Frequently Asked Questions
What is a CNM?
Certified nurse-midwives (CNMs) are registered nurses who have graduated from one of the midwifery programs accredited by the American College of Nurse Midwives. CNMs provide prenatal care to expecting mothers, attend the birth and provide postpartum care to the mother and her baby. They specialize in normal pregnancy, childbirth and the postpartum period. CNMs also provide general women's health care and are able to write prescriptions and treat common women's health issues. Certified nurse-midwives must pass a national certification exam and meet strict requirements by state health agencies.
All of the Certified Nurse Midwives at Dar a Luz Birth & Health Center also hold a master's degrees in nursing and have clinical experience caring for pregnant women after numerous years of hands-on experience.
What is the difference between a CNM and a doctor?
CNMs at Dar a Luz Birth & Health Center practice the midwifery model of care. This care includes:
- Monitoring the holistic well-being of each woman throughout the childbearing cycle;
- Providing each woman with individualized information, counseling, and prenatal care;
- Providing continuous hands-on assistance during labor and birth;
- Minimizing technological interventions;
- Providing post-partum care;
- Identifying and referring women who require an OB/GYN's attention.
A physician's education and experience is typically focused on complications in pregnancy and delivery. We believe that pregnancy and birth are normal, natural events in a woman's life and that birth is less complicated with fewer interventions.
Is it safe to have my baby outside of the hospital?
Except for serious medical conditions, all pregnant women are eligible for care by the CNMs at Dar a Luz Birth & Health Center.
Very few pregnant women are unable to have their baby with a midwife in the birth center. Age is not a risk factor, and neither is infertility, nor is a history of miscarriages, as long as things are progressing normally. Women of any age who begin their pregnancy in a healthy state generally remain healthy and have a normal delivery. For a more detailed list of conditions that are eligible and not eligible for birth center birth, click here.
During regular prenatal visits, we conduct thorough screening to ensure that you remain healthy and normal. We also use education, nutrition and exercise to prevent problems and can manage most of the common pregnancy complications that may arise.
Women who plan to deliver out-of-hospital must medically low-risk and be expected to have an uncomplicated birth. Examples of conditions that may place a woman in the higher-risk category and need medical care and hospital birth may include risk factors such as uncontrolled high blood pressure, heart disease, kidney disease, current addiction to drugs or alcohol pre-existing Type II diabetes, bleeding or blood clotting disease. Please note that gestational diabetes or a previous cesarean section in a prior pregnancy does not automatically exclude you from consideration for a birth center birth.
We suggest you call us with specific questions or to register for an orientation at the birth center for further information.
Why do women choose a birth center?
There are many reasons why women choose to give birth at a birth center. Some of them include:
Freedom- You are encouraged to walk around, eat and drink during labor. You can have your baby in whatever position seems most natural to you and are never confined to a bed or strapped to monitors. The midwife uses a doppler to intermittently monitor your baby throughout labor so you are not restricted in your movement. Studies have clearly shown that labor is shorter and easier if a woman is active and is able to eat and drink. The baby also suffers less distress if mom is upright during labor.
Privacy- You and your family will have complete privacy and will never be cared for by strangers. You will get to know our small staff during your pregnancy and by the end we usually all feel like family. You can have as many friends and family members with you to welcome the new baby.
Personalized care- During your pregnancy, we get to know what is important to you and your family, so that we can accommodate your wishes. Would you like to avoid an episiotomy? Would you like to avoid unnecessary labs and procedures? Would you like your partner to help "catch" the baby? Would you like to be the one to announce if your baby is a boy or a girl?
Breastfeeding support- We will encourage and assist you to nurse your baby soon after birth. We do not routinely offer sugar water or pacifiers to babies and your baby will never leave your side. Should you require assistance with breastfeeding in the days and weeks following your birth, a few of our staff are certified breastfeeding educators. Our birth assistants are also excellent in providing breastfeeding assistance.
Safety- Research has proven that out-of-hospital birth leads to fewer interventions and complications for both the mother and the baby. The caesarean rate for women receiving care from birth centers is about 5-7%. Your baby will not be subject to unneeded injections and examinations. Your body and your choices will be respected.
Studies comparing out-of-hospital birth to in-hospital birth consistently show that out-of-hospital birth is at least as safe as in-hospital birth, and for many, it's safer. It's also more satisfying for the family and more affordable for parents, insurance companies and taxpayers.
The National Birth Center Study
A multi-center study of over 17,000 women seeking birth center care published in the New England Journal of Medicine concluded that birth centers offer a safe and acceptable alternative to hospital birth for healthy, low-risk women, and that birth center care leads to fewer cesarean sections.
2012 Cochrane Review
"When compared to conventional institutional settings, alternative settings were associated with reduced likelihood of medical interventions, increased likelihood of spontaneous vaginal birth, increased maternal satisfaction, and greater likelihood of continued breastfeeding at one to two months postpartum, with no apparent risks to mother or baby."
What if something goes wrong?
The chances of you having a problem are very small. Unlike the stories one hears or the dramas one sees on television, birth is generally a straightforward and safe process. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time and we can calmly plan for, prevent or manage a problem. The more interventions performed during the birth process, the greater the likelihood for the development of problems.
We do not handle high-risk pregnancies and you must be full term (37 or more weeks) and essentially healthy to have your baby in the birth center. If problems arise with you or your baby, we have emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and pain medication), and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation). If you or your baby need to transfer to the hospital, we will accompany you. Our medical consultant, Dr. Larry Leeman, MD, has privileges at University Hospital.
Nationally, about 10% of women who plan to have their baby out-of-hospital end up transferring to a hospital-based practice (CNM or MD) and have their baby in the hospital. About half of these transfers happen during pregnancy, for conditions such as gestational diabetes and high blood pressure. During labor, the single most common reason for hospital transfer is actually not an emergency; most of our hospital transfers are due to stalled labor.
If you need to be cared for in the hospital, the midwife will accompany you to the hospital to provide support and assistance. You can then transfer back to us immediately after discharge for post-partum care (including a 3-4 day visit visit, breastfeeding support, etc).
We have developed a comprehensive class about interventions and hospital transfers that will answer all of your questions and calm your fears. All of our maternity clients are required to attend. It's offered once a month. Find it on our Calendar page here.
How much does it cost and will my insurance pay for it?
We contract with most major insurance companies, but each policy is different, so we cannot quote an exact price. However, complete care at Dar a Luz Birth & Health Center costs about 1/2 to 1/3 of a typical delivery in a hospital. We have very affordable self-pay rates and payment plans can be arranged to meet almost any budget. Please call us to register for an orientation. If you are interested in coming to the birth center, we will make a copy of your insurance card and check your benefits.
Do not be discouraged if your insurance company is not on this list. Considering the high cost of using a hospital for delivery, our rates can sometimes mean fewer out-of-pocket costs for you. Even if it turns out that having your baby with us costs you a few dollars more, we are certain that you will find the personalized, family-centered care you receive is well worth a small additional expense.
Do I need a referral from my doctor to be seen at Dar a Luz?
In most cases, no. If you are insured by Tricare, yes: You can ask your PCP for a referral or you can simply call Tricare and make one of our midwives your PCP. If you need more information on accomplishing this, contact our billing specialist.
What happens when I go into labor?
When your labor starts, you will call the midwife, who will meet you at the center. We expect you to labor at home until your labor is active. When you arrive with your family at the center, you will get settled in your choice of private birth suite.
We ask you to bring nutritious snacks and energy drinks. Not only are you allowed to eat and drink during labor, you are encouraged to do so. Most hospitals have rules against laboring women having anything but ice chips, expecting you to rely on IV fluids for the strength to get through labor. You will wear your own comfortable clothes, instead of a hospital gown. You may bring your own music to play on our iPod docks. The midwife stays with you during your labor. A birth assistant will be present for the birth and stays with you until you leave the center after birth.
We will closely monitor your labor and the baby's health during labor, but we do so in such a way as not to interfere with your mobility. We have a variety of tools to help you with labor - cold and hot packs, birth balls, birth swing, massage, hydrotherapy and the constant support and supervision of a skilled midwife and birth assistant. We have mild pain relief medications such as Fentanyl, nitrous oxide and sterile water papules as well. We do not offer epidurals.
We encourage you to consider a water birth. Laboring in water shortens labor, eases labor pains, makes pushing easier, and protects your vagina from unnecessary trauma. It is also the gentlest way for your baby to enter the world. Protected by the "Dive" Reflex, the baby will not try to breathe until we lift him or her gently out of the water and into your arms. Don't worry -- during this time your baby will continue to receive oxygenated blood through the umbilical cord. Read more about the safety of water birth here.
During labor and birth, we don't tell you what to do; instead, we guide you to the best way for you to get through the hard work of having your baby. You can be in any position you like for the birth. Basically, you will find the right way through labor and we will be there to support you. We encourage you to invite anyone you wish to be present at the birth. If you bring children, they must have their own support person, but they are welcome to be part of the magical experience. There is a separate room with toys for the entertainment of children and family while they wait. Your friends and family can participate in whatever way you wish. You may photograph or videotape any part of the birth, if you like.
How long can I stay at the birth center after I have my baby?
After your baby is born, most families stay about 4 hours. The maximum stay is 24 hours but is very rare. Before you leave, the midwife does a thorough check of the mother and newborn to ensure that you are both safe and healthy for discharge.
Can't imagine going home so soon after having the baby? Most of our clients feel great after their unmedicated labor and birth and are ready and anxious to get back to their own bed and their own home. It is amazing how much energy you have after accomplishing your goal.
Can my family be present for the birth?
You can have as many people with you during labor and birth as you like. Some clients have multiple friends and family, others prefer the privacy of being alone with their partner. However, we highly encourage our clients to have a minimum number of people at the birth, if any at all. The few short hours following your birth are extremely important for bonding, breastfeeding and getting to know each other. These are hours that you never get back. It is best for your family and friends to wait to come and see you until after you are settled into your own home.
We have a separate family room where people can be close by without actually witnessing the birth, allowing you privacy while still having important people nearby.
What about children attending the birth?
Some people worry about having their young children present during the birth. Our experience with hundreds of siblings and cousins has been overwhelmingly positive. The only way to make the experience negative is to not allow the child to dictate his or her level of participation. Very few children under three are interested in actually seeing the baby born, but they are often eager to be the first to hold their new sibling.
Little ones need their own support person (not your partner, because he/she will be busy helping you). Every child must have an adult present at all times to supervise in them in the birth center.
Natural Labor sounds like a good idea, but what if I want pain medication?
Some women, especially those having their first baby, are frightened by the idea that they will be forced to labor without the option of pain medication. None of us knows ahead of time what labor will be like or how we will cope. Many women tell us that they have a low pain tolerance. That may be true for certain things, but labor is unlike any other experience of pain. For many women it is more manageable because it has a positive purpose, it is expected and understood, and it comes with our bodies' natural pain killers, endorphins.
You will be thoroughly prepared through prenatal visits with the midwife. The continued presence of the midwife during labor will reassure you that you and your baby are safe. We require childbirth preparation classes and we offer a variety of classes at the birth center. See our Calendar for the content and schedule.
Should you desire some form of pain relief during labor, we have injectable narcotics available. We use it very rarely, because our clients usually surpass their own expectations of what they are capable of, but some like to know it is there just in case. We also offer nitrous oxide (laughing gas) to our laboring mothers, which is safe for you and your baby in labor. Our midwives can teach you acupressure points and they can also inject sterile water papules to partially block some nerves.
Can I have an epidural at the birth center?
Epidurals are not available outside of the hospital. While epidurals are commonly used and considered to be relatively safe, there are major risks to the mother and baby involved in using an epidural. The mother's blood pressure can drop dangerously low and the baby can have distress. Epidurals can safely be used only in a hospital, with an anesthesiologist and OB/GYN surgeon available in the event of complications.
Is water birth safe?
Most people worry about the baby breathing under water and this is a very common question. When the baby is born in water, it is still attached to the umbilical cord and receiving oxygen exactly as it was in the womb. As a matter of fact, a baby born under water doesn't even realize it is born until you take him or her to the surface. The midwife brings the baby out of the water within a few seconds of birth, to minimize any risk. Waterbirth has been proven through thousands of births around the world to not only be safe, but perhaps safer for the mother and baby.
Can I become a client during pregnancy?
Women may transfer into care at Dar a Luz Birth & Health Center at any point in their pregnancy. Some women need some time to realize that their fears about birth are misplaced and that they want to have their baby in a private, relaxed setting. Becoming a client during pregnancy is as easy as coming to an oreintation and if we agree that Dar a Luz Birth & Health Center is the place for you, we will fax a request for your prenatal records to your current care provider.
What are your policies on episiotomies, intravenous fluids and newborn treatment?
The nurse-midwife does not cut routine episiotomies. Episiotomies are used occasionally in cases of fetal distress. Intravenous fluids are used in the Center for women who become dehydrated, need IV antibiotics, have significant blood loss after the baby is born, and occasionally in other circumstances. Our philosophy about newborn care is to prioritize family bonding. At the moment of birth, the baby is passed directly to the mother. The newborn exam is done in the room with the family present about 2 hours after birth.
What kind of post-partum care will I receive?
If the mother and baby are healthy, and the mother desires, the family may return home just a few hours after birth. Some families stay at the Center longer depending on client preference and the health of the mother and baby. Most of our families are eager to go to their own home and snuggle in bed with their new baby.
You and your baby will receive a home visit 24-48 hours after birth by one of the midwives, if your home is within 30 minutes of the birth center. Your baby will have a visit three or four days after birth so we can assess the baby for feeding and jaundice. You and your baby will then return to the center two weeks after birth for an appointment for both of you. Then we see the baby one last time around 4 weeks of age, and the final visit with you six weeks post-partum. The midwife is available throughout the post-partum period to answer breastfeeding questions or other concerns you may have. We also have lactation specialists on staff who are available to assist you with feeding concerns.
What happens if two people are in labor at once?
We have a backup midwife on call to ensure that every woman in labor will receive the attention she requires.
Who is your back-up doctor?
We don't have a doctor on staff, so if you need a doctor before labor begins, we can assist you in your transfer. We often recommend Dr. Larry Leeman, our physician consultant, but you may go to any back-up doctor you choose.
If you decide to go from the birth center to the hospital electively during labor, your midwife will accompany you if she is able. Some situations beyond our control could limit her ability to be with you throughout your labor in a hospital. In the case of an emergency in labor (which is rare), we will transfer you to The University of New Mexico (UNM) Hospital.
How many babies do you deliver per month?
Our practice is growing! In 2011 we attended 4-6 births a month. In 2012, we had an average of 9 births per month. We brought a new midwife into the practice in the fall of 2012 and increased our capacity. In 2013 we had an average of 11 births per month. In late 2013 we brought in a fourth midwife to help accommodate the many families who are finding us for the first time and are returning to have their second and third babies with us. By the spring of 2014, we had 15 to 18 due dates per month, a trend that continued into 2015.
What routine prenatal tests do you require?
We will offer to you all tests recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM), as well as those of the State of New Mexico. 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 HIV screening
- Pap smear
- Gonorrhea and Chlamydia screening offered
- Cystic Fibrosis 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 indicated
What method of childbirth preparation is recommended?
Our childbirth education classes are included in our facility fees. We offer traditional childbirth classes (full length or condensed) and hypnosis childbirth classes, plus classes on newborn care, breastfeeding, carseats and much more. A detailed description of the classes is here. And the class calendar is here. Please call the center to register for classes. These classes are also open to women who are not birth center clients for a fee.
Of course, you are free to participate in whatever method of childbirth preparation best meets your needs and interests, as long as you do take some form of education.
What complications have you handled? How did you handle them?
Briefly, many complications can be and are handled 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.
What procedures do you require on the newborn?
We are required by the state of New Mexico to offer antibiotic eye ointment to prevent infection caused by undetected or untreated Gonorrhea and/or Chlamydia infection (screening for these infections is offered during prenatal visits, but not required). Also offered is a one-time injection of Vitamin K to prevent Hemorrhagic Disease of the Newborn. We encourage you to educate yourself and make an informed decision as to whether or not you would like these procedures for your newborn. You have the option of refusing treatment with a signed waiver.
A Newborn Screening Test for inborn metabolic errors, obtained by a heel stick for blood collection, will be collected at the home visit and again at 2 weeks of age. It is required by the state of New Mexico.
What if I want a circumcision for my baby boy?
The American Academy of Pediatric does not recommend routine circumcision. Studies have shown that there is little benefit to this procedure and it does carry risks. If you desire a circumcision for your son, you will need to do so through your pediatrician.
What do I need to do to transfer my care to Dar a Luz Birth & Health Center?
If you have decided that Dar a Luz Birth & Health Center is the place for you, transferring to us is very simple. You will only need to attend an orientation and sign a release of records from your previous care provider. It is never too late to transfer, as long as you have a normal healthy pregnancy.