Wise Women Care Associates

Frequently Asked Question’s

1. What is a Freestanding Birth Center?

A freestanding birth center is a homelike, out-of- hospital facility where normal low-risk women giving birth vaginally come for full spectrum maternity care.  A woman’s choices in pregnancy and birth are supported and respected. This birth center meets all local, state, and federal health, fire and safety regulations and is licensed by the state of Oregon. Women can feel safe and secure in the fact that midwives and other health care providers work together as part of a unified system of quality healthcare. Most of all a birth center provides a program of care that gives a woman confidence in her ability to give birth, balancing her need for human touch and companionship with her potential need for technology and medical intervention.

2. What is the difference between a freestanding birth center and a hospital birth center?

The major difference between freestanding birth centers and hospital birth centers is that hospitals create policies to care for people who are sick, while freestanding birth centers design programs for healthy pregnant women. Also, freestanding birth centers are based on the midwifery model of care which approaches pregnancy and birth as a normal family event until proven otherwise. Freestanding birth centers offer the personal yet comprehensive care that every expectant mother and her family deserve.

3. What is the cost for giving birth at Trillium Waterbirth Center?

The total fee for prenatal care, birthing, and postpartum care at the Trillium Waterbirth Center if you have no insurance is $6000.  This includes a midwifery professional fee of $3,000 and a $1500 fee per day for the use of the birth center.  (Average stay is 2 days).  We also bill all insurance plans and OHP.

The professional fee includes:

- 9 months of 24-hour availability of the midwife and her team.

-Prenatal care from the first day you come to us ‘til you are in labor.

-Labor and birth care for as long as it takes.

-Multiple newborn assessments through the first hours and days of life.

-One, two, four, and six week postpartum office visit for mom and baby.

The Facility fee includes:

-Orientation to care.

-Labor and birth supplies.

-Support and care by a doula and midwifery assistants as well as the state-licensed Midwife.

-Use of the center’s facilities from admission to discharge.

-Availability of consultation with a Lactation Consultant

-Round the clock postpartum care for your entire stay at the birth center

-A 24-72 hour postpartum home-visit if the family lives within a thirty minute driving distance.

4. How soon after the birth do the mother and newborn go home?

Providing that no complications arise, women may choose to go home as soon as six hours after giving birth. However, most mothers choose to stay in the Birth Center between 1 and 3 days after the birth to fully recover in our luxurious suites with round-the-clock postpartum care, get comfortable with breastfeeding, and learn infant care techniques from our baby experts on staff.

5. What if an emergency happens and I or my baby needs to go to the hospital?

In the unlikely event of an emergency, Trillium Waterbirth Center is two blocks from a hospital to the north and less than one mile from a hospital to the south. We are also equipped with all routine emergency equipment. The midwives are health care professionals trained to treat birthing mothers and their newborns until an ambulance arrives.   In reality most transfers that happen are for completely non-emergent reasons such as a stalled labor requiring medication or a request for pain medication in which case transport happens by private vehicle at an unrushed pace.

6. Who is a Certified Professional Midwife?

A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.

She provides comprehensive care in all aspects of women’s health. This includes low-risk maternity care, attendance at births, postpartum care, contraceptive counseling, screening of routine gynecological problems, as well as histories and physicals.

7. What Makes Us Unique?

Trillium Waterbirth Center is one of the few licensed birthing centers in Oregon and the only one in Southern Oregon. Here, the able midwifery staff of Wise Women Care Associates offers a full scope practice and provides safe, compassionate care to families of Southern Oregon and the very Northern California area.

Low risk women may opt to birth downstairs in one of the Center’s beautiful, homey rooms or in their own home (within a 20 min driving distance from the I-5 corridor in Jackson Co or Josephine Co.)

Our midwifery staff believes there is no one right way to have a baby. We support the use of complementary medicine: chiropractic, acupuncture, massage, herbal and homeopathic medicines, and others for those who desire them.  Our goal is to offer birthing families a full complement of options from natural water birth at the Birth Center, to a family-focused homebirth.  In all settings, we believe that pregnancy, childbirth, and early postpartum are events of life-affirmation — not only physical, but also social, emotional, and spiritual– and should be honored as such.

Our caring does not end with the birth, and we invite you to continue a relationship with our midwives for annual GYN exams & family planning.

9. May I interview the midwives before I decide?  How do I find out if our insurance covers the birth center?

Yes, we actually encourage all prospective families to come and meet with our midwives.  Ask questions and get acquainted.  Take a tour and see the whole building.  While you are here for your interview, fill out our insurance registration form and we will do the research for you.  Our Billing manager, Sherri, will call you with the information she gathers and then can set up a complimentary appointment to discuss your financial benefits from insurance.

10. What Happens at my First Visit?

The first visit is a very important time for us to get to know you and your family. A thorough history is taken; we need to know about you, your family and the paternal history. Your diet, exercise habits, medications, etc., are very important to the health of you and your baby. We will advise you on changes or additions to your current regime that we feel may provide an optimal outcome.

We will discuss your plans and the course of your care; appropriate testing, genetic screening, ultrasounds, and blood work that you may want or that you are choosing to decline.

You and your family, of course, will have plenty of time to ask your own questions of us! This is a great time, if you haven’t already, to tour the center.

11. What Happens at Subsequent Visits?

All of your appointments are scheduled for 60 minutes. This allows us about 40-45 minutes of “talk time” per visit. We try very hard to run the office visits on time. You will follow a routine course of visits, generally once a month until 28 weeks, then every two weeks until 35 weeks, and then weekly until you deliver. Of course that may vary according to your particular situation.

When you arrive, you will be welcomed by one of our caring front office staff or one of our many skilled midwifery students and encouraged to use the restroom to obtain your weight and test your own urine for protein and glucose. We hold all of our visits in one of our three birth suites where we will check your blood pressure and discuss your general health and your perception of the baby’s movements.

The midwife will allow sufficient time to let you ask questions that you may have. She will let you know what testing is “coming up” for you and your baby and help you decide what testing is right for you and your health status. Then she will examine your belly and listen for the baby’s heartbeat. If you are in the latter half of pregnancy she will measure your uterus from the top of your pubic bone to the top of the uterus (also called the fundus) to see how many centimeters it is. If you have brought other children with you she will probably see if they would like to help perform these “belly chores”.

She will review any testing that had been done in a prior visit with you and your family and will order ultrasounds or tests that will be due before your next visit. There is time to discuss any feelings or concerns. We believe that the body, mind and spirit are all important components of prenatal care.

12. What Tests are required? May I “Opt-Out” of Any?

Only low risk women may birth in the center. It is very important that some testing be done to ascertain that both you and your pregnancy are, and continue to be, low risk. You are highly encouraged to have initial blood work done during your first trimester. We need to know that you are not anemic, that you are immune to Rubella, whether or not you have ever been exposed to Syphilis, Hepatitis B, or HIV. We must know what your blood type is and whether or not you have developed any antibodies.

Later in pregnancy you will need to have your hemoglobin retested.  This is also a time that a glucose tolerance test can be done.   A GBS culture is performed at approximately 35 – 36 weeks gestation.  All genetic testing is optional, and available for families that desire it: CVS, First Trimester Screening, Amniocentesis, and/or AFP testing.  Complete anatomical  ultrasounds are referred out to the faculties near our office in the Rogue Valley. If you prefer we can refer you to the facility of your choice in a location close to your home.

We place a high priority in supporting patient’s rights for informed consent held right next to informed refusal.  We support families to learn the risks, benefits, and alternatives to all tests and procedures and help them to make informed decisions.

13. Can I have a water birth?

Waterbirth is a wonderful option; helping to ease labor discomfort and providing a natural space in which to birth for those families choosing it. Statistically around 35% of our moms birth in the water with another 80% choosing water for labor discomfort.

14. Can I choose an epidural?

For your safety, epidurals are not allowed to be performed outside of a hospital. However, some labors prove to be longer or harder than anticipated. If you change your mind for any reason, and decide you want the options available in a hospital, we support you and will help you to get that care as quickly as possible.  It is important to keep in mind however, that none of our midwives and in fact, no CPM’s in Oregon have hospital privileges and so you would need to, then in labor, transfer care to a hospital care provider.  While this choice is rarely made by our well-prepared mamas and papas, it is a valid choice for a labor that is abnormally progressing.  Your midwifery team would not hesitate to support you if this became your wise and compassionate choice.  It should be noted, however, that in the past it has been our experience that once at the hospital it has still take 2-4 hours for hospital staff to order an epidural even for a mom asking strongly for it.

15. What if I need antibiotics for Group B Strep?

Positive GBS status does NOT risk you out of birth at the Birth Center.  All patients are strongly encouraged to be checked to see if they are carriers of Group B Strep (GBS), between 35-37 weeks gestation. Women who are positive will be given the recommendation to receive IV antibiotics as suggested by the Center for Disease Control (CDC) guidelines; for those moms that do refuse antibiotics, we will then encourage the use of the UK ‘hibiclens’ protocol.

16. If I have risk factors, can I still choose to birth at Trillium?

Risk factors rarely risk you out of our midwifery care, but there are some very strict guidelines that risk women out of birthing at our birth center such as: Twins, breech presentation, labor before 36 weeks gestation, labor after 43 weeks gestation, certain medical conditions including but not limited to insulin dependent diabetes. There are also risk factors that can arise during the labor that would risk you out.  We discuss these specific issues during our prenatal visits in depth.

17. How do you monitor the baby’s heartbeat during labor?

We monitor the baby throughout labor using the hand-held Doppler, listening intermittently at prescribed intervals according to the stage of labor, and what we are hearing. The Doppler can be used underwater for water births. We follow the accepted national guidelines of the American Association of Birth Centers (AABC).  They are proven to be safe and efficient at following the well-being of the baby during labor. Of course if at any time if we hear a heart rate that is non-reassuring we would transfer from the birth center to the hospital for continuous fetal monitoring.

18. What if I need to go to hospital during labor?

While no one wants to consider the possibility of changing plans, it is a reality that we do sometimes need to birth at the hospital instead of the center for safety’s sake. In that event we try and make the transition as smooth as possible. Care is then managed by the on-call physician at the hospital that you either choose (time-allowing) or we go to, based on your medical need.  While the midwives of Trillium don’t have hospital privileges, someone from your birth team will stay with you through your labor as your advocate, help you understand options, and serve as your support.  At least one of us will stay with you until your baby is in your arms.

19. How long can I stay at the Birth Center after giving birth?

After your natural birth in the Center you and your family will have time to bond together, recuperate breastfeed and get to know each other. Discharge cannot occur until at least 6 hours after birth. Most families choose to stay 2 days. One Midwife or Midwives’ Assistant will come to your home (provided you live within 30 minutes of the center) 3-4 days after birth to follow-up with a home visit. We will examine both mother and baby; check vital signs, and recovery status of new mother. We will weigh the baby, check vital signs, perform another physical exam, and check for jaundice. We will help & support breastfeeding, answer questions and offer guidance, all in the comfort of your own home.

20. Does my baby get the routine tests after birth?

Before you go home; usually within the first few hours after birth, your baby will have his or her first physical examination performed in your room and in your view by the midwife. The baby will, at this time, have an injection of Vitamin K and instillation of erythromycin eye ointment if you desire. We will weigh and measure your baby at this time.  Your baby will have the’ PKU’ newborn metabobolic-screening test performed on the 1st postpartum day and again at the 2 wk visit. At that time we will also check for jaundice using a Transcutaneous Biliruben Meter.

21. I just found your practice on the Internet…I’m already 36 weeks pregnant…. can I still come to you?

A good many of our patients transfer into our practice during their late pregnancy. While we always appreciate having many months to get to know you and your family it is possible to transfer to us very late in pregnancy provided you have had regular, routine, low risk prenatal care and are able to supply us with a copy of your complete prenatal records including laboratory work that has been done and any ultrasound reports.

22. I have other children at home. Can I bring them to my appointments?

This is a family event, and we welcome children at the office, and your prenatal visits. Our waiting room is child friendly, with a selection of toys and books to entertain them. Children usually enjoy being the midwife’s “helper” during the belly checks in the exam room.

24. Can I bring them to the birth?

Of course! This is a family affair, and children are always welcome. You can chat with us throughout the pregnancy about how best to prepare your older children for the birth, and we do require that an extra support person be available and assigned to the children throughout the labor, birth and your stay at the Center.

25. I’m a busy woman. I prefer to not have to go to the laboratory for my blood testing. Will you draw my blood at the office?

No problem, and one of the features our patients love; the convenience of nearly all lab work done right in our office.

26. Is it true that you have had female doctors deliver their own babies at the center?

Doctors, lawyers, judges, stay-at-home moms, bus drivers, teachers, nurses; you name it……we cater to a very diverse population of families from all walks of life. All sorts of families that are interested in birth that is natural, safe and satisfying seem to find their way to us!

27. How do we obtain the birth certificate and social security number for our baby?

Before you are discharged from the center you will need to fill out an Oregon state worksheet that will use to fill out the electronic version in a secure state website.  Your midwife then signs the birth certificate with her thumb print electronically.  From there a social security number is generated and mailed to your home, no matter where you live. Once you have received this in the mail you know that the birth certificate has been generated and you can now order your personal copy at the Oregon Vital Events Website.  There is a small fee associated with ordering the birth certificate. The manner in which these two documents are secured is identical to how they are handled in a hospital delivery.

If you are not married to your partner you will need to fill in paternity papers or if in a same sex relationship; civil union documents.  Paternity papers need to be notarized.

28. How can I find out more about the birth center?

We offer free, sixty minute, individualized midwife interviews and tours for families that are considering the center. This “meet and greet” is a great time to come see the center, speak with a midwife and get a feel for whether this is a good “fit” for you. There is never any pressure during the visit. We want you to decide for yourselves whether you’d like to receive care here with us. You may make this appointment for regular office hours by calling us at 541-772-2291