FAQs — Joyful Beginnings Birth Care

Frequently Asked Questions

What is a Licensed Midwife?

Licensed Midwives (LM) in Texas are trained perinatal professionals qualified to care for healthy, low-risk women & newborns throughout pregnancy, birth, and up to 6 weeks postpartum. LMs provide out of hospital birth in home or birth center settings only.

To legally practice midwifery in the State of Texas, a midwife must either be a Licensed Midwife (LM) or a Certified Nurse Midwife (CNM). At this time, Joyful Beginnings Birth Care is staffed by Licensed Midwives (LM).

Any additional credentials, such as CPM (Certified Professional Midwife) are optional in this State.

Midwives believe that pregnancy is not an illness, and shouldn't be treated as such. At the very core of the Midwifery Model of Care is a desire to educate and provide informed consent. This is a very important season in your life, and we want families to be active participants in their health care.

What's the difference between home birth & birth center?

Really, not much aside from address!

Our birth center is designed to have a home-like feel, and features the same team AND equipment that is available at all of our home births. However, some families may live further away from a hospital, and in the event of a transfer, feel more comfortable being near by. Our birth center is conveniently located across the street from Christus Santa Rosa - New Braunfels!

We are happy to provide home birth services within 45 minutes of our office address, provided that you also live within 30 minutes of a hospital. When checking to see your nearest hospital, please confirm that they provide Labor & Delivery as well as NICU services. (In recent years, Texas has seen many hospitals close their obstetrics units, thus creating "Maternity Care Deserts". This means nearly half of all Texas counties are without obstetric services!)

If you are outside our home birth radius, or live > 30 minutes from an appropriate hospital - you will be asked to plan a Birth Center delivery.

You can discuss your specific needs and options during your consult with us!

Is out-of-hospital birth safe? What are the benefits of Midwifery Care?

Birthing with midwives has been shown to be a safe option for healthy, low-risk women & babies, whose normal pregnancies go to term & are attended by trained midwives. To read the most recent study of midwife attended births, visit:

https://mana.org/blog/home-birth-safety-outcomes

Some of the many benefits include:

Individualized & evidence based care: all decisions are made together with you. We'll have detailed discussions about your needs, and lay out the current research so that you have the opportunity to take charge of your health!

Your own environment: you're free to move around, eat & drink in labor!

Bonding with your baby: experience immediate & uninterrupted skin to skin contact following delivery. We perform all necessary exams and monitoring right at your bedside.

Am I a good candidate for out-of-hospital birth?

Because we only care for healthy, low-risk women - this is an important question! Our goal is safe & healthy mom, baby and birth at all times. At your consultation we will assess your personal health history to ensure that you are a good midwifery candidate. We provide an ongoing risk assessment throughout your care with us as well in the event something changes. Our clients must be committed to healthy lifestyles and without chronic health conditions.

The following pre-existing conditions or risk factors would be considered high-risk or outside the scope for safe, out of hospital birth:

Insulin dependent diabetes, or Gestational Diabetes that requires medication to manage your glucose readings
Hypertension (High Blood Pressure)
Current smokers (all nicotine use must be discontinued as soon as possible, but no later than 16 weeks, to be considered as a candidate for our practice)
History of cervical incompetence with surgical therapy
Rh or other blood group isoimmunization
Triplets or higher order multiple gestation
A previous uterine surgery involving an incision into the uterine muscle (except for a low transverse cesarean section)

Please keep in mind that this is not an exhaustive list, and that there are other unique situations where someone may be considered high risk.

Because this answer is different for everyone, we encourage you to call our office to talk specifics about your personal health history and eligibility for care with our practice and other conditions which may risk you out of care during your pregnancy or birth.

I've been seeing another care provider, can I still transfer to Joyful Beginnings?

Yes! In general, we are able to accept late transfers of healthy, low-risk women. To discuss your options, our availability and your personal health history, please contact our office to schedule a consult.

If I am using Joyful Beginnings, do I need to see a physician also?

Nope! Licensed Midwives are qualified to provide complete prenatal, birth and postpartum care. If something arises during your care with us, we have a network of providers that we can consult, refer and collaborate with. Collaboration does not always neccesitate a transfer of care. This may look like a visit to and/or co-care with Maternal Fetal Medicine, local consulting physicians, specialists and more!

What do prenatal appointments look like?

Prenatal appointments take place in our office and are scheduled for 60 minutes. This gives us plenty of time to get to know eachother, answer all of your questions, and more! Your other children/family members are also welcome to join your at prenatal visits.

Prenatal Visit Schedule:

Monthly visits until 28 weeks,
Biweekly visits until 36 weeks,
Weekly visits until delivery

We detail all of our services here!

What about labs or sonograms?

All labwork is drawn in-office and sent out to Quest Diagnostics. Basic lab panels are required according to midwifery law and/or practice guidelines. All lab options are discussed with client for consent.

Referrals for sonograms given during care, we limit use to medically necessary. Requirements: Anatomy Scan at 20 wks, and a Biophysical Profile at 41 wks. Additional scans used only if clinically indicated.

Are there alternatives to Gestational Diabetes testing?

Yes! We offer The Fresh Test as a clean, approved testing alternative! We will discuss any personal risk factors, the need for Gestational Diabetes testing during all pregnancies, and any alternative testing options which may be of interest to you.

Who will attend my birth?

When you come into care, you are assigned a "Primary Midwife". We value continuity of care, so this is the midwife who is planning to be at your birth and who you will see for the vast majority of your prenatal visits.

We will schedule you to have at least 1 visit with each of the other midwives on our team in your third trimester, so that you can get to know our entire team.

There are few instances in which your Primary Midwife may be unavailable during your birth such as illness/emergency, if she is at another labor, or if she is off call. (Each midwife receives 1 weekend off call each month)

During these times, you will be informed of the next available midwife who is on call for you, and you would have already had the opportunity to meet her at a previous prenatal visit.

In addition to the primary midwife, there will be a second fully licensed midwife or trained Birth Assistant at every delivery. (There may also be an additional Birth Assistant or Student Midwife present.)

We value and respect your desire to know who will be at your birth, and strive to make sure the entire team has a chance to get to know each other throughout the pregnancy. You are also welcome to have your family and other support people participate as you desire.

What about "the mess"?

This is a popular question! Unlike the wildly inaccurate Hollywood portrayals, birth isn't as messy as you're thinking! And we've been doing this a while, so we're pretty good at protecting things. We'll provide you with a list of necessary birth supplies and help you prepare your space appropriately. Lastly, we clean up for you which includes starting the laundry! By the time we leave, you shouldn't see much evidence of a birth having occurred there other than your sweet new baby being tucked into bed with you!

What happens if birth doesn't go as planned?

Midwives are trained to handle certain complications at home, and to recognize complications that require a hospital transport.

Throughout labor, we'll be intermittently monitoring the baby using a fetal doppler. This allows us to listen to changes in the baby's heart rate so that he or she can let us know how they're doing. If we begin hearing changes that baby isn't tolerating labor, we'll transport to the hospital for delivery. During a transport, someone from our team will be notifying the receiving hospital and sending a copy of your medical record. In most situations, your primary midwife will accompany you to the hospital and stay until baby is born. After discharge from the hospital, we will resume your postpartum care as previously planned.

Every member of our team is also certified in Neonatal Resuscitation as well as Adult & Infant CPR for Healthcare Providers. Resuscitation equipment & oxygen is available at every delivery in case of emergency.We are also licensed to carry certain medications such as Pitocin and Cytotec in the event of a Postpartum Hemorrhage.

At your consultation with us, we'll discuss more in-depth our protocols for handling complications and what a hospital transport looks like.

What type of supplies do I need to provide?

If you are planning a homebirth, you will need to order a birth kit specifically designed for our practice. This kit includes all of the disposable medical supplies for your birth. You will also be given a list of other items that you will use to setup your space for home delivery. (Sheets, towels, etc.)

If you are planning a birth center delivery, all supplies are included in our package rate.

What about epidurals or other pain medication?

We do not offer any type of pain relief medication for labor. However, don't count yourself out just yet! Birth is NOTHING like what you've seen on TV, and many women are surprised to discover that there is a difference in intensity without Pitocin to augment labor. Furthermore, all of our clients have access to other "tools" in the toolkit when it comes to pain management during labor. This can look like having a doula present for labor support, moving freely throughout labor, delivering in any position you prefer and access to hydrotherapy! We encourage you to browse EBB's Pain Management Articles to learn more about all the other ways clients may manage their labor!

https://evidencebasedbirth.com/blog/

What does Postpartum & Newborn visits look like?

We provide care for both mother and baby from birth until six weeks postpartum.

Typical Postpartum Visit Schedule:

Home Visit within 24-48 hours of birth
Home Visit around 5 days postpartum
Office Visit at 2 weeks postpartum
Office Visit at 4 weeks postpartum
Office Visit at 6 weeks postpartum

We detail all of our services here!

What about Newborn testing or procedures? Do you provide vaccinations?

We offer all standard Newborn screening with the exception of the Hepatitis B Vaccine and Circumcision. We discuss all recommended tests/procedures during the pregnancy, providing parents ample opportunity for evidence-based researching prior to making any decision either to accept or decline newborn testing.

Our practice offers the following:

"Preservative Free" Vitamin K Injection
Erythromycin Eye Ointment
Critical Congenital Heart Disease (CCHD) Screening
Hearing Screening
Newborn Screen - a standard heel prick testing for over 55 serious metabolic and genetic disorders

If a family desires the Hepatitis B Vaccine or Circumcision, we will provide you a referral to a local Doctor who offers those services for you to schedule an appointment with.

We do not provide any vaccinations.

What are your fees? Do you offer payment plans?

We strive to always be as transparent with our fees as possible. Depending on delivery location and a few other factors, our package rates range from $6,000-$6,500. This rate includes all of your prenatal visits, birth with both Licensed Midwives present, six weeks of postpartum care for mom and six weeks of Well Baby Care!

We offer flexible payment plans, including discounts for those paying in full by 34 weeks! Prior to your first visit, you will have the opportunity to review our Financial Contract in full.

This fee does not include:

Bloodwork (which should be covered by your insurance; self pay clients receive significant discounts on these rates | est. $250)
Sonograms (which should be covered by your insurance; self pay clients receive significant discounts on these rates | est. $190)
Childbirth Education Class (required for anyone having their first unmedicated delivery)
Home Birth Kit (this is a small kit of disposable medical supplies that is required for homebirth families | est.$80-$90)
Rhogam Injection (for those with RH Neg. blood types | est. $300)
Incidental Procedures/Services: these are minor additions that are not needed by every client so are not included in our package rate. These services may include emergency medication at delivery, suturing or IVs. We strive to keep costs low for our clients by passing along our whole sale pricing!

Can I use my insurance?

Unfortunately, most insurance companies have not yet realized that midwifery care is not only offering their consumers a quality, safe option - but we're also saving them money! (Traditional hospital deliveries can average anywhere from $5k-$30k+!)

Because we are a small practice, and we are out of network providers, we do not currently bill insurance. (We hope to offer insurance billing in the future if legislation changes!) This means that all of our clients are considered self-pay and are responsible for paying our fees before delivery.

At the end of your care with us we will provide you with an itemized invoice, with insurance codes, that you may choose to use to seek reimbursement from your insurance provider. As every plan is different, we cannot guarantee this outcome...but we have learned that insurance providers are much more likely to listen to you as their consumer!

We currently accept cash, check, credit cards, automatic withdrawals, HSA cards and ACH payments.

We recommend reading the following resources when planning to seek reimbursement from your insurance company:

Ultimate Guide to Home Birth Insurance Reimbursement

If you have are contracted with a Healthshare (such as Samaritans or Christian Healthcare Ministries) - your care is often 100% reimburseable.

What about a birth certificate?

We take care of that for you! Our Administrative Director is a birth registrar with the state of Texas. Following birth, she will complete all necessary paperwork, send to you for review, and then submit to the State according to Texas Law. You should be able to pickup/order your child'r birth certificate by 2 weeks, and the social security card will arrive in the mail by 6 weeks.

What other resources are there available for me to review before making my decision?

Many families choose to do more in-depth research before booking their initial consultation. To help you with your search, we've linked some online resources that include information, statistics, behind-the-scenes views and more!

To Watch