Prenatal Care
Regular prenatal screening is required of all mothers preparing for an out of hospital birth with CMS midwives. Appointments include monitoring your baby's growth and heart rate, fetal position and size, maternal weight gain, a urine dipstick test, blood pressure and uterine growth. You will be given a lab slip to obtain your routine blood work. This must be done by the 16th week of pregnancy. Finger sticks to check hemoglobin or blood sugar may be done as needed in the office at additional charge. Glucose tolerance tests will be offered but not required unless there are other indications pointing to gestational diabetes.

Nutritional counseling is at the basis of all prenatal care at CMS. We will discuss your nutrition at every visit and assist you in learning what you can do to ensure a healthy pregnancy. Problems associated with pregnancy can many times be traced back to a nutritional deficiency and can be alleviated by a change in diet or nutritional supplements. Each visit is scheduled at 30 minute intervals. If you feel that you need a longer visit please inform the midwife prior to your appointment and we will schedule an extended visit.

We encourage you to bring the people close to you along for your prenatal visits. We want the opportunity to become familiar with those who might be at your birth. We have great interest in answering questions or addressing fears posed by your family and friends. Homebirth is something that seems out of the ordinary for most people today so we understand, encourage and welcome questions.

Children are also welcome at CMS but for your child's safety, we must ask that you keep your children with you at all times. We have toys and books in the exam rooms for them to play with but they cannot be allowed unsupervised access to the house for safety reasons. Please understand that we do not have the staff to supervise your children at this time. We appreciate your cooperation.
Labor and Birth
The attendants at your birth will include at least one Senior Midwife and one assistant. Your midwife may decide that more assistance is needed at your birth and call in more help. You may have the opportunity to choose the assistant who will be helping at your birth, however this is at the midwives discretion. She may have a very good reason for choosing a particular assistant based on her personality or special skills. Midwives at CMS follow the Code of Ethics, Standard of Practice and Protocols set forth by the OMA Certification Handbook. Our Certified Nurse Midwife follows the guidelines of practice set forth in the Nurse Practice Act and by the ACNM. If you would like to see any of these guidelines, simply ask and they will be made available. Our guidelines of practice serve to ensure the safest birth possible but should not prevent us from honoring your wishes whenever possible.

Care during labor will consist of monitoring the progress and condition of the mother, the condition, position and station of the baby while assisting the family in birthing their baby. After the baby is born, we will assist in the birth of the placenta and evaluate the mother and baby. Antibiotic ointment and Vitamin K is available for the baby after the birth, if you choose. We will be happy to explain these procedures so you can make an informed decision. Other topics regarding your newborn are PKU screening, hearing screening, breastfeeding, circumcision and immunization. We will be happy to explain these issues in order for you to make the decisions that are right for you and your baby. The midwives CMS will not make decisions for you regarding these procedures.

We will do our best to provide an unbiased review of the reasons for the procedures, reasons some choose to decline and then allow you to decide for yourself. One or more attendants will remain with the mother for 2-6 hours. We will remain with you until it is determined that the mother and baby are stable. If you birth in our birthing cottage we ask that you stay at least 4 hours.

We are trained to initiate emergency procedures, according to our ability and available equipment. We are trained to detect common abnormalities in the mother and baby. The midwife will alert the parents to any abnormal situation and offer them the options available. If you are from out of town and are traveling to CMS to birth your baby, you may wish to stay over night or wait until you are well rested to return home. We will do our best to accommodate your needs. The midwife will file a certificate of live birth with the Oklahoma State Health Department Vital Records Division.

A postpartum visit will be scheduled for 2-4 days after the birth, either in your home or by phone when necessary. You will have a two and six week check- up in the office. Other visits may be necessary and will be scheduled accordingly. There will be no additional charge for additional visits in the 6 week postpartum period.

If you transport to the hospital during labor, at least one attendant will remain with you until your baby is born or the situation is resolved. In the event that your baby is born in the hospital you will still have the benefit of postpartum care by our midwives.
Responsibility of the Client
It is vital that you take responsibility for your health and the health of your baby. Delivery of your baby at CMS or at home is dependant on your health and low risk status. Remaining low risk involves eating a healthy diet, moderate exercise and avoiding any substances that could harm your baby or endanger your health. Parents who choose an out of hospital birth with CMS are saying that they are educated about birth and the possible risks in and outside the hospital, have chosen to birth outside the hospital and assume responsibility for the outcome.

When you choose a CMS midwife you have the freedom to make choices regarding your prenatal care and your birth. When you choose to birth outside the hospital you will not have to be subjected to the interventions that can create added risk and are common in hospital birth. However you must be aware that situations can arise quickly and time is lost in receiving advanced medical attention. These situations are very rare but they do happen. You need to spend time educating yourself about the risks and work to try and prevent them. Again, the best way to stay low risk and ensure the health of your baby is to gift yourself with exemplary nutrition and good health practices. These issues will be discussed at your prenatal appointments and in your classes.

If you have any pre-existing conditions, such as cardiac disease, diabetes, hypertension, etc., you cannot be accepted as a client by CMS and you will be strongly advised not to attempt a birth outside the hospital. We can assist you in finding a physician who will allow us to be involved with your prenatal care and your birth.

Communication is very important. We will be open and honest with you and we expect the same in return. Please feel free to talk to us if you have any physical problems or problems affecting your emotional health. Sometimes pregnancy hormones can make even the simplest thing hard to cope with. The good news is there are usually solutions that are easy to implement and you will enjoy your pregnancy so much more if you trust us enough to share your concerns. Your birth experience will be greatly enhanced if there are no lingering problems or anxieties.
Insurance
Many insurance carriers are paying for the services of midwives. We will assist in filing for insurance reimbursement with an itemized bill. You will be required to pay your deductible and any co payments required by your insurance policy. CMS will do everything possible to aid in insurance reimbursement.
Classes Offered
We are pleased to offer a variety of classes to our clients. Childbirth education, breastfeeding, nutrition, early pregnancy, infant massage and other classes may be presented at CMS. Please ask for information on any classes you maybe interested in and we will do our best to provide a list of instructors and fee schedules.
Special Circumstances
We have already discussed the possibility of special circumstances that can occur requiring a transfer of care during pregnancy, labor or postpartum. CMS has an excellent plan of action in the event that you should need care by a physician or your baby should need extra attention. Be aware that the midwives at CMS participate in Peer review through the OMA and any special circumstances are shared with the Certification Review Board. A member of the OMA CRB may contact you after your birth to discuss your experience. By signing this document you are giving permission for your birth to be included in this peer review process. Only Intern and Senior Midwives are allowed to attend Peer review and all of the information shared is confidential.
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