AquaNatal Birth Center's  Frequently Asked Questions

We realize there are many important questions you have about AquaNatal Birth Center, 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 Medicaid cover your services? Are prenatal and postpartum visits included in price?

AquaNatal Birth Center's 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 Birth Center 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!

The following is a partial list of Insurance companies we work with frequently and have seen steady results as far as reimbursement rates:

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 birth).
On call  Midwife 24 hours
Comprehensive health physical and pap smear
Out of Hospital Birth Details Class
Labor and Birth
Postpartum care (Immediate, 3-5 days & 6 weeks)
Immediate newborn physical
Newborn assessment at the 3-5 day visit.
35 Week Conference (1 hour Birth Plan)
Birth Kit and supplies
Facility Fees
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?
Between them, Elena and Joyce have assisted at over 1200 homebirths, births at birth centers, and even assisted at hospital births.  They have been trained in a variety of manners:  Elena has graduated from medical school and is a licensed Medical Doctor (MD) in Mexico.  In 2007 she challenged and passed the California Midwifery Challenge process and received her Licensed Midwife (LM) desgination.  Joyce was a homebirth midwife years ago in San Diego, having apprenticed an Australian midwife while she was a US Navy wife in Connecticut.  In San Diego, Joyce worked with one of the few homebirth physicians of the time, Dr. Richard Butcher.  Together they authored the California Midwifery Pilot Project, HMPP #146 in 1983 – a decade before the California Midwifery Licensing was available.  Joyce has graduated from a 3 year midwifery program:  National College of Midwifery and has passed the certification examination of the North American Registry of Midwives (NARM) which is the licensing examination for the California Medical Board’s “Licensed Midwife” designation.  Joyce was a homebirth midwife for over six years, left midwifery to earn a Masters Degree in Healthcare Administration (MHA) from the University of LaVerne, and work in healthcare administration for several years.  Both Elena and Joyce are mothers – Elena has 3 children, and Joyce has 4.  They both have sons the same age (11) – and Joyce has a grand-daughter:  Moira Elisabeth, age 14.

Why did you become a midwife?
It was through Elena and Joyce’s own experiences that they became professionally interested in pregnancy and alternative childbirth. They often refers to themselves as a "homebirth wannabes". They never had the chance to give birth at home or in a birth center, so they takes great joy in helping women have their choices honored.
Both midwives have dedicated their lives to assuring that women are empowered by their birth experiences and assure that everything that needs to  be done, will be done, in order for each woman to have the birth experience she desires.

What is your philosophy about childbirth?
CLICK HERE See our “We Believe” page for an overview. Link to “We Believe” page
Are you certified or licensed?  Both!
Both Elena and Joyce are Licensed Midwives, licensed by the California Medical Board and accredited by the North American Registry of Midwives.   Joyce has also passed the Certified Professional Midwife exam from NARM.  In addition, Elena is a licensed medical physician in Mexico.
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.

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 Hospital, San Antonio Community Hospital, Doctors Hospital of Montclair, and more!

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 herbalist and homeopath for natural remedies and support.

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.

Approximately 85% of those who required 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 12 - 15 women with “guess” dates in each month. Because some go early, some go late, and some right on time, we help approximately 10 -12  women have their babies per month.  Months can easily fill up, so we encourage you to call today for your complimentary consultation and tour!

Can you do Vaginal Birth after Cesarean? (VBAC's)
Yes we do, and quite successfully, we think because of the excellent care our VBAC mothers receives, nutritional counseling, more prenatal visits (every other week starting at 24 weeks), and waterbirth.  This combination of care, circumstances and waterbirth makes most of our “trial of labor” successful VBACs.

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.

How do I get our 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 at the office.  Usually the lab will bill your insurance, or you can make payment arrangements with them.

What routine prenatal tests do you require?
We will offer to you all tests recommended by the North American Registry of Midwives, the California Association of Midwives, American College of Obstetricians and Gynecologists (ACOG), 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                                                                                Hemoglobin A screening
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?
Childbirth classes are taught by independent teachers.  The only childbirth education we recommend and provide at the birth spa is Hypnobabies Complete Childbirth Education.  CLICK HERE for class outline, dates, registration, etc.

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 35-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 of our assistants.

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 mom get out for fetoscope use, and doesn't require mom to be repositioned.

Do you have birthing tubs? Do you do deliveries in water?
THAT’S WHAT THE AQUANATAL BIRTH CENTER  IS ALL ABOUT!  We have 2 specially-designed oversized Jacuzzi tubs at the birth center!  They are specially-designed for laboring in – and you can have your husband with you, too.  We also have  birthing pools available for rental.  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  CLICK HERE to order from our website. [Suggested Reading List page]

What situations should they occur, would I be too high risk for giving birth at the Birth Spa or having a homebirth?
While we do provide a “trial of labor” births after Cesareans (VBAC), breech presentations can not be offered at this time. Some of the other common exclusions from our care would be multiple gestations, insulin dependant diabetics, epilepsy, preterm pregnancy, substance abusers and hypertension.

In what situations will you transport?
If a woman should opt for analgesia 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 at the Birth Spa or bring to a home birth?
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 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 husband will be instructed on how and when to call the midwife (at the 36-Week Conference and Birth Details 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 woman is in established active labor (about 6 centimeters dilated), the midwife and team will join the family, at the birth center or at home.

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 aid in this process”, do they provide loving energy, can they help with our children or prepare food.  Remember, you need to be able to let go during birth. We offer a Birth Details Class 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!

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. 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 happens if our 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!  Many of our clients have had “special labor projects,” with their children or family members:  scrapbooks, photo albums, “birthday” cakes for the new baby, finishing puzzles, completing a crocheted or knitted afghan or putting the finishing touches on the new baby’s quilt – made just for their crib.

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 me, 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 pharmaceutical drugs, homeopathics and/or herbs do you use prenatally and at births?
This is specific to the individual woman and not routine. 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.
Newborn resuscitation equipment is always set up and ready at every birth.  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 done routinely.

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 carrier) to prevent infection caused by undetected or untreated gonorrhea and/or chlamydia infection (we can screen mom, at her 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

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!