INFORMATION DISCLOSURE

My Philosophy and Responsibilities

I believe that childbirth is a normal and natural event, which left to natural, will proceed to an uncomplicated end in most cases. I believe the midwife's job is to assist the birthing couple in the journey through pregnancy, labor and birth, by monitoring that natural process. Cases involving complications, which in my judgment cannot be handled safely in the home, will be referred to a person trained to deal with obstetrical difficulties.

I also believe that childbirth is a family centered event and the midwife's role is to enhance, not to usurp, the family's power of unity, except where there is an issue concerning the safety of the mother or child. I believe the parents should have the experience they desire and I encourage specific parental requests for the birth experience.

Couples must maintain the full responsibility for their own health care and for the outcome of the birth. I will assist with information on nutrition, exercises and childbirth education, but you must assume the responsibility of maintaining your own excellent health care. Home birth couples must take extra responsibility in this area since technological help is not immediately available as it is for those birthing in the hospital.

Qualifications and Legal Status:

Education
Volunteered at White Bird clinic in Eugene, OR as a medical assistant	(1973-1974)
Mentored under an English trained midwife Mabel Dzata	(1979-1981)
"Labor Sat" and assisted births with Dr Robert Kirchner	(1980-1982)
Apprentice Academic Home Study Midwifery Course	(1980-1981)
Numerous Workshops, Seminars, Conferences	(1980 to Present)
State required CEU's continuing education
Professional Experience
Began attending births in 1978. As of Jan 2005 1 have assisted moms in giving birth to well over 600 babies
Professional Certification
Licensed by Oregon Board of Direct Entry Midwifery 700 Summer Street NE Suite # 320 Salem, OR as a Licensed Direct Midwife (LDM) 1994
Registered with North America Registry of Midwives (NARM) PO Box 672169, Chugiak, Alaska 99567 as a Certified Professional Midwife 1994
Certified through the Amercian Association of Medical Assistants as a Certified Medical Assistant (CMA) 1995
Professional Affiliations
Member of OMC, NARM, CfM (Citizens for Midwifery).
Board Member for "Traditional School of Midwifery" Ashland, OR

If you have any complaints or concerns I ask that you first talk to me directly. If your concerns remain unresolved, you can direct complaints to NARM or the Licensing Board at the addresses given above.

Prenatal care:

I believe strongly in preventative health care and feel that good prenatal care is the best way to avoid most complications. I utilize nutritional and holistic whenever possible. Regular visits are made once monthly until the seventh month then bi monthly the seventh and eight month then weekly from the ninth month until the birth. Additional visits may be may be scheduled if needed. Visits last from 45-60 minutes. During these visits you will meet my assistant on several occasions. Prenatal visits consists of measuring the uterus, access fetal position, listening to fetal heart rate, checking weight gain, blood pressure, urine for protein/glucose, I provide equipment necessary to provide this care. We discuss physical complaints and changes and can talk about any emotion ional and social issues, stress, hopes and fears as well as information you need to make decisions about your care. Medical and obstetric history are discussed. Nutritional advice is given. Gyn exams, cultures, and hemoglobin (anemia) checks discussed and done as needed. In addition laboratory tests are strongly recommended during early pregnancy. These blood tests will be sent to OML Laboratory and will be billed directly to you or your insurance company. The initial test is the "Prenatal Profile". Group B strep, 1 hour GTT and STD testing will also be gone over and done as needed. Ultra sound imaging is not performed routinely, but can be obtained if indicated through referral as is amniocenteses to detect genetic abnormalities or other problems. At 41 weeks a non-stress test or accelerated auscultation is done. If the pregnancy continues past 42 weeks we will recommend a biophysical profile, checking amniotic fluid index. For your convenience I stock high quality vitamin and mineral supplement. To enable women to have access to the best I sell them at wholesale cost.

Labor and Delivery:

I feel it is important that parents have the kind of birth experience they desire and my trained assistant and I are there to help you meet these needs. A home birth can occur between 36 and up to 43 weeks of pregnancy. You will be given a handout called "What to Do When Labor Begins". It will have phone numbers on how to reach me and tips on what to do now you are in labor. When you require concentrated breathing to maintain comfort, it time for me to come to your house. We will help coach you if you wish, or allow you to labor alone or as a couple. I will always try to honor your requests concerning the delivery itself as outlined in the "Birth Plan Worksheet". The use of water during labor is encouraged. It can help you relax while making labor contraction more effective. Perinea] support is used rather than an episiotomy (cut) to allow gentle birth of baby's head and body. The cord is not usually cut until after it has stopped pulsing. I will provide the instruments and equipment necessary to facilitate a vaginal birth. Those in the house during the birth must be free from communicable disease. If you chose to have children at the birth someone must be specifically appointed to care for their needs. Also no unrestrained pets in the birthing room. Newborn suctioning is not usually necessary, but if indicated I provide equipment for emergency resuscitation (DeLee device, oxygen, bag-valve-mask set-up). Once the baby is born it is placed across the mother's stomach or in her arms for breastfeeding and welcoming.

Immediate post-partum care (Mom) herbs, and anti hemorrhagic drugs are used to manage unusual bleeding along with intravenous fluid replacements if needed. Once the placenta has been delivered I will assess your perineum and if necessary, with local anesthetic, repair any tears. We monitor the mother's condition for at least 1 hr or longer if indicated.

Immediate post-partum care (Baby) includes Apgar scoring of the infant at one and five minutes. Then when you are ready, your baby is thoroughly examined. Eye prophylaxis (Erythromycin ointment) and oral or injectable Vitamin K are administered, unless declined. Breastfeeding is highly recommended as it is extremely beneficial for both mother and baby's health and well-being. With some situations a professional lactation consultant may be needed. I can provide a referral if indicated. A trained assistant or myself will stay a minimum of 2 hrs after the birth or until everyone is stable. Handout "WHAT NOW" is given upon departure. It goes over what is normal and what to report to me regarding Mom and Baby well-being over the first few days following birth. It also has phone numbers on how to contact me 24/7, if needed.

Postpartum:

Regular postpartum visits are usually made on day one (24-36 hrs), day three, one week, three weeks and six weeks. During these exams vitals are checked, uterus, lochia discharge, blood pressure, pulse, temperature, fundus and ability to ambulate and urinate. Rh- moms giving birth to Rh+ infants will be given Rho immune globlin intramuscularly within 72 hrs post-birth. I will discuss physical and social parameters including adequacy of support systems. We encourage couples to have a friend or relative come to stay with the new mother after the baby is born, or to contact Doula service to aid in chores. We strongly urge parents to have their baby checked by a physician within the first week of life or sooner if indicated..

Expectations:

My goal as a midwife is not to "deliver" every woman out-of-hospital, no matter what, but to assist you to have the best, safest birth possible, while respecting your choices and individuality. I have found that clients who demonstrate a high level of responsibility and interest in their pregnancies and births have the best outcome, even if plans should suddenly change and hospital transport becomes necessary. Therefore, based on my experience, I hold the following expectations:

1. I expect parents to shape their own birth experiences and to make their own decisions, using me as a resource, and to accept responsibility for the results of their decisions.
2. I expect clients to demonstrate interest and responsibility by obtaining the necessary prenatal care, eating nutritiously, eliminating cigarettes, alcohol, and drug abuse, learning and practicing body conditioning exercises, relaxation and labor breathing techniques, keeping informed through reading and asking questions and meeting their financial obligation.

I expect honesty from couples I help and they can expect the same in return. Likewise please let me know what you expect of me. Clients who consistently demonstrate their lack of concern and interest in their own health and birth outcomes by not meeting these expectations generally contribute to a higher risk situation not conducive to a safe out-of-hospital delivery. At my discretion, I retain the right to refer such clients to other health care provider and to refuse additional services.

You probably have formed some ideas of what you expect from your care providers. I practice the "Midwifery Model of Care" and hold the following expectations of myself as your midwife:

1. To safeguard your privacy by protecting the confidentiality of care your receive,
2. To maintain high standards of honesty and always be truthful when communicating with you
3. To provide respectful, personalized care based on your unique needs
4. To the extent possible, to provide continuity of care so that I can form a relationship of trust and familiarity
5. To serve as educator, advisor, and care provider, but not to make decisions for you. Rather, I strive to assist women in making their own informed choices.

Legalities and Insurance

In Oregon midwife attended homebirths are legal, the following stipulations must be met:

• Midwife must file birth certificate within one week of the birth
• Midwife must test for infant metabolic disorders (PKU test) unless parents decline
• Midwife must administer eye prophylaxis (to protect against venereal disease blindness) and vitamin K (to protect against newborn clotting deficiency) unless parents deny permission

Liability Insurance, Liability (malpractice insurance is unavailable to direct-entry midwives in Oregon. Mid Valley Birthing Services does not carry such insurance. If obtaining a recovery in a malpractice action is an important factor for you, you are encouraged to investigate hospital delivery.

Use of Student Midwives

I feel it is important for midwifery skills to be passed on from experienced midwives. In teaching such skills I may have an apprentice at the births I attend. Apprentices engage in on going study, participation in prenatal and postpartum care and may serve as an assistant at the birth. When the apprentice gains more knowledge and skills, she may do vaginal exams, facilitating the birth and do newborn care. Acquiring clinical skills is an essential part of an apprentice education. You will meet my apprentice/assistant during your prenatal care. Feel free at any time to make me aware of any concerns regarding this aspect of your care. Another assistant may be chosen or another arrangement made if you so desire.

Thank you for taking the time to read my "Information Disclosure"