• Whole foods prenatal vitamin:  A good quality, whole foods PNV will serve several purposes.  It will provide folic acid necessary to help prevent neural tube defects in your baby.  It will supply a whole foods iron source, which will help prevent anemia without the constipating effects of unnatural ferrous sulfate.  It will also provide a multitude of trace minerals, such as calcium, magnesium, zinc, etc.

Some favorite brands are: New Chapter, Source of Life, and Rainbow Light.  But any over-the-counter PNV that says “whole food source” should meet these needs.  Check with your midwife if in any doubt. Some women experience nausea in early pregnancy with PNV.  This is much less with the whole foods type, but can still occur.  Take it during your least nauseated times of the day, typically in the evening just before bed.

• Vitamin C 1000 mg daily:  This helps build a strong amniotic sac.  It also has immune boosting properties.

If taking as a tablet, try to find one with bioflavinoids.  You can take the 1000mg at one time, or two 500 mg capsules, one in the morning and one at night. A favorite source is Emergen-C drink packets.  It is a fizzy, mix-in to your favorite beverage, and comes in multiple flavors.  Wal-mart sells them for the best price in town.

• Probiotics:  Immune-boosting supplement for the gut that benefits the entire body.  Helps prevent GBS colonization (more on this later).  Be sure to buy a quality one from a refrigerated source; my favorites are Udo’s Choice and Jarrow.
• Vitamin D3:  Research is showing more and more benefits from D3 supplementation.  Specifically, there is a proven reduction in c-section rates with 1000 i.u. daily.
• Essential fatty acids (EFAs):  The omegas are so beneficial for baby’s brain development and your skin elasticity (think stretch marks {not so great} and perineal stretching {fabulous}).

Start these after 12 weeks of pregnancy (3 months):

• Red Raspberry leaf tea:  A nourishing tea that is a well-known uterine tonic.  Increases blood flow to the uterus to grow a healthy baby.  Supplies some nutrients as well.  Can enjoy hot or cold, 1 glass a day until 34 weeks, then can enjoy as much as you’d like, up to a quart a day.  If you notice increased uterine activity with any warning signs provided by your midwife, call her immediately and stop the tea.  Avoid if you have a history of preterm labor.
• Nettles:  A super-nourishing tea that provides many vitamins and minerals, including calcium.  Drink as much as you’d like.
• Sage Mama Pregnancy Tea is locally made by Lost River Naturals, and I highly recommend it!  It contains the above organic herbs and many other beneficial, nourishing loose-leaf herbs to support a healthy pregnancy.

Start these after 34 weeks of pregnancy:

• Alfalfa tablets:  Nourish the blood to provide clotting factors.  These will do  help prevent any abnormal postpartum bleeding.  These also act as a precursor to Vitamin K,  for which babies are naturally deficient.  Start with 3 in the morning and 3 at night, and gradually work up to 6 in the morning and six at night.  Softer, darker stools are a very common side effect.  Loose stools indicate the need to back down by a tablet or two.

Optional:

• Evening Primrose Oil after 36 weeks:  Contains prostaglandins to help soften your cervix, getting it ready to labor.  However, Mother Nature designed your body perfectly for this great task, so this is most definitely optional.
• Garlic tablets:  Also immune boosting, especially if GBS is of concern to you.
• Vitamin E:  400 I.U. daily can help build a strong placental bed.  STOP TAKING AT 34 WEEKS TO HELP PREVENT A RETAINED PLACENTA!

Download

Download

Client Health History

PKU Exemption Form

Pregnancy Protein Sheet

SC Medicaid Application

Download

The only one I ask to be completed before our first appointment is the health history.  It’s important that we review this information together to determine if you have any needs that I might be able to help you meet as your pregnancy advances.  A Financial Agreement is available upon request by sending an email.

The very next day, I call to check in with a new mom of about 2 1/2 weeks.  We’d played phone tag for several days, and were finally able to catch up.  She filled me in about her recent visits with the Lactation Consultant (Huh?  Didn’t know these were even happening??  But, I digress…), her decision to pump and bottle feed most of the time, and to supplement with artificial infant food.  She sounded really at peace about it as she spoke, and then said that she and her husband were much happier with this plan.  Would this have been my choice?  No.  But, as I keep learning, these choices were not mine to make.  My job is to offer information, and support parental decisions.  Serve families where they are, not where I am.

• A small bottle of unopened olive oil (perineal massage, if necessary.  It is also most useful to apply to the area prior to meconium lays a layer of tar on you baby’s genitals; the oil makes it slide right off!)
• A large pot with a lid for preparing a batch of herbs for perineal care
• A colander or strainer, for preparation of an herbal tea for perineal care after birth
• A pitcher, such as used for iced tea or lemonade
• A large, flat cookie sheet (portable flat surface to move supplies where we’ll need them for birth)
• A vinyl tablecloth with flannel back (to protect your furniture/bed/carpet from birthing stains)
• A crock pot, preferably with a “Keep Warm” setting  for portable warm water for washcloths for perineal soothing during crowning.  These will be offered to you; feel free to accept them with a quiet nod or a head-shake of “no.”
• A waterproof sheet that fits your bed (to protect your bed)
• Fresh ginger root (ginger in the crock pot helps bring blood flow to perineal tissues to maximize stretching)
• A flashlight and batteries (for viewing when room is dark or candlelit)
• Large bowl (for placenta)
• Birth Kit.  Information about the disposable supplies that must be ordered are available.
• Healthy food choices for the family postpartum
• Variety of mom’s favorite beverages for labor
• Several pairs of comfortable, cotton underwear for after the birth

Additional water birth supplies that are necessary:

• A new, lead-free or “drinking-water safe” hose (very clean for filling the tub)
• Any connection pieces necessary to connect hose to a hot water supply
• A new fish net (for any “floaties” in the tub; probably the most important purchase!)
• Tarp to put under the tub (to protect your floors from any drips)
• 2-3 extra towels for drying midwife arms, doppler, dad

LINENS – We tend to use quite a bit of linens during a birth.  Please have available, in a storage box/laundry basket of sorts:

• 2 complete sets of sheets that fit your bed
• 1 extra pillow case
• 4 large towels
• 12 wash cloths
• A set of clothes for your baby, including:  T-shirt or Onsie,  Long-sleeved Footed Sleeper, Hat, Socks, Three (3) Receiving Blankets.

The parties agree as follows:

·        Philosophy and responsibilities of the midwives

Pregnancy, birth, and breastfeeding are natural, normal functions of a woman’s mind, body, emotions, and spirit, all of which are equally important.  As midwives, we seek to nurture a woman’s sense of personal strength and self confidence so that she may realize birth as an empowering and enlarging life experience.  We do not feel we “deliver” babies; we assist and support women to give birth.  We believe that women are uniquely suited to attend other women during this life passage.  Most of the world’s women give birth with midwives who serve as guides to the total pregnancy experience.   Birth at home among family members, coupled with continuous care by skilled attendants, can provide an optimal environment for the majority of women.  When birth is integrated into life as a family event, the family is strengthened as well.

As care-givers, our clinical skills, intellects, and intuitions all serve as valuable tools in our work as guides to understanding the process of pregnancy and birth.  We believe the things which matter most in creating a physically healthy pregnancy are those things you have the most control over, including good nutrition, exercise, and the elimination of tobacco, alcohol, and drugs.  On an emotional, psychological, and spiritual level, we recognize that birth is not an event which is isolated from the totality of a woman’s life.  We endeavor to assist women to become as conscious of their personal processes as possible so that they may have a broad base of resources to draw on during their birth experiences.  Our responsibility is to make you aware of any concerns we have based on our past experience and current perception.  We seek to offer informed choice, not merely informed consent.  You are our clients, never our patients.  Any decisions regarding options are yours to make.  At the same time, there are limit to what we are willing to take on as responsible care providers.  When and if our limits are reached, we will let you know immediately.

We offer our services as a team working in partnership with clients before, during, and after the birth of their child.  For us, midwifery is a continually evolving process and we are always learning from our experiences.  Working in partnership with clients means we are supporting you to create your own experience.  You are responsible for the birth and we are assisting you in taking that responsibility.  It also means that we must all be in agreement regarding the care needed and our ability to provide such care.  Complete prenatal care creates the opportunity to develop a relationship before the birth as well as to establish the parameters of well-being unique to each individual client.

Any environment, whether home, hospital, or birth center, presents a distinct set of risk factors for birth.  Nothing can guarantee a perfect outcome.  We believe each woman has the right to an informed choice of the environment she perceives as safest for her and her baby.  Many women do not appreciate mainstream obstetrics’ approach to pregnancy as a problem waiting to happen.  Our care reflects their own desire to trust birth and themselves.  For such women, homebirth is a logical choice.  We endeavor to create an environment which supports women in opening to their own intuitive process rather than imposing artificial interventions or attempting to make labor conform to a specific pattern.  When allowed to follow its natural course, pregnancy usually results in the birth of a healthy baby and mother.  The range of natural variation is extremely wide.  Occasionally, a critical situation arises during pregnancy or labor which necessitates specialized care that cannot be provided in a home setting.  In such cases, a previously established medical back-up system will be relied on for appropriate care.

• • Prenatal Care

We strongly believe that preventative health and prenatal care are the best ways to avoid complications.  We believe that prenatal care is given to your baby every day by you and monitored regularly by us.  Regular care occurs monthly until the seventh month, twice monthly in the seventh and eighth months, and weekly for the ninth month until birth.  Additional visits may be scheduled as necessary.

South Carolina (SC) law requires you to have two additional visits with a physician during this pregnancy, with one occurring in the last six weeks of pregnancy.  At this visit, the OB or CNM must sign some documents (which we will provide) that verify you are an acceptable, low-risk candidate for a home birth.  Again, this is a requirement of the Department of Health and Environmental Control, who regulates the licensed midwives in SC.  The complete regulations under which licensed midwives practice is available here.

• • Labor and delivery

We feel it is important that parents have the kind of birth they want, as long as their desires do not fall outside a reasonable realm of safety.  We are present to help you meet those needs.  We will help coach you if you wish or leave you to labor alone or as a couple with minimal interruptions.  We will always try to honor your requests regarding the delivery itself.  We will stay after the birth until everyone is stable.

• • Postpartum

Regular home postpartum visits are usually on day one and day three by a midwife, with an additional visit on day five if needed.  Telephone assessments will be done on day two and day four.  We encourage couples to have a friend or relative come to stay with them after the baby is born or to contact a doula service to aid in the chores.  We strongly urge parents to have the baby seen by their pediatrician within the first week of life, or sooner if there is a cause.

• Legal Status

Direct Entry Midwifery is legal in SC.  We are licensed by the Department of Health and Environmental Control which allows us to practice midwifery by virtue of an approved course of education, clinical experience, and licensing examination.

***I understand that Brandy Brandfass, RN, LM, CPM is a licensed midwife in South Carolina.  I am aware that Brandy is also a registered nurse in good standing in South Carolina with over 10 years of inpatient labor and delivery experience.  It has been fully explained to me that Brandy is NOT a Certified Nurse Midwife, that she does not have her Master’s degree, is not working directly under a physician’s written protocols, does not have hospital privileges, and cannot write prescriptions.  I have had the opportunity to question Brandy about this matter, and am comfortable with her status in South Carolina.

Initials of both parents:  __________                      _____________

• Expectations

We expect honesty from couples we help and they can expect the same in return.  We expect couples to be well informed about home births, and to take seriously the special responsibility they bear for their health, pregnancy, and preparation for their labor and birth.  Please let us know what you expect from us.

The midwives reserve the right to resign at any stage of the pregnancy if we believe it is necessary to do so.  We will discuss with you fully the risks, our concerns, and our reasons if this becomes necessary.  Risk assessment is a tool we use from our initial consultation to six weeks postpartum to ensure you the most appropriate and best care possible.

• Philosophy and Responsibility of Parents

We have chosen to have a home birth based upon what we believe to be a thorough examination of the alternatives.  We have discussed our prenatal care and birth options between ourselves, and with other knowledgeable people to the extent we think necessary.  After considering these options we have asked Transitions Midwifery Services, LLC,  to assist us in our home birth.

In addition to the agreements above, we also fully understand and agree as follows:

• It is impossible at a home birth to provide the same type of care that is available at a hospital.  We are fully aware that in the event of a complication or emergency there are fewer alternatives available at a home birth then would be available in a hospital.
• We believe that birth is a natural, generally safe process.  We have, however, discussed some of the problems which can arise in childbirth and feel comfortable with our decision.
• It may become necessary during the birth to transfer the mother and/or child to the hospital.  We may choose to go to the hospital at any time.  If the midwives in attendance believe it is necessary to transport mother or child to the hospital, either before, during, or after the birth, we agree to go to the hospital upon their request.
• We agree to take the baby to a pediatrician for a newborn exam within one week of the birth.
• We agree to be seen by an OB or CNM for the two required visits prenatally.  We agree to follow our midwives’ recommendations regarding healthy pregnancy, labor, and birth.
• We agree to comply with prenatal testing, including Hepatitis B and HIV for the safety of the mother, child, and midwives.
• We agree to participate as a couple in natural childbirth classes unless our midwives specifically indicate that this is not necessary due to our previous experiences.

• Financial Agreement

A clear understanding of our financial obligation to the midwives helps insure a smooth working relationship.   Toward that end we have expressly entered into this financial agreement:

1. By the 37^th week of pregnancy, we agree to pay $2400 for the birth.  If filing insurance, $200 will be added to this total to cover billing services fees, making the final total $2600.  We understand that if not paid in full the midwives are not obligated to attend the birth.  Should this be the case, the midwives will notify the parents immediately by phone or in person.
2. If the midwives travel outside a 75-mile radius, we agree to pay an additional $400, due by the 37^th week of pregnancy
3. We agree to pay a gratuity of $100 to the birth assistants/apprentices at the time of the birth.
4. We agree to pay for all supplies, lab work, medical visits, and childbirth classes requested by the midwives.
5. We agree to payment on the schedule set forth in the financial agreement.
6. Transitions Midwifery Services, LLC, maintains a no refund policy.
7. If during labor it becomes necessary to transport to the hospital because of a complication, we realize that the midwives will have done their job to assess an abnormal situation and we agree that the midwives will be paid in full.
8. The midwives will be paid in full if they arrive after the delivery as a result of a delayed notification or a precipitous (very quick) birth.

Transitions Midwifery Services, LLC, and the parents each promise to work to establish an atmosphere of trust and cooperation that will contribute to a healthy, safe, and rewarding birth experience.

LM_________________________________________________  Date__________

Parent_______________________________________________  Date__________

Parent_______________________________________________  Date__________

• Add the following to your diet:  Apples, apricots, asparagus, bananas, beets, black cherries, broccoli, egg yolks, kelp, leafy greens, miso, okra, parsley, peas, plums, prunes, purple grapes, raisins, rice bran, sea vegetables, squash, turnip greens, whole grains, and yams.
• Iron-rich meats may include wild Alaskan salmon, shellfish, clams, sardines, and free-range or organic:  organ meats such as liver, heart, tongue; beef, pork, lamb, and poultry
• Increasing intake of Vitamin C-rich foods can enhance absorption of iron.  One orange or 6 ounces of orange juice can double the amount of iron your body absorbs from plant foods.
• Grape juice (preferably organic) with no sugar or preservatives is a wonderful source of iron; drink 8 ounces a day.
• Eat raw spinach salads often (wash well).  Add any of the following iron-rich foods:  watercress, radish, kohlrabi, garlic, chives, leek and onion.
• Daily intake of 3-4 pieces of dry fig
• Brewer’s yeast is a good iron source
• Every morning and evening, eat two dried apricots.  Snack on raisins.
• Beet juice is a fabulous anemia remedy; make fresh in a juicer.  Throw a few beet roots into soup a few times a week.
• Try to cook in cast iron pots and skillets.  It is proven to significantly increase the amount of iron in foods.
• Honey helps increase the hemoglobin.
• Consume at least 1 Tablespoon of blackstrap molasses twice daily
• Avoid foods that are high in oxalic acid, as it interferes with iron absorption, such as:  almonds, cashews, chocolate, cocoa, kale, rhubarb, soda, sorrel, Swiss chard, most nuts and beans.
• Avoid beer and other alcoholic beverages, candy, dairy products, ice cream, soft drinks, coffee, and black tea.  Additives in these foods interfere with iron absorption.
• Do not take calcium, Vitamin E, zinc or antacids at the same time as any iron supplements; they interfere with absorption.
• Perform 20 minutes of pulse-raising exercise every day; this lets the body know it needs more oxygen.
• Vitamin C 1000 mg three times a day.

If anemia is not responsive to the above dietary changes, consider adding the following homeopathic remedies:

1. Ferrum metallicum
2. Helonias
3. Natrum muriaticum
4. Pulsatilla
5. Secale
6. Ferrum Phos.  30C three times a day
7. Kali Carb

Herbal remedies include:

• Yelllow dock root tincture 25-40 drops 3 times daily
• Beet root capsules
• Wheat grass juice, 4 oz, 4 times a day
• Iron tea:

2 tsp Yellow dock root

½ tsp nettle leaves

½ tsp dandelion root

½ tsp beet root

½ tsp licorice root

½ tsp cooked rehmanni root (may be found in a Chinese grocery store)

3 cups water

Directions: Bring herbs and water to a boil, turn down heat, and simmer for 5 minutes.  Turn off heat and let steep for 20 minutes.  Strain out herbs.  Drink 2 cups a day.

• Chlorophyll, 4-6 daily or 1-3 Tbsp daily
• Floradix Iron plus Herbs 2 teaspoons daily
• Source Naturals Chelated Iron
• Standard Process Labs Ferrofood 3-6 tablets daily

These symptoms can include:

• Painful, heavy breast, ranging from uncomfortable to downright excruciating;
• Redness and swelling of one or more specific areas of the breast;
• Fever, commonly very high (104 is not unusual);
• Body aches and chills;
• Feeling “like you got hit with a truck.”

Some therapies you can try at home are:

• Get in bed with your baby and rest, drink lots of water, and NURSE, NURSE, NURSE
• Offer the affected breast first with every feeding
• Massage from the chest wall toward the nipple to encourage emptying of the affected duct.  This will hurt, but is very necessary.
• If possible, offer the breast is a position that will allow maximum drainage of the duct.  Kneeling on hands and knees over baby is great.  Also, lie down on the side of the unaffected breast.  Offer the affected breast to baby on this side.  You will lay over baby this way, but the duct will drain well.

• Alternate hot castor oil packs and cold cabbage leaf/potato packs.  Sounds crazy, but is very helpful: Pre-heat a heating pad as warm as you can stand it.  Tear a sheet of plastic wrap and place it on your work area.  Get a washcloth damp with hot water; place it on the plastic wrap.  Pour about a tablespoonful of castor oil on the cloth; smear it around.  Place the whole thing over the affected area of the breast.  Lay down with a heating pad on it; rest for at least 20 minutes with this on.  Keep it on as long as it feels good.  Wash the oil off your nipple before baby nurses again; it can cause diarrhea.
• When you are ready for a change, get out your oldest bra and T-shirt.   Grate a potato, and squeeze out the excess water.  Place the potato in a cold cabbage leaf, and place it in your bra.  The potato juice does stain, so please do wear old things.  Go back to bed and rest and drink more water.

• Homeopathics can be very helpful for mastitis.  Phytolacca 30C every 3-4 hours is wonderful in general.  Belladonna 30C every 3-4 hours can be fabulous if the breast is very red and hot.
• Vitamin C 1000 mg with bioflavinoids every 4 hours
• Echinacea tincture: Calculate your body weight; divide in half.  This is the number of drops you can take every hour during the acute phase of a sever infection.

You should feel much better within 24-36 hours of this regime.  If not call your doctor; you may need antibiotics.  Mastitis can get very serious if left untreated.

BREATHING: Babies make all sorts of sounds with normal breathing.  They may breathe irregularly with fast, shallow breaths followed by deep, slow breaths.  The most common breathing sounds may come from small amounts of mucous in their nose and throat.  Babies will also have periods of quiet breathing.  When they cry, they may become redder.

If your baby shows any of the following:
• Labored breathing with a grunt sound with each breath
• His/her chest seems to cave-in with each breath when baby is not crying
• Is breathing more than 60 breaths a minute and lasts more that 15 minutes

You will need to call us right away.

COLOR: A small amount of blue color on the hands and feet is normal for a new baby.  They may even have irregular color patterns called mottling on their chest or tummy.  If your baby has blue coloring on lips or body, or is gray, call us.

TEMPERATURE: Your new baby is adjusting to life outside and the temperature may be unstable the first few days.   The best way to help your baby regulate her temperature is LOTS of skin-to-skin contact, with both of you.  Dad, baby will love to snuggle in on your chest, too.  Take your baby’s temperature under the arm for 5 minutes.  If the temperature is BELOW 97 or ABOVE 100 F, consistently, call us.

FEEDING: Your baby should have a strong, vigorous suck.  Babies should be fed EVERY TIME they seem hungry.  Babies need to breastfeed at least every two hours at first.  Frequent feedings encourages your milk supply to increase to meet your baby’s needs.

DIAPERS: Watch for your baby’s first wet diaper.  Call your baby’s care giver if your baby has not urinated by 24 hours of age.  After your milk supply has increased, 6 or more wet diapers a day is normal.  The first bowel movements (BM) your baby will have are large, sticky, black/green stools called meconium.  It normally happens by one day of age.  The BM’s between meconim and milk stools can range from brown to green and may seem soft.  The breast milk stools are more mustard in color and loose.

MOVEMENT: Babies movements are somewhat jerky at first.  Your baby may seem to startle easily in the first 3-4 months.

CORD: Your baby will have a cord clamp on the cord.  We will remove it at the first home visit.  You can clean the cord with moist Q-tips at diaper changes, if you’d like.  Keep the diaper folded under the cord to help it dry.  When the cord falls off, it may bleed a very small amount; this is normal.  If it develops a foul odor, call your baby’s doctor.  Until the cord falls off and the belly button is dry, give your baby sponge baths using plain warm water or a mild soap.

JAUNDICE: Your baby will begin to break down extra red blood cells which are no longer needed.  The liver breaks down (metabolizes) the red pigment matter called bilirubin in the red blood cells.  When there are too many cells to handle, the liver can’t keep up.  The extra bilirubin gives the baby a yellow color to the skin and the whites of the eyes.  This is called jaundice.  Check this by looking at your baby under natural light (by a window).  Gently press on the skin.  Almost all babies, especially breastfed ones, are slightly yellow 2-3 days after birth.  The best way to clear this normal, slight jaundice is to nurse, nurse,  nurse!  Also, spend 10 minutes, on each side, twice a day with baby wearing only a diaper in filtered sunlight (by a window is fine).  If jaundice develops before 24 hours of age, or baby looks more than slightly yellow, call the midwives.

APPOINTMENT: Call your pediatrician within the first 24 hours to let him/her know that your baby has been born.  We recommend you see your pediatrician within the first week of life.

INSURANCE:  Call to add your baby to your insurance plan within the first day or two.