Frequently Asked Questions
Most pregnant women who are low-risk and meet specific guidelines can be cared for and give birth at Stand & Deliver Family Birth Center. There are certain pre-existing medical conditions, or medical conditions that can arise in pregnancy or labor, that can prohibit you, by state guidelines to receive care from a birth center, or for medical reasons, it might be decided that a birth center is not the best birth site choice for the type of care a higher-risk woman might need.
Florida law has specific requirements and guidelines regarding certain medical conditions. Each situation is considered on a case-by-case basis, so give us a call and you can speak with one of our Midwives about your particular situation.
These are the guidelines and medical criteria Florida birth centers use to determine whether a birth center is the ideal setting for a pregnant woman’s prenatal care, labor and birth:
- Client must be considered low-risk at the initial evaluation
- Age limits are determined on an individual basis
- Major medical problems include but are not limited to:
- Chronic hypertension, heart disease, or pulmonary embolus
- Congenital heart defects assessed as pathological by a cardiologist, placing mother and/or fetus at risk
- Severe renal disease
- Drug addiction or required use of anticonvulsant drugs
- Diabetes mellitus or thyroid disease which is not maintained in a euthyroid state
- Bleeding disorder or hemolytic disease
- Previous history of significant obstetrical complications
- Previous Cesarean birth or another uterine wall surgery
- Rh sensitization (This is not the same as Rh negative blood type)
- Seven or more pregnancies – (you may be eligible for home birth)
- Previous placenta abruption
- Significant signs or symptoms of Hypertensive disorders, such as preexisting hypertension, gestational hypertension, preeclampsia, eclampsia, HELLP syndrome
- Poly or oligo hydramnios
- Certain placental disorders or infections
- Baby not in Vertex (head down) position
- Malformed fetus
- Multiple gestation
- Intrauterine growth restriction
- Fetal distress
- Alcoholism or drug addiction
A birth center birth is gentler and easier on both the mother and the baby and the rest of the family can be active participants in the process.
- Freedom – Not only are you allowed to walk around during labor and eat and drink, we actually encourage it. You can have your baby in any position and are never confined to a “birthing bed” or strapped to monitors. You will wear your own clothes, instead of a hospital gown. During labor we monitor the mother and baby and the progress of labor in a way that doesn’t interfere with your ability to move around. Studies have clearly shown that labor is shorter and easier if a woman is active and is able to eat and drink. The baby also suffers less distress if mom is upright during labor.
- Privacy – You and your family will have complete privacy and will never be taken care of by strangers. You will get to know our small staff during your pregnancy and by the end we usually all feel like family. You can have as many or as few friends and family members as you like with you to welcome your new baby.
- Bonding – Your baby will never leave your side. Your partner will play a pivotal role in assisting you in labor. Your other children can be present for the labor and birth.
- Individualized care – During your pregnancy, we get to know what is important to you and your family, so that we can accommodate your wishes. Would you like to avoid unnecessary labs and procedures? Would you like your partner to help “catch” the baby? Would you like to be the one to “announce” if your baby is a boy or a girl? All of these and more are routine at the birth center.
- Shared decision making – Nurse-midwives believe that optimum health and safety are achieved when you are making the decisions regarding your care. We like to say that everything is up for discussion and nothing is routine. We will help you to be informed and educated about your choices, through teaching during pre-natal appointments and childbirth classes.
- Breastfeeding support – We will encourage and assist you to nurse your baby during the first hour after birth. We have a pro-breastfeeding policy and actually require that you nurse successfully before you may leave the birth center. We are here to support your journey through breastfeeding!
- Safety – Research has proven that out-of-hospital birth leads to fewer interventions and complications for both the mother and the baby. The chances of you having a cesarean, for example, are greatly reduced. Your baby will not be pulled out with forceps or vacuum. Your baby will not be subject to unneeded injections and examinations. Your body and your choices will be respected. As a matter of fact, the American Association of Birth Centers statistics demonstrate that birth centers have very low cesarean rates and infant and maternal death and injury rates. A study comparing out-of-hospital birth to in-hospital birth showed that for first time mothers, out-of-hospital birth was as safe as in-hospital birth, and for mothers who have already had one baby, out-of-hospital births are actually safer than in-hospital births.
We have affordable self-pay rates and payment plans. We cannot quote an exact price on this web site, because of contracts with some insurance companies, but complete care at Stand & Deliver Family Birth Center costs about one third to one half of a typical hospital birth.
We believe the quality of personalized care and attention received at Stand & Deliver is worth the investment. Midwives and birth centers enjoy better health outcomes for mothers and babies than hospital care. There is no comparison!
Due to the technology-intensive style of care, hospital charges for maternity care for mothers and newborns far exceed charges for any other hospital condition at over $100 billion/year in the U.S.
- Rising Cesarean Section rates- This is the most common operating room procedure in U.S.
- Six of the ten most common hospital procedures in the U.S. are maternity-related.
- The Pensacola area has a C-Section rate of 37%. World Health Organization recommends 5-10% C-Section rate. Birth center care facilitates physiologic childbirth which is less costly. Care is provided in an outpatient setting and is an excellent value for health care dollars.
We do offer home birth to some clients on a case by case basis. However, we pride ourselves on the home like setting offered at our Birth Center.
Florida law prohibits a woman from having a Trial of Labor After Cesarean (TOLAC) and a Vaginal Birth After Cesarean (VBAC) at a birth center.
There are few pregnant women that are unable to have their baby with a nurse midwife in the birth center. Age is not a risk factor, neither is infertility, nor is a history of miscarriages.
Women of any age who begin their pregnancy in a healthy state generally remain healthy and have a normal delivery. During regular prenatal visits, we conduct thorough screenings to ensure that you remain healthy and normal. We also use education and encourage nutrition and exercise to prevent problems. We can manage most of the common pregnancy complications.
Florida Law regulating birth centers requires that women who plan to deliver out-of-hospital be medically low-risk and be expected to have an uncomplicated birth.
The following conditions would place a woman in the “higher-risk” category, according to state regulations, and she and her baby would be better off being cared for by a physician (or a nurse-Midwife working with a physician) and giving birth in a hospital:
- Chronic High Blood Pressure
- Heart Disease
- Kidney Disease
- Current addiction to drugs or alcohol
- Insulin Dependent Diabetes*
- Bleeding or Blood Clotting Disease
- Prior Cesarean Section
- Multiple Pregnancy (twins or triplets)
- Pre-eclampsia in current pregnancy
- History of Placental Abruption
- Extreme obesity
- Women on certain medications
Note: Gestational Diabetes in a prior pregnancy does not automatically exclude you from consideration for a birth center birth. Except for women with these conditions, most pregnant women are eligible for care by the nurse-midwives at Stand & Deliver Family Birth Center. We suggest you call us to discuss your questions or schedule a free tour/consultation of the birth center.
We wish that we could let women with a prior c-section have their babies at the birth center but for women with a prior cesarean section, the current guidelines require that VBAC (Vaginal Birth After Cesarean) be attempted in a hospital setting.
Women who have had adequate prenatal care may transfer to the Stand & deliver Family Birth Center. We get phone calls every week from women who have discovered that their hospital or doctor isn’t meeting their needs. Some women need some time to realize that their fears about birth are misplaced and that they want to follow their heart and have their baby in a private, relaxed setting, rather than in the hustle and bustle of the hospital.
Becoming a client is a simple matter of calling our office to discuss the process which includes getting your prenatal care records from your current care provider so our nurse-midwives can review them to verify that you are eligible for birth center birth.
Some women who are considering changing care providers worry about offending or disappointing their current provider. While this shows thoughtfulness on your part, you should know that no doctor wants an unhappy patient. You have the right to exactly the care you desire and if you can’t get it with your current provider, no one should fault you for changing providers.
Most women are concerned about vaginal tearing during birth. We take this concern very seriously. We work very hard to prevent or minimize tearing. We encourage you to ease the baby out and teach you how to push in a slow, controlled manner to minimize trauma to the tissues.
Water is a perfect way to prevent tearing. Water softens tissue, allowing it to gently stretch during birth. Delivery underwater has been proven to dramatically reduce the risk of tearing, because the water not only softens the tissues, but the natural analgesic effect of the water makes it easier to deliver your baby slowly and gently.
Should you require stitches; the nurse-midwife will perform the repair after birth. We use local anesthetic for stitches.
The nurse-midwives are also trained to cut an episiotomy in emergency situations. It is done very rarely, but the ability to perform an episiotomy is an important component of the nurse-midwife’s management of birth complications.
We are required by the State of Florida to offer antibiotic eye ointment to prevent infection caused by undetected or untreated gonorrhea and/or chlamydia infection. We also offer Vitamin K injection to prevent Hemorrhagic Disease of the Newborn. We will discuss the risks and benefits of both Vitamin K and Erythromycin eye ointment with mothers and their partners. We will also provide materials so you may educate yourself to make an informed decision. You have the option of refusing treatment with a signed waiver.
A Newborn Metabolic Screening Test (PKU), a heel stick for blood collection, will be offered between 2 and 6 days after birth at your postpartum visit. It is required of the State of Florida. You also have the option to decline the collection with a signed waiver.
Unlike hospitals, we have no restrictions on video or photos during birth.
You may have anyone you like at your birth. We strongly urge our clients to surround themselves with positive, supportive people. Some clients have multiple friends and family members present; others prefer being alone with their partner.
Please remember that this time is all about you and your family. When choosing who to have present, ask yourself – How will this person support us during our birth?
Remember, you need to be able to let go during birth, with absolutely no inhibitions. We will also serve as your guardian and see to it that unwanted guests do not find their way in uninvited. We want to help maintain your vision of birth. A prepared birth team and family with love and support make for a wonderful birth!
We help you introduce the idea of the new baby by welcoming your other children at pre-natal visits and making the birth center feel like a comfortable, welcoming place for them.
No need to hire a babysitter, just to come in for your visit. We love getting to know your entire family and making everyone feel at home and part of the process. You are creating a family; we are here to support you.
Most children under three are not interested in actually seeing the baby born, Older children, especially girls, are often fascinated by the process and want very much to be a part of the experience. Having your other children present for the birth can be an important part of their bonding experience and acceptance of the new baby.
Children will need their own support person while in the birth center (not daddy, because he will be busy with mommy). In our experience, they are usually content to play or nap and check in on mommy periodically. With basic age-appropriate preparation, children of any age can participate fully in the experience.
After your baby is born, you must stay for a minimum of 4 hours.
Most of our clients feel great after their unmedicated labor and birth and are ready and anxious to get back to their own bed and their own home. It is amazing how much energy you have after natural birth.
Before you leave, the nurse-midwife does a thorough check of the mother and newborn.
At Stand & Deliver Family Birth Center we take the “fourth trimester” as seriously as we do the three trimesters of pregnancy.
One of our Nurse- Midwives will see you in 24 hours at your home to check on you and baby. We want to be sure you are adjusting well to breastfeeding and life with a new baby. We will remain your partner and support as you navigate this new milestone. You will come to see us on day 2-3 and then 6 weeks after your baby is born.
The “PKU” test (Newborn Screening Test) on the baby can be done at the 2-3-day office visit.
We will offer all tests recommended by the American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM), as well as those of the State of Florida. We will discuss the risks and benefits of the screening, so that you can make an informed decision.
Examples of some screenings:
- Obstetrical Panel -complete blood count (CBC), blood type, Rh factor, antibodies, rubella, hepatitis B, hepatitis C, and syphilis status, urine culture, vitamin D.
- HIV screening
- Pap screening offered if indicated or requested
- Gonorrhea and Chlamydia screening
- *Genetic Screening
- Diabetes Screening Test and Anemia screening at 28 weeks
- Group B Strep (GBS) screening at 36 weeks
- *Early ultrasound (indications may be suspected twins, unknown date of last menstrual period or conception)
- Anatomy ultrasound
- *Non-stress test (NST)
- *Biophysical Profile (BPP)
- *Thyroid Testing if Indicated
* indicates test not routinely performed
Our birthing rooms have supplies and medications equivalent to a Level I labor and delivery room in a hospital. The difference is, we only use them if absolutely necessary. We have all of the equipment necessary for resuscitation (including oxygen and suction) and postpartum hemorrhage (includes IV fluids and medication), among many other things.
There are many minor complications that can be and are handled in the birth center without further incident. For instance, a cord around the neck, GBS + mother, shoulder dystocia, maternal exhaustion, dehydration, retained placenta, and postpartum hemorrhage. If the situation cannot be stabilized, we will not hesitate to call “911” for emergency assistance and guidance. You will be transported by ambulance to the OB ER room at Sacred Heart Hospital, a short ambulance ride from Stand & Deliver.
The chances of you having a problem are very small. Unlike the stories one hears or the dramas on TV and movies, birth is generally a straightforward and safe process. Healthy, normal women usually stay healthy and normal and have a normal birth. Most problems that develop during pregnancy or birth have clear warning signs well ahead of time and we can calmly plan for preventing or managing a problem.
We do not handle high-risk pregnancies and you must be full term and essentially healthy to have your baby in the birth center. If we run into a problem with the mother or the baby, we have emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and resuscitation medications), and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation).
Stalled labor is, by far, our single most common reason for hospital transfer. Although we must resolve the situation in a timely manner, it is not truly an “emergency” and we generally have plenty of time to try various natural methods to get labor going again. By the time we decide to go to the hospital, generally the entire family is in agreement that it is the only reasonable course of action. Mothers can be driven to the hospital in their own car or via ambulance if needed. Mom’s care is then transferred to Sacred Heart Hospital.
Your nurse-midwives will gently bring the baby out of the water within the first few seconds after birth and place him/her into your arms. There is no physiological reason to leave the baby under the water for any length of time.
There are four main factors that prevent the baby from inhaling water at the time of birth:
- Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby’s muscles for breathing simply don’t work, thus engaging the first inhibitory response.
- Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
- Water is a hypo-tonic solution and lung fluids present in the fetus are hyper-tonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hyper-tonic solutions are denser and prevent hypo-tonic solutions from merging or coming into their presence.
- The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemo-receptors or taste buds. The larynx has five times as many taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
Most people worry about the baby breathing under water and this is a very common question. Research has determined that the risk of the baby breathing under water during birth is a false fear.
Don’t forget that the baby has been “under water” the entire time he or she was in the womb. Water is the most natural environment for the baby.
When the baby is born into the water, they are still attached to the umbilical cord and receiving oxygen exactly as it was in the womb. A baby born under water doesn’t even realize it has been born until you place them into Mama’s arm, even then it may take a few minutes for them to realize something is different! It is a very gentle way to welcome a new life.
The nurse-midwife brings the baby out of the water within a few seconds of birth, to minimize any risk.
Recent studies on water birth show it is as safe as land birth and are recommending more hospitals offer this option to women.