AquaNatal Midwives’ Frequently Asked Questions

We realize there are many important questions you have about AquaNatal Midwifery, so we've compiled a list of commonly asked questions for you to see in advance so that your consultation time can be maximized. If you don't see your question here, please feel free to ask it during your consultation.

What are your fees? What do they include? When is payment expected? Does insurance or Medi-Cal cover your services? Are prenatal and postpartum visits included in price?

At $5500 for a global fee, AquaNatal fees are approximately 50%-75% less than the average uncomplicated hospital delivery. As well, we provide reasonable payment terms for all services not covered by insurance.

We feel the quality of personalized care and attention received at AquaNatal Midwifery is worth investing in. Midwives and Birth Centers enjoy better health outcomes for mothers and babies than hospital care. There is no comparison!

We offer a wide variety of payment plans and discount options. Among others, an additional benefit of our complimentary consultations is that our financial/insurance staff will investigate your insurance plan and provide you several options. We will certainly find a plan that works best for you & your financial situation!

 We provide the coding and electronic claims processing to your insurer, and answer any questions they may have about your care.  And we assist you to discover early on what reimbursement you might expect from your insurer.  However we are not contracted with any third-party payer at this time.  Which means basically -- that you pay the birth center's global fee -- and your insurer reimburses your for your expenses, less any deductible and co-insurance.

The following is a summarized list of services included in our fees:
Routine prenatal visits (once a month until 28 weeks, every other week until 36 weeks, weekly until delivery).

• On call Midwife 24 hours
• Comprehensive health physical and pap smear
• Out of Hospital Birth Details Class
• Breastfeeding Class
• Baby Care Basics Class
• Labor
• Birth
• Postpartum care (Immediate, 3-5 days & 6 weeks)
• Immediate newborn physical
• Newborn assessment at the 3-5 day visit.
• 36 Week Conference (1 hour Birth Plan)
• Birth Kit and supplies
• Facility Fee
• Parent Educational Binder
   

How long have you been practicing and how many births have you been the primary midwife responsible? How did you receive your training?

The first baby Joyce "caught" was in 1975 while attending a homebirths with another US Navy wife, who was from Australia. The mid-70s saw a complete loss of qualified physicians after the Vietnam War ended, so US Navy dependent wives were being ‘shipped out’ to local Obstetricians.  By the time Joyce left Connecticut, she had been primary or secondary attendant at over 45 US Navy homebirths.  She arrived in San Diego in 1976 and started do homebirths with local midwives there and with Dr. Richard Butcher, a homebirth physician at the time.  Leaving midwifery in 1985,  Joyce enrolled in graduate school, completing a Masters in Healthcare Administration from the University of LaVerne in 1987.  She also gave birth that year to a tiny 2 ½ pound preemie, who was born at 31 weeks after her membranes ruptured prematurely.  Joyce returned to midwifery in 2004, enrolling in the 3-year National College of Midwifery, in Taos, New Mexico, one of the 2 universities which have distance-learning for midwives in the United States.  She performed most her clinical work at a birth center in Los Angeles, “caught” more babies at the Casa de Nacimiento birth center in El Paso, Texas, and went to Tijuana with Elena (who is a Medical Doctor there) to complete her hospital rotation.  

Elena Navarro has been a Licensed Midwife since 1997 when she successfully challenged the licensing process available at that time from the California Medical Board.  Elena has been the primary midwife at over 1200 births and hundreds more as a student or assistant.   Between the AquaNatal midwives, they have combined attended over 1600 births!

Why did you become a midwife?
It was through Joyce’s and Elena's own experiences that they became professionally interested in pregnancy and alternative childbirth. Never having the chance to give birth at home or in a birth center, both midwives take great  pleasure in helping women have their choices honored.

Are you certified or licensed?  BOTH!
The AquaNatal midwives are either Certified Professional Midwives through the North American Registry of Midwives (NARM).  They are also Licensed Midwives, licensed by the California Medical Board and accredited by the North American Registry of Midwives.

What happens if two people are in labor at once?
It has happened before! We have a unique practice in that we have two midwives on call and a back up midwife to ensure that any woman in labor will receive the attention she requires. We also encourage all clients to hire their own birth doula to assist them at home prior to active labor.

Who is your back up doctor? What hospital is s/he at?
We have the privilege of working with several area doctors with a variety of hospitals in which they have admitting privileges and will consult or refer to them accordingly depending on the situation at hand. These hospitals include Pomona Valley Medical Center, Doctors of Montclair and San Antonio Community Hospital!

Do I need to see him/her prenatally?
It is not necessary, as we practice independently of physicians. However, if you are an HMO insurance subscriber, it is advisable to remain in contact with your assigned doctor in the case of non-emergency transfer is necessary or in case of transfer out of care.

What situations do you consult him/her for?
We may speak with a consulting physician for reasons ranging from labs to results to treatment recommendations to discussions of risk assessment for any developing problems. For example, we will consult with the physician for some of our mothers who are being managed for hypothyroid or those who have a threatened miscarriage and in need of hormonal treatment to support the pregnancy.

We also consult with an acupuncturist, herbalist and homeopath for natural remedies and support.  We utilize the talents of a local chiropractor, Dr. Debbie Runyun, who is certified in the Webster Technique.  It is a specific chiropractic maneuver which can tn a breech presentation to vertex (head down) or turn a posterior presentation (baby facing your back) to the correct anterior presentation (baby facing front).

What's your hospital transfer rate? What's your Cesarean rate?
Following you will find the average statistic rate for some of the most commonly asked categories.

• Non-Emergency Transportation to Hospital: 12%
• Emergency Transportation to hospital: <.005%
• Cesarean Sections: 6%
• Episiotomy: <1%

Approximately 85% of those clients requiring non-emergency transportation to the hospital were for some form of failure to progress.

How many families do you accept per month into your care?
We do not exceed 15 women with due dates in each month. Because some go early, some go late, and some right on time, we help approximately 10 - 12 women with their babies per month. 

Months can easily fill up, so we encourage you to call today for your complimentary consultation and tour!  We also have FREE birth movies and tours the first and third Thursday of every month -- 6pm-8pm.  Call for current schedule.

Can you do Vaginal Birth after Cesarean? (VBAC's)
YES!  We are eager to assist you with a Vaginal Birth After Cesarean – as long as it is at the Birth Center.  You will love our big birth tubs – and they are what make your VBAC a success.  We also highly recommend Hypnobabies childbirth education, which Joyce is certified to teach, because it allows such complete and deep relaxation for mothers having a VBAC.

How do I contact you?
For general questions and inquiries, you can call us at the office during business hours. Our voicemail is available 24 hours a day. For our midwifery clients (during pregnancy and up to six weeks postpartum), a paging system is in place if you should need us for emergencies or labor in the off-clinic hours.  As one of our clients, you have our undivided attention, 24/7.

How do I get my lab work done?
We will collect your lab work in the office. It will then be sent and processed by the lab for testing and results. We will review the results with you over the phone or at the office.

What routine prenatal tests do you require?
We will offer to you all tests recommended by the the Midwifery Alliance of North America (MANA), the National Association of Registered Midwives (NARM),  American College of Obstetricians and Gynecologists (ACOG) and the California Association of Midwives (CAM), as well as those of the State of California. We will offer education on the screening, so that you can make an informed choice.

Some of those screens are:
"OB Panel" to show complete blood count (CBC), blood type, Rh factor, antibodies, rubella, hepatitis B, and syphilis status, and a random glucose result.
HIV screening
Hepatitis C screening
Pap smear offered if indicated or requested
Gonorrhea and Chlamydia screening
MSAFP (Maternal Serum Alpha-fetoprotein) screening between 15 - 20 weeks of pregnancy
Diabetes Screening Test and Anemia screening at 28 weeks
Group B Strep (GBS) screening at 36 weeks
Ultrasound* (indications may be suspected twins, unknown date of last menstrual period or conception)
Urinalysis with culture & sensitivity
Non-stress test (NST)*
Biophysical Profile (BPP)*
* indicates test is NOT routinely performed

What method of childbirth preparation is recommended or taught?
We offer HypnoBabies complete childbirth education. Most classes are also taught in the birth center.  We also hold Waterbirth classes, Sibling Classes, Breastfeeding classes and Support Groups, and BellyDance for Birth AND AquaNatal Water Exercise for Pregnancy & Birth classes.  Call for our current schedule.  

GO TO WWW.AMAZING-BABIES.COM and check the upcoming Chino Valley Hypnobabies schedule!  We limit these classes to only 5 couples for personalized education and training.  So, please DON'T WAIT to sign up! 

How long are prenatals? Who does them? Where do you conduct prenatal examinations?
Your first visit with us is approximately 1 hour long. We will conduct your history review, take care of lab work, and physical examination. Each visit after that will be 30 minutes, with the exception of your 36 week visit. At that time, we'll spend an hour with you for your prenatal exam and birth plan conference. The visits are conducted at the birth center with one midwife and one assistant.  If you are planning a homebirth, your 36 week visit is at your home, with your birth team present, too.


Do you use a Doppler or fetoscope? Why?
During prenatal visits we can use a Doppler or fetoscope to assess fetal heart tones. At birth, a Doppler is preferable as it is quick, audible by speaker, can be submersed underwater without having you get out for fetoscope use, and doesn't require you to be repositioned.

What situations should they occur, would I be too high risk for homebirth?
Some of the other common exclusions from our care would be multiple gestations, insulin dependant diabetics, epilepsy, preterm pregnancy, substance abusers and                   hypertension that cannot be controlled by diet and exercise.

In what situations will you transport?
If a mother should decide she needs pain medication or anesthesia, a transport becomes necessary as we do not have these medications available at home or in our birth center. Such medications increase risk and must be monitored in the hospital. A woman may have become exhausted and in need of compassionate use of medication to help her rest and progress before complications arise due to her fatigue. If a non-emergency transport is recommended, it will be because we have exhausted all resources available (i.e. homeopathy, herbs, etc.).

What complications have you handled? How did you handle them?
Briefly, many complications can be and are handled at home or in the birth center without further incident. For instance, a cord around the neck, shoulder dystocia, fetal distress, maternal exhaustion, dehydration, postpartum hemorrhage, and newborn respiratory distress. If the situation cannot be stabilized, we will not hesitate to call for emergency assistance and guidance.

What emergency equipment and medicine do you have?
Basically, we carry more emergency equipment for a mother and newborn than what is found on an ambulance (paramedics provide the safe ride). Our birthing suites are have supplies and medications equivalent to a Level I labor and delivery room in a hospital.  We carry the same equipment to our home births.  We have all of the equipment necessary for resuscitation (includes oxygen and suction) and postpartum hemorrhage (includes IV fluids and medication), among many other things. Because our supply list is so extensive, we can provide you with a list at your consultation upon request.

When will we meet during labor?
This is based on each woman individually. You and your partner will be instructed on how and when to call the midwife (at the 36 Week Conference and Birth Class). Instructions for first time mothers are different from those who have had previous births. Adjustments will be made according to previous labors and distance from midwife or birth center. Occasionally a woman may need to be evaluated in early labor (about 1-4 centimeters dilated) and offered recommendations of homeopathy, herbs, rest, etc. Once a mother is in established active labor (about 6 centimeters dilated), the midwife and team will join the family.

At what point after the birth will I or you leave?
Certain safety criteria must be evaluated before the client is discharged or the midwife leaves the home. The newborn must be stable (we will assign Apgar scores) and physical within normal limits, with no signs of respiratory distress. Mother must also be stable, including her vital signs, postpartum bleeding to a normal amount, and breastfeeding established.

After your baby is born, we will ensure everyone is happy and healthy, then leave the new family alone for a chance to get to know each other and nurse. After a time we will return and offer to help mom up to the bathroom, assist her with a shower or bath to refresh herself (if sutures are needed, we will do this before the shower), then back to bed (or wherever mom is most comfortable). We will provide a complete newborn physical to the baby (assessing heart, lungs, weight, and measurements), dress him or her, and once again leave the family alone, while we do clean up and charting. Then we will say good bye after approximately 2-4 hours. The midwife will then be in touch with the family in the day following birth. This is an approximation for a normal, uncomplicated delivery. We have stayed up to 14 hours postpartum before and will not leave until a level or "normalcy" has been met. We will see her with the baby at the birth center for the beginning of her postpartum visits (3-5 days, 1 week and 6 weeks).  This is subject to change of course, if there are any complications following the delivery that must be attended.

What procedures do you require on the newborn?
We are required by the state of California to offer antibiotic eye ointment (erythromycin in a vaseline-like salve) to prevent infection caused by undetected or untreated gonorrhea and/or chlamydia infection (we can screen you, at your request, for these infections at a prenatal visit). Also offered is a one-time injection of Vitamin K (0.5mL) or 3 doses of oral Vitamin K to prevent Hemorrhagic Disease of the Newborn. We encourage mothers and their partners to educate themselves and make an informed decision as to whether or not they would like to proceed. You have the option of refusing treatment with a signed waiver.

A Newborn Screening Test, a heel stick for blood collection, will be offered between 2 and 6 days after birth. It is required of the state of California that you have proof of the test or a signed waiver for it in order to apply for a birth certificate for an out of hospital birth. We can administer the test at the birth center or have you sign a waiver if you decline the collection

Who may I have with me at the birth?
You may have anyone you like at your birth and who is supportive and inspiring to your choices. We strongly urge our clients to surround themselves with positive, helpful people. We will help maintain your vision of birth. Please remember that this time is all about you and your family.  When choosing who to have present, please consider “how will this person support me at this important time in my life?", do they provide loving energy, can they help with my children or prepare food.  Remember, you need to be able to let go during birth. Our 6th Hypnobabies class is an actual Birth Rehearsal and welcome you to bring anyone you may be thinking of inviting to your birth. We will also serve as your guardian and see to it that unwanted guests do not find their way in uninvited. We hope the class will give everyone a sense of what to expect at the birth and what should be expected of everyone: A prepared birth team and family with love and support make for a wonderful birth!

What happens if my labor goes on for days?
Herbs help to decrease the time of labor, but pre-labor might last days! As long as mother and baby are doing well, there is no need to intervene. We encourage you to continue to eat, drink, and rest for the long haul. Women who aren't able to do these things often become dehydrated and exhausted, which increases the possibility for unwanted interventions or transfer to hospital. We encourage you to go about your every day activities in early labor and enjoy the beginning of the final journey to meet your baby!    Get plenty of sleep -- you don't want to go into active labor with no sleep.

What happens if it's so fast you miss the birth? Have you ever missed a birth? Why?
From the time you contact us and we determine it is time for us to be with you, we will be in constant contact as we make our way to your home or you to the birth center.  There have been times when the baby has come as we were en route, but never en route to the birth center. In those very few times, we will be on the phone with the partners of the mothers and coaching them through the birth of the baby. Reasons why the baby comes faster than us are between the baby and Mother Nature! Once a mother was unsure if it was time to call us, while another time the baby surprised his mother with a 20 minute labor after her older child was born after 18 hours of labor. You will be briefed on Rapid Childbirth at our Birth Details Class.

What homeopathics,  pharmaceutical drugsand/or herbs do you use prenatally and at births?
This is very specific to each woman.  While one woman may prefer pharmaceutical remedies, the next will prefer homeopathy or herbs. We are flexible and will work with you to see that you are using the most effective remedy or medicine to fit your situation. That said, we do recommend a herbal combination in the last four weeks of pregnancy, along with prenatal vitamins for use throughout. We carry herbs and homeopathy for a variety of uses to every birth. They may or may not be used depending on what the mother needs as well as her preferences.

Whether it's herbs, homeopathy, essential oils, prenatal vitamins, minerals, personal care items, we have most of them in stock and available for purchase at the birth center.

When will you use the following: Pitocin or Methergine, newborn resuscitation equipment, oxygen, suturing materials, IVs?
Pitocin and Methergine will only be used in the case of excessive bleeding after the placenta has been delivered. In the case Pitocin becomes a necessary intervention in labor, a transfer to the hospital is necessary for fetal monitoring and IV administration of the medication.

We are both NRP-Certified and our newborn resuscitation equipment is always set up and ready at every birth. While many midwives only set it up as needed, we feel it is important to have it available on a second's notice.

Oxygen is also standing by in the case that mother needs to bring more oxygen to her baby as she labors or in the case of a baby who is slow to transition after birth.
Suturing materials (including anesthetic to numb the area) is available if necessary.
IV supplies are available for a variety of reasons, which might include the administration of antibiotics in labor (for treatment of group B strep for example), replenishing fluids due to dehydration, administering medication due to excessive bleeding, and to replace excessive fluids lost with bleeding. Starting an IV line is not routine.

Do you do a postpartum home visit? When?
Postpartum visits are usually conducted in our office unless mother or baby's condition warrants a home visit. Postpartum home visits are available for those interested!

Do you have birthing tubs? Do you do deliveries in water?
We have 2 great Waterbirth International tubs at the birth center, as well as birthing pools available for homebirth. We love water labor and births! The pain relief and relaxation offered by a simple pool of warm water is amazing! See Barbara Harper's (author of Gentle Birth Choices) website for more information on water birth