delivery at the birth center.
For more information about the Community Birth and Family Center, click here.
Insurance Coverage
Many insurance plans do cover facility fees at Group Health Cooperative (GHC) in Seattle. Unfortunately, Cindie is not able to accept clients who have Group Health insurance. It is best to inquire directly with your insurance plan to confirm coverage of Cindie as your provider and to confirm GHC as a contracted hospital for delivery if you are planning a hospital birth.
If your insurance does not include GHC as a contracted facility, consider:
- upgrading your insurance plan to one which includes GHC, or
- paying out-of-network costs for delivery at GHC (sometimes this percentage is not largely different than in-network), or
- writing a letter to request an exception for delivery site.
Most insurance plans do cover facility fees at the Community Birth and Family Center.
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