Sometimes I'm asked what the benefits of using a nurse-midwife are....
While I respect and honor midwives from all paths of education and apprenticeship, I thought I would fill you in on some benefits of my licensure/advanced education:

• Lower transfer rate to the hospital related to fewer legal requirements for transfer when compared with licensed midwives in the state of Florida. For example: More leeway with ruptured membranes and post-dates pregnancies. More is left up to my practice protocols and clinical judgement and less to the state's arbitrary rules (many of which I disagree with). 
• Ability to prescribe medications if needed. While I respect and honor natural and herbal remedies, sometimes Western medicine pharmaceuticals are useful tools as well. This is helpful if you have hyperemesis, bacterial urine infections, mastitis, hypothyroidism, etc. 
• Ability to prescribe controlled substances if needed. This is useful for severe pain due to kidney stones, gallstones, or prolonged early labor-when someone really needs a nap. 
• Ability to treat mood disorders like anxiety and depression in the perinatal period if needed. You deserve to be happy, and your baby deserves a healthy, happy parent. 
• More training on complications and how to manage them during pregnancy.
• Ability to provide full-service gynecological care for the lifetime. 

I pray you are feeling well, staying safe, and staying calm in this difficult time we find ourselves. Every week it seems we learn new information about the COVID-19 virus and how to protect ourselves. I want to keep all of you and your families safe and also keep our team and our families safe. We are all in this together.

Symptoms of COVID-19: per the World Health Organization.
Common symptoms include: fever, tiredness, cough.
Other symptoms include: shortness of breath, aches and pains, sore throat, and rarely diarrhea, nausea or a runny nose. Most people may only have 1-2 symptoms. 
                                                                                                                
Telehealth visits:

• Can be used anytime that labs are not needed, you are feeling well, and no ultrasound is needed to confirm baby’s position.
• Can be used if you are experiencing symptoms that might be Corona Virus
• All current pregnant clients should visit www.MidwifeRx.com and set up an account on eVisit platform. Most telehealth visits will be done at your regularly scheduled appointment time. Becki, our office manager, at ext 1, can help with you any difficulties with scheduling your telehealth visits.
• All pregnant clients should buy or borrow a fetal doppler and automatic blood pressure cuff-preferably upper arm, not wrist.

 
Drive Up Prenatal/Postpartum Check Ups:

• Can be done any visit where labs, ultrasound, or vaginal exams are needed.
• Should only be done if you are feeling well and have no COVID symptoms.
• Use your bathroom at home before you leave your house.
• If you have a scale at home, weigh yourself. If not, no worries.
• BYOP-Bring your own pen if you have consents to sign.
• When you arrive in parking lot, stay in your car. Call Angie at ext 2.
• We will do the talking part of your prenatal over the phone. We will discuss your physical and emotional status, labs, educational topics, and any of your concerns or questions. This may take 30 minutes or more.
• Get into your passenger seat of your car. Slide the seat back as far as it will go. Recline the seat back as far as it will go.
• Angie will come out and check your blood pressure and the baby’s heart rate.
• The goal is to minimize exposure-under 10 minutes of contact.
• She may be wearing a mask or gloves. It’s nothing personal, just trying to stay safe.
• Wear your mask if you have one available. 

 
Office Visits with Invites Inside:

• Will begin like the drive up visits with talking on the phone for awhile.
• Then Angie will invite you into the office, and directly into the back lab/ultrasound room.
• No children inside the office except newborns.
• We would prefer you come into the office alone if you are ok with that.

Payment Options

• Telehealth appointments-eVisit platform automatically collects your credit card info, so you can just pay with that for convenience.
• Cash or check are easily accepted and welcomed.
• Sending money with PayPal is easy and has no risk of COVID-19. Our PayPal email is: MidwifeLove@gmail.com Also, if you send it to us as a family/friend, we’ll get no interest removed.
• Becki at ext 2, can take credit card payments over the phone.
• If you must pay with credit card in person, let us know and we will have a tablet you can sign.

New Birth Policies

• At 37 weeks, stop working 
• Having COVID-19 at time of birth, makes you high risk for pulmonary complications during labor.
• If you have diagnosed or suspected COVID-19 in labor, that will require hospital transfer.
• Attendance Policy for Homebirths: Two (2) support people in the birthing space at home. Other family members/friends, including children, who live in the home or who are providing childcare to the older siblings, should be encouraged to stay in another part of the home to reduce risk for exposure to the midwifery team.
• When you start labor, take a symptom check of your 2 birth support people. If anyone has any symptoms, please let the midwife know so she can use appropriate mask/PPE.
• Continue social distancing following your birth and avoid introducing in-person introductions of your newborn to family and friends.
• The Midwifery Team (Angie and 1 assistant/student) will screen themselves for symptoms before attending your birth. If symptomatic, a backup midwife or assistant will be called in. I know this is not desirable, but it is necessary to keep you safe.
• Most hospitals are only allowing 1 visitor per laboring patient. So if a hospital transfer is needed, most clients would choose their partner, and thus I cannot accompany you. However, I will be available via phone throughout your labor and birth. Postpartum visit at your house post hospital discharge is still available. 

 
Mental Health

• Please practice self-care daily.
• Get outside, take walks, feed yourself nutritious food, and get good sleep at night.
• Take Melatonin or Benadryl if you need it to sleep while pregnant. 
• Download Insight Timer a great free meditation app. Start meditating 5 minutes per day to lessen your anxiety and learn to calm your mind. It’s a great way to start the day. Look for the Beginner’s Section if Applicable.
• Have your partner monitor the news so you don’t have to. Get off the news and too much negative social media.
• Let me know if your moods are unbalanced. I’m here to help.

Sending you all the love and energy that my heart and body can make…. And a fun picture of my kayaking adventure this week. The Earth keeps on turning, the birds keep on singing, the flowers keep opening, and families welcome new life. I am happy to be your midwife and serve you through it all. 
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Questions you should consider when choosing your prenatal care and birth attendant. If someone doesn’t know their rates, they either do not want to divulge or don’t care about their outcome statistics.
These statistics for Midwife Love reflect the 359 births from 2010-Jan 2020.
 
What is your c-section rate? What have been the reasons?Medically indicated c-section rate was 9%: Reasons: maternal high blood pressure during labor, breech baby, transverse baby, placental abruption, failure to progress and non-reassuring fetal heart tones.  Elective c/s rate was <1%. Compare that to local hospitals who report over 35% c/section rates.
 
How do you feel about episiotomies? When are they needed?We think they are unnecessary and lead to greater tearing. The episiotomy rate was 1%. We teach clients perineal massage techniques and pushing methods to help avoid tearing. Natural tearing requires fewer stitches and heals quicker than episiotomies. Moms remaining completely intact, needing not even 1 stitch after birth, our rate in 2019-36%.
First time moms: intact rate: 25%                          3rd/4th degree tears: <1%
 
How long should my pregnancy continue?Your baby and body will decide how long your pregnancy goes. Most first time moms go 7-10 days past their due date. We can discuss natural labor induction techniques you can do for yourself, but it is your choice whether to use them. We can continue taking care of you for as long as you need. Preterm Birth-<1%
 
What is the normal postpartum visit schedule? Do you include the PKU test?We do a home visit day 1-3 postpartum and offer you the PKU test for your baby then. We then see you and offer lactation support back in the office, 2 weeks, and 6 week and additionally if necessary. Breastfeeding at 6 weeks: 95%

Are labs drawn on premises or do I go elsewhere?Labs are drawn in the office for your convenience.
 
What is your transfer to the hospital rate? What have been the reasons?Antepartum transfer rate in 2019=7%. Our intrapartum (during labor) transfer rate was 12%. Reasons included high blood pressure, failure to progress, epidurals, non-reassuring fetal heart tones, preterm birth, fever, and  breeches.  The postpartum maternal transfer rate was 1%, reasons included too much blood loss.
 
How many births have you attended? How long have you been in practice? In what environments have you practiced?Angela: In my 15 years as a midwife I have caught 902 babies, and attended many more births. I practiced 5 years at a busy birth center in Miami, where we did 30-40 births a month. I have been attending home births on the Treasure Coast since 2010.
 
If I need a prescription drug during my pregnancy or birth, or birth control later, do you provide that?Yes. Nurse practitioners can prescribe medications.  We have extensive training in contraception, IUD insertion, and gynecology when needed for your annual Paps for years to come.
 

Laboring in water helps relax muscles, minds, and ease discomforts. It allows for easy and gentle movements which facilitate labor. We recommend water to be available for comfort for all clients. In 2019 47% of our clients had underwater births, which is a gentle transition for baby, and helps decrease perineal tears in mom.
 
What is your VBAC success rate? In 2019, our VBAC success rate was 100%, and all at home. Since 2010, 87% have had a VBAC, 79% at home , transfers for reasons of failure to progress, epidurals, and transverse lie.