FAQs

Midwifery is one of the oldest known professions and thus has a rich and diverse history. Internationally, midwives care for most pregnant and birthing individuals. However, midwives attend only about 12% of births in the U.S. and less than 1.5% of our births occur at home. If you are here, you are likely aware of the significant problems that exist in the conventional U.S. medical model of pregnancy care, and of the evidence-based benefits of midwifery care. (But if you’re not, let’s talk!)

Currently there are three primary educational routes to become a midwife in the U.S.: Traditional Midwife, Certified Professional Midwife (CPM) and Certified Nurse Midwife (CNM) . Each state has its own guidelines for that kind(s) of midwives are legally recognized. Traditional midwives usually apprentice with other midwives for several years, attending prenatals, births and postpartum care visits for parents and newborns. There training also involves deep studies in all areas pertaining to reproductive, maternal and newborn health and learning to recognize deviations from normal and how to address these concerns and when referral is needed.

CPMs (another pathway) have a variety of different training options, they can learn through a rigourous apprenticeship, attend a 2 - 4 year midwifery program. Traditional and CPM midwives focus there education and skills training on midwifery, newborn and well person care. Currently they practice exclusively in the home or birth center setting, specializing in community based care. CNMs are nurses (RN’s) first, so learning the medical model of care and the obtain more education to learn midwifery care. Often they will seeking this additional educations after years of experience in birth as a labor and delivery nurse, with medical model framing of care. Their apprenticeship is usually and primarily in the hospital, but may be out-of-hospital at a birth center. CNMs can work in hospital, birth center, or home birth settings, the vast majority choose the hospital setting to practice in. . Both CNMs and CPMs must undergo rigorous study to sit for a nationally recognized board examination. All midwives are trained to provide prenatal, labor/birth, postpartum, and newborn care, as well as basic gynecology. Brenda and Emily are CPMs, have trained in a traditional apprenticeship model and our licensed.

The most recent research on planned home birth, which was published in 2014 by the Midwives Alliance of North America (MANA), found that among 17,000 families:

• Only 4.5% of the 17,000 study participants required Pitocin augmentation or epidural analgesia. That is much lower than the average for the US, where 26% have Pitocin and 67% have epidurals.

• 5.7% of the families who planned home births in the MANA dataset ended up birthing their babies via Cesarean, as compared to the 31% national average for full-term pregnancies.

​

There are many other benefits to giving birth at home with midwives, including:

• A focus on informed consent and informed choice. You’re in charge!

• Individualized care. We know that you know yourself better than we ever could, and it’s our job to listen to you and tailor your experience to your specific needs.

• Continuity of care. We take care of you prenatally, at your birth, and for six weeks postpartum, so you have access to familiar, known care providers throughout your childbearing year.

• Evidence based care. We practice in alignment with practice updates and evidence so we can provide up to date information to help you make decisions.

Home birth is a safe option for most expectant families whose pregnancies are without complications. For some babies or parents, a hospital is a safer option, and part of the role of the midwife is to help families identify when their pregnancy is not low-risk and when a hospital birth may be a safer option.

Multiple studies have shown the safety of home birth for low-risk parents to be the same (or safer) than birth taking place in the hospital. There are (of course) risks involved with any birth, and community based midwives are trained and skilled in managing emergencies and unexpected complications. Here is a link to a quick 1 page summary of studies on the safety of home birth and Advantages to home birth from the Citizens for Midwifery.

Here are some additional resources to learn more about home birth safety:

a) The Homebirth Midwife Podcast

b) Outcomes of planned homebirth with CPMs in North America

c) Outcomes of planned homebirth after regulation in British Columbia

d) UK Safety Study

We are committed to holistic community midwifery care. Our investment is in helping you make informed choices, supporting you through those choices and offering wisdom based on our experience and knowledge.

We co-create your care together, trusting that you hold the wisdom, expertise and understanding of your life experiences, health and circumstances to design care that is uniquely suite to you and your family needs. We take cues from your leadership in your care, honoring the choices and decisions that are right for you.

We believe that nutrition, activity and life balance are as important as medical care. We will suggest natural allies, approaches and nutritional - lifestyle adjustments whenever applicable and offer you resources for more medical support when needed.

We believe that pregnancy, birth and postpartum are miraculous transformations and that everyone deserves to be supported and celebrated through these portals. We are committed to investing in families worldwide.

We donate, participate in shared learning, volunteer and teach in economically under resourced settings where these services are crucial. You are also investing in this work if you choose to birth with us. Together we can make birth safe for every woman.

People select our care for a variety of reasons, and they quickly learn that we:

​

• Emphasize comprehensive prenatal care

• Incorporate herbal and nutritional and lifestyle practices

• Support the natural abilities of your body

• Adapt flexibly to enhance your care plan

• Aim to surround you with care that supports your empowered

• Advocate for the well-being of you, your, baby, and family

• Maintain open and honest communication to build trust

• Combine expertise with compassion

• Provide unmatched support

• Are skilled practitioners

• Limit our client load each month to ensure top-quality care

Yes! Prenatal care, birth, newborn exam, and postpartum care is provided by licensed midwives. We are able to obtain lab work and order ultrasounds, for those desiring those. We are able to order any typical testing offered in traditional maternity care. We will assist in filing for a birth certificate and social security card as well.

Likely not. We follow and individualized care schedule and offer the same testing and screening options. During a low-risk, uncomplicated pregnancy, there is no need to see an doctor besides your midwife. If there are certain complications or situations that arise you may be encouraged to see a physician. If necessary, your midwife will refer you to a local OB or Maternal Fetal Medicine Doctor.

Most likely! The easiest way for us to answer this question is through a consultation appointment. At your consultation, we will go over your personal history and help you determine if this is a comfortable option for you. All parents are encouraged to research for themselves and explore all of their available options. We have a comprehensive informed consent document that we provide with each consultation. And please, ask us the tough questions, we welcome them!

The basis of midwifery care is shared decision-making and informed choice/consent/declining. True shared decision-making and informed care, means you are offered unbiased education and resources to help guide your decisions. You are then encouraged to do your own research and take the time you need to feel solid in your decision. It also means that you are respected for the choices you make for yourself and your baby’s care. We see you as the expert on your life, health and baby, having a collective of life long lived experiences that shape your choices and decisions. Holding the responsibility for these choices in your own hands is both an empowering and life-affirming process.

A hallmark of care with Willow River Midwifery is co-creating care that fits the individuals and families we are serving. This includes the frequency of visits. Some people are ready to begin care in the first trimester and others who perhaps have had several babies, might wish to begin care much later. After baby arrives we continue to follow this model of customized care and offer a blend of home and clinic site visits for you and your baby. The frequency of prenatal and postpartum care is individualized to each person we serve.

We see clients regularly in our cozy clinic settings in our four locations: Decorah, IA, Elma, IA, Cedar Falls, IA, Rochester, MN, and La Crosse, WI. We also will do a home visit prenatally usually around 36 weeks and then home visits in the first week to ten days postpartum.

We carry a hefty birth bag to births. It contains: a fetascope and fetal doppler to listen to baby’s heartbeat, herbs and homeopathic remedies and medications to use for a postpartum hemorrhage, IV supplies, laceration healing options, resuscitation equipment, an oxygen tank, stethoscope, a blood pressure cuff, instruments, a birth stool, a rebozo, a TENS unit, our caring support, open hands and encouraging word medicine.

Willow River offers a sliding scale to cater to our diverse community of clients. Fees for full midwifery care are on a sliding scale from $5200 - $6800.

A sliding scale allows families to pay for services based on their income and financial situation. This system helps make midwifery care more accessible to a wider range of people, including those with limited financial resources. You will select your care fee in the range of $5200-6800. Care is the same for all families, no matter what they select for their care fee and no income verification is required. Full payment is due by 34 weeks.

There are a few expenses which are not included in the fee.

• Lab work or an ultrasound, Labs and ultrasounds can be billed to insurance. We are contracted with Quest Labs and provide labs at very reasonable rates!

• Birth supplies to gather for your birth. We will provide you with a list of these items.. The cost of the kit is $50-135 depending on your needs.

• Rhogam

• Vitamin K Injection

• Birth Pool Rental

• Recommended supplements, herbs and teas

• Referrals to other health care providers

The short answer is yes, however not in the way you are probably accustomed to. The great news is many insurance companies are now covering midwives and home birth as out-of-network benefits. We are out of network with all insurance companies. We do not directly bill your insurance company. We can refer yo to an excellent insurance biller who specializes in home birth midwifery billing. They can submit a verification of benefits to determine your out-of-pocket costs for home birth services and what will be covered. They can help guide you with submitting a claim for the best possible reimbursement after your birth. This is a third party insurance biller who is not part of our practice. They will inform you of the fee for their services. Any coverage, if available, will not be sent by your insurance company until at least several months after the birth. Therefore, regardless if insurance coverage will be pursued, the full fee paid to Willow River midwifery is due by 34 weeks of pregnancy. Unfortunately, we cannot accept any form of Medicaid insurance at this time. We offer families with Medicaid a discount sliding fee scale option. We want to be transparent and upfront with costs so that there are no surprise bills following the birth (which is frequently the case following hospital births!).

HealthShare insurance plans such as Liberty Health Share, Samaritan and Christian Health Share usually always pay most of the fee. Typically, all they require is a receipt of your care fee for reimbursement.

We offer payment plans, and expect the full balance to be paid off by 34 weeks in the pregnancy. However, we understand that healthcare expenses can be challenging to pay off on a timeline. We are not able to offer financing, but we are happy to refer you to organizations that do. For example, United Medical Credit are low-interest options to help you finance midwifery services. We are committed to making home birth and midwifery care accessible - we will work with you to come up with a personalized plan to cover the costs of your care.

Cash, checks, major credit cards, bank cards, FSA’s and HSA’s. All credit cards, debit cards and electronic payments will be subject to an additional 4% processing fee.

If your care needs to be transferred to a hospital based provider in the last few weeks of pregnancy, during labor, or just after birth, there is no refund available. We will continue to provide support while you are in the hospital and offer postpartum care as planned once you are back at home.

If you need to transfer care before 36 weeks, we will bill for each week of care and services rendered instead of the full fee as outlined in our contract. We will provide postpartum care (if appropriate) for you and baby even if you have a hospital birth. If you choose to have us come to attend and support you in the hospital our full fee applies.

We have excellent relationships with the hospitals regionally. If we need to change birth settings, the hospitals we transport to are happy to take our transfers, and we often end up with a continuation of midwifery care in the hospital setting! The midwife caring for you at home will facilitate the transport by calling ahead, giving a report to the on-call midwife or physician, bringing or faxing records, and going to the hospital as an advocate and support person. Our rate of transport during labor is low, and we make sure that those families get as much support as possible during and after their birth. We resume your postpartum care again as soon as you are home from the hospital.

Transfer and transport are not common. Maternal exhaustion is the most common reason for your birth setting plans to change. Fatigue, is most common with a first vaginal labor and birth. Your body has never done opened in this brand new way before and it needs time to accomplish this miraculous event. A study found that labor fatigue is a frequent cause of physical and mental discomfort, increasing the likelihood of medical interventions such as instrumental delivery and cesarean section. Preparing for childbirth in a way that is helpful for you can make a huge difference. There are classes, books, videos, audio recordings, doulas, and loved ones that can help you plan and prepare along with your midwives. In early labor we encourage you to ignore the sensations and rest or carry on with your day as long as possible. Continue to nourish, hydrate and rest. Labor won’t forget you and at some point it will insist on your attention. This is when those tools you have been planning for and practicing will be important. If you feel fatigue setting in, nourishment, hydration and therapeutic rest can be invaluable to help you to reset. Together we are the usual experiences of labor and suffering, never wanting to reach this level of experience. Midwives know normal, and the difference, and want you to have beautiful, empowering memories. Other rare reasons for transport might include extra bleeding during labor or postpartum, a baby who is showing us they need some extra care and anytime you tell us you would like to transport. You are the expert on you and we trust your knowing.

We do our best to serve those presenting with normal pregnancy in our service area. There are particular health and well being concerns that may cause us to decide that we are not the right fit.

You can invite anyone you wish to attend your birth. In addition to these wonderful people, your midwife, apprentice and birth companion will be present to serve you. The birth companion often takes care of logistics behind the scene. Thinks like creating nourishment and beverage for you, preparing herbal teas and postpartum soaks, getting the shower or tub ready, tidying the home after the birth, beginning laundry, making a fresh bed while you take a wonderful postpartum soak or shower. They also help us set up our gear and pack it down and take notes while we are caring for you and baby.

Willow River is privileged to be founded on the traditional apprenticeship midwife structure and supports apprenticeships in our practice to educate and empower the next generation of midwives. Brenda is certified through the North American Registry of Midwives as a preceptor to guide student midwives through to their own certification. Student midwives are a part of our practice, though as with any member of our team, you are leading your care.

An apprentice midwife or student midwife is an individual training to become a professional midwife. Typically this is done through certified program within the practice or a course with time spent in various midwifery practices to gain experience.

The choice is completely yours. For first time mothers or primary VBACs (first vaginal birth after cesarean birth) we recommend a doula for labor support. First time birthers and primary VBACs usually have longer labors and have more to work through. Having a doula there for early support and present each step of the way, is supportive of achieving the birth you desire. Studies have shown over and over that outcomes when doulas are supporting clients and their families. Once you are in active labor or transition, we provide some additional labor support care and can offer suggestions on the phone before hand.

Not at all! We attend birth in all sorts of spaces, including apartments, Airbnbs, hotels, backyards, mobile homes, tiny homes, Rv’s—you name it! All that we require is that there will be source of water, lighting, and cell service.

All the time! Immersion in a deep pool of water during labor eases stress, provides deep relaxation, and greatly relieves pain. Many women find that the calming environment of the own home, the freedom of movement, and the continuous support that they receive from their midwives is just what they need to achieve a peaceful, transformative natural birth. Studies show that hydrotherapy and water immersion during labor reduces pain, length of labor, improve satisfaction with the birth experience, and decrease the incidence of perineal tissue separation. Research shows there is not an increased risk of infection, or any differences in the baby’s transition after birth for women who labor in water during the first stage of labor. Some use water immersion for labor and birth on land and others stay in the water for their baby’s birth. Your baby is born from a peaceful place of water into a peaceful place of water making their transition to the world more familiar and comforting. We have inflatable tubs available to rent.

Yes we have, many times! Each persons circumstances is so unique, lets connect so we can explore your specific situation.

You know your children better than anyone else and we trust in your decision about their presence for this family event.

We adore having children present for the births! Moreover, we think it's of significant importance for the bonding of the family and welcoming of the newborn. It's important, though, to have an adult present just for your children. Ideally, that adult should be someone who can be completely present and responsive to your child. And, of course, it should be someone with whom your child is comfortable. There are wonderful books and materials for preparing children for the sights and sounds of labor and birth; we can help you find these. Rest assured that children generally do great with birth, especially when they've been adequately prepared.

Yes you can! We frequently have families enter care after seeing other providers for a variety of reasons.

It's never too late to join care. As long as we feel that we are a good fit and have space available. Note that the fees for midwifery care do not change depending on when you begin care.

• Read About Home Birth Services, Location & Service Area, Financial Information, and FAQ. Write down any questions you might still have.

• Schedule your complementary consultation. Contact Us.

• If you would like to move forward after the consultation, reach out and let us know. We will keep an opening for you for 1 week while you make your decision. You can always re-connect after that time, we just cant ensure there will still be an opening.

• Complete your client registration intake in Mobile Midwife: you will receive an invitation to do so via email.

• We will reach out to you to schedule your first visit.

• At your initial visit, we’ll begin prenatal care, finalize paperwork, collect the retainer if not already paid, and set up your payment plan. We’ll also order any labs or ultrasounds you desire.

We are thrilled with an invitation to walk alongside you on this special journey!