Services

Community Midwives, LLC is a small family business pledged to individualized and sustainable practice, accepting four births each month since 2001.

It is our privilege and commitment to have midwife apprentices working at Community Midwives (see "About us" above). A midwife apprentice learns the art, science, and skills of midwifery through academic and hands-on immersion over a period of three or four years. An apprentice is present at each visit and birth.

We invite you to call or email for a free interview.

Antepartum care

Regular prenatal visits last up to one hour and typically take place on Tuesdays and Thursdays at our home office, 3530 Lucia Crest in Madison (map here). While prenatal visits can be individualized to your circumstances, we typically follow a standard schedule. We meet once a month until your 7th month and every two weeks in your 7th and 8th months. At 36 weeks we come to your home, then resume office visits weekly until birth. You have 24-hour access to Community Midwives, however, to protect our family time, non-urgent calls after 7pm and on weekends are returned the next office day.

You are invited to join us for monthly homebirth group meetings at Happy Bambino, 2045 Atwood Ave., first Thursdays from 7pm-8:30pm. Following our first prenatal visit, you also are invited to join a planned homebirth yahoo group list. These supportive resources offer dynamic community networks to share stories, research, questions, and expectations surrounding everything related to pregnancy, planning a homebirth, and parenting.

During our time together we pay attention to your blood pressure and lab work, your nutrition, activity, stress levels, fears, feelings, dreams. We pay attention to your baby's growth, position, movement, and heartbeat. We review national guidelines for tests and procedures, typically spending a great deal of time discussing risks, benefits, research and choices. We can draw your blood in my office for all necessary and standard lab tests. We listen to your baby's heart with a doppler and/or fetoscope and order desired ultrasound scans. We review community class options and suggest books and dvds, most of which can be borrowed from the office lending library.

In the event of a pregnancy complication, we consult with a physician or UW CNM. For this reason, most women choose to visit one of the many excellent hospital practitioners in the Madison once during pregnancy, as well as preregister at the appropriate hospital. In some situations it will be safest for you to make a plan to birth in hospital. These situations include twins, placenta previa, preterm labor, preeclampsia, pregnancy induced hypertension, and persistent breech presentation. We offer doula service and continue to work together to ensure an empowered birth, breastfeeding, and newborn experience.

Intrapartum care

The same midwife you have come to know through pregnancy will be at your side through labor and birth.

Often, we talk by phone several times in early labor, before you feel ready for us to join you. Each labor is a complex cascade of chemical, physical, and environmental interactions that creates its own rhythm and expression - we individualize our care around you and your baby's needs and cues. When contractions are taking your breath away and are repetitive and frequent, you are probably ready for us to come to your home.

When we arrive, we check in with you and your labor partner(s) to assess how you are feeling and how labor is progressing. We perform internal exams only as you request or the situation indicates. We listen to your baby's heartbeat. If everything is reassuring, we proceed to set up our equipment. An inflatable birth pool (the same model carried by homebirth midwives in Britain) is available to all women who desire it.

We assess your well-being and labor progress continuously and your baby's heartbeat at regular intervals. We strive to promote that exquisite cascade of labor hormones by making suggestions only as needed (e.g. to facilitate your baby's descent) and by guarding the labor space and presence that you indicate work best. For some women, this means frequent verbal affirmations and normalization or constant hands-on support; for other women, this means stillness and silence. Often, needs change as stages of labor change. Whenever possible, we encourage you and your partner to receive your baby together.

In the event of a labor complication, we facilitate transfer to hospital. Complications can include abnormal fetal heart pattern or rate, concerns regarding the amniotic fluid, maternal fever, severe hypertension, active bleeding, or an umbilical cord that is presenting in front of the baby's head. Typically we have time to thoroughly discuss our concerns with you and your partner and agree upon a course of action. Some situations are more black-and-white or more urgent. If the situation is urgent, we move quickly to your car as we call the hospital to report our status and time of arrival. When ambulance services are required, we call 911. We remain by your side in the role of doulas and for all-important continuity of care.

Postpartum Care

As your baby rests against your skin, we monitor for bleeding and delivery of your placenta, at the same time ensure your baby is making all the appropriate adaptations to life outside the womb. If your baby requires help with secretions or breathing, we provide deep suctioning or oxygen in your comforting presence and with the umbilical cord attached. An intact cord provides oxygenated blood when your baby needs it most.

Often, the placenta delivers before the umbilical cord is cut. We monitor for extra bleeding while you feed your baby. When your baby takes a break from nursing, we weigh and measure your baby and perform a newborn exam. We administer ophthalmic erythromycin and vitamin K as desired. We require that you breastfeed, and that you and your partner provide continuous skin-to-skin contact with your baby for the first 24 hours. In this way, organs that are critical to your baby's breathing and temperature stabilization and to your baby's further development - your breasts and skin - take over where your placenta and uterus left off.

We examine your bottom for any lacerations. In the rare event of a deep or bleeding laceration, we stitch at home with local anesthetic. We stay with you until you and your baby are stable and comfortable. We require that you have alert assistance available to you during the first 24 hours after birth.

In the event of a newborn complication, we will discuss a plan of action for physician follow-up or initiate transport to a neonatal intensive care unit, as indicated.

We return to your home 24-36 hours after birth and again on the 3rd day postpartum. We pay close attention to feedings, elimination, baby's weight, vital signs, color, and umbilical site. We assess your sleep and comfort status, breast sensations, and support level. We facilitate any needed extra assistance or referrals. We create a birth summary document, where we can place your baby’s footprints. We file a legal birth certificate worksheet and perform the newborn metabolic screen and acoustic brainstem response hearing screen if desired.

Many parents choose to take their newborn to a physician of choice at 10 days-2 weeks postpartum. We fax a birth and postpartum summary to your physician. If you have not seen another provider by 2 weeks postpartum, we will return to your home at that time. Our final postpartum visit occurs 4–6 weeks after birth, when we check your baby's weight, feeding patterns, assess your physical and emotional status, review your birth experience, and look ahead to the next few months of important self and baby health care measures.

You are invited to attend a monthly postpartum peer group meeting the 4th Friday of each month at Happy Bambino from 10:30am - noon. You can reconnect with homebirthing families from prenatal gatherings and meet new parents and babies, while enjoying a wealth of breastfeeding and parenting support.

Partners, familes, friends

Pregnancy, birth and parenting are shared life events - all your loved ones are welcome at Community Midwives. We invite you to include your partner, older children, and/or other support persons at the interview, visits, and prenatal groups.

We acknowledge support partners and children as dimensions of your well-being, and most enjoy participatory roles at our visits. Children help listen to and measure the baby and easily move back and forth between the office and adjoining sibling playroom. During labor also, children enjoy a sense of involvement and purpose, at the same time freedom to come and go as instinct leads them. For this reason, we highly recommend you designate a labor resource person for older children. With ongoing inclusion in your pregnancy experience and a little anticipatory guidance, children tend to respond matter-of-factly to labor. Following the birth, they feel proud of their helpful and welcoming roles.

Like children, pets take the lead from adults around them. In a positive environment free from fear, pets quickly grow accustomed to unusual people, smells, and sounds.

Some families decide it is best that older children and/or pets stay at the home of friends or family during labor.

We support your choices regarding with whom and how you walk this unforgettable life journey of pregnancy and birth!