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Do you
deliver babies at home?
No, our practice of Certified Nurse Midwives
delivers babies in the birthing rooms of the
labor and delivery area of Maine Coast
Memorial Hospital. We are hospital
employees. In fact, most Certified Nurse
Midwives in the USA perform hospital
deliveries. In Maine, most home deliveries
are performed by “Certified Professional
Midwives” (also known as direct entry
midwives or lay midwives). Nearly all
Certified Nurse Midwives are registered
nurses first, then obtain masters degrees or
certificates of midwifery from a University
program. Certified Nurse Midwives support
the concept and choice of home delivery for
low risk women. Currently legislation is
being written (LD1827) to assure minimum
competency and oversight mechanisms be set
in place for the practice of the direct
entry midwives in Maine.
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Maine Coast Woman Care
306 Main Street,
Ellsworth
664-5650
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Our Patients say...
"All staff members are
superb. I feel so well cared for."
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Can
you be “back up” for my plans for a home
birth?
No, we are unable to be a back-up system for
planned home birth. We feel it is crucial to
build close relationships with our patients,
to over see prenatal care ourselves, work
closely with women in presenting options,
and follow our own protocols for care of any
out of the ordinary finding. Also, our
employment within the hospital prohibits
back-up arrangements. Home birth clients
experiencing complications at home should go
to the nearest emergency room where they
will be seen as “unassigned call” (meaning
not currently established within a practice
of that hospital) by the obstetrical
provider on call at that time for that
hospital.
There
are four CNMs in the practice. How does that
work when I come for appointments or go into
labor?
Your prenatal visits will rotate through all
of the CNMs. Usually you will have about
three prenatal visits with each one during
the course of your pregnancy. We spend time
with you at your visits, so that by the time
of delivery you feel comfortable and happy
with any one of the four of us. We
understand that occasionally a woman will
have a “favorite” midwife! The midwives
rotate call in 24 hour increments (7 am to
7am), with Sat/Sun the same person. Which
ever midwife is on call during your delivery
is the midwife who will deliver your baby.
Sometimes when the early labor is lengthy,
you might have a change of midwife during
that time. Of course, if you are pushing
your baby out at 7:15 am, the midwife who
has been with you will stay to help you
through the final moments!!
When I
think of “Midwife” I think that means that I
have to have a natural birth, without any
pain medications. Is that true?
No. We are able to order IV medications for
labor pain (such as stadol), or an
intrathecal (similar to a “walking
epidural”) if either of these interventions
would be what the woman wants and is
appropriate/safe for the stage of labor and
circumstances. We also will continue to help
you through your labor with other,
nonmedical comfort measures. It is
impossible to give birth without any
physical sensations; we (as well as the
wonderful labor and delivery nurses) will
help you through these stages, leading you
to your incredible, fantastic experience of
delivering your baby into the world.
I want
to have a natural delivery. Can you help me
to do that?
Yes. This all begins with your desire.
Childbirth education is important for
everyone, as well as learning relaxation
techniques. “Hypnobirthing” is terrific. A
healthy diet, lots of stretching flexible
type exercise, and an ability to work
through emotional issues are all helpful.
The tub is a marvelous help with the
sensations of active labor, helping most
women to “melt“ into relaxation, and thus
cervical dilitaion. We also recommend a
doula in many instances. We use intermittent
monitoring in almost all cases, and
encourage being upright, moving around,
aroma therapy, shower, music, massage, and
we have a birthing stool for pushing if
needed.
How
many people can I have in the delivery room?
As many as you like. We know, however, that
anyone who is with you should be someone
important in your life, who is helpful and
kind to you, who you don’t mind being naked
in front of, or making noise in front of. We
have seen cases where too many “watchers”
cause labor to virtually stop. We will spend
time talking to you about these issues
during your prenatal care, and help you to
decide who you want with you. It is our job
to help you have the smoothest, best labor
experience possible. Being with you at your
birth is a privilege, not a automatic right.
What
if I need a C-section?
We have back up Physicians available to us
at all times. Reasons for a C-section are
sometimes found before labor (such as a
breech baby who won’t turn into head down
position near the due date), but mostly
occur during labor and are not known to be
needed before hand. In any of these cases we
(or the nurse at our request) would phone
our back-up MD and explain the situation. A
C-section can be performed in less than 30
minutes if necessary. The midwives usually
serve as first surgical assistant during the
C-section; if two doctors are performing the
C-section, the midwife will accompany you
into surgery for support.
Can I
have a VBAC (vaginal birth after Cesarean)?
Currently the policy of MCMH allows VBACs in
low risk women. It must be at least 18
months since your C-section, and you must
have only had one C-section. Your pelvis
should be thought to be adequate shape for
vaginal delivery, and we will need to see
the operation report to make sure that there
were no extensions to the usual low
horizontal uterine incision. During
pregnancy we will ask that you have a
consult visit with one of our back up MDs to
discuss VBAC in your case. We will ask that
you sign a VBAC consent form. Our policy
requests that you allow us to place a saline
lock (an IV not hooked up to anything)
during labor for quick IV access if needed.
We also will continuously monitor your baby,
but this does not mean that you have to lay
down- we have “telemetry” monitors that can
be worn while you walk around in labor. We
will not use pitocin at any time to induce
or add to your labor. We strongly believe
that women should have the choice to VBAC.
I know
I want to (or have to) have a repeat
C-section. Can I come to your practice?
In most cases, yes. You can receive your
prenatal care through the midwives, and also
have one or more consult visits with the MD
who we arrange for you to have your
C-section with. Repeat C-section patients
with other high risk issues would be better
served by establishing care with an OBGYN
practice.
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