Believe Midwifery Services L.L.C.

Believe Midwifery Services is currently served by one Certified Nurse Midwife, as well as a graduate trained Registered Nurse and three birth assistants.  As a team we work closely to meet the needs of our clientele.

Women who labor at home avoid spending energy on adapting to a new environment, leaving more energy to devote to the work of labor.  They can engage in a wide variety of activities of daily living until labor requires their undivided attention. 

Every single mother in our practice has had an unmedicated birth.  Pain medications are not provided in our practice, as this would increase the risk of homebirth management.  However, our clients are offered a plethora of comfort measures that overwhelmingly satisfy, including: labor support, hydrotherapy, herbs, nutrition, encouragement, sterile water papules, massage, TENS machines, aromatherapy, music and prayer. 

You can read further about pain management here, with respect to the misconception that our hospital's conveniences offer increased safety in childbirth.

Interventions such as these, when necessary, often indicate the need for immediate medical care which is best provided within the hospital.  The intrisic safety in homebirth is that the natural process is supported and interventions are at an absolute minimum.  However, after weighing the risks and benefits of various interventions, an occasional family has chosen a particular intervention that they felt would optimize their outcome.  The practice has not yet found either an episiotomy or a cesarean section indicated within the intrapartum period, although if ever indicated, the practice is prepared to do so or transfer for that care appropriately.

You are welcome to invite whomever you feel would support and comfort you during your birthing experience.  However, feeling obligated to invite friends and family to your birth who are fearful quite frequently lengthens the labor experience, as mom is unable to relax and allow the birth process to occur.  It is also vital that the number of people invited respect the midwife and her assistants need to provide a safe environment.

The practice offers a home visit at 36 weeks of gestation, upon which we encourage you to invite any family members and friends who are hesitant or unsupportive of homebirth, so that we can explore their concerns.  Most always these sessions conclude with great peace. 

All prenatal visits, with exception of the 36-week home visit occur in the Thorntown office.  Each visit is offered thirty minutes, with exception of the initial visit and postpartum visits, which are sixty minutes in length.  Two postpartum visits are provided in your home and the remaining two, at two-weeks and six-weeks, are offered in the office.

Appointments are available on Mondays from 10:00am through 8:00pm and Thursdays from 10:00am through 5:00pm.  Well-behaved children are always welcome at your visits.

Believe Midwifery Services, LLC hosts a confidential yahoo group for our clientele, which not only offers all of our childbirth education hand-outs in the file section, but also videos for reviewing at your leisure.  Questions can be posted to the group that do not require the urgent or emergent attention of the midwife.  Clients are encouraged to participate in discussion, sharing your experiences and advice; however, birth assistants are also available to answer questions as well. 

The midwife will review many of the major teaching points within the thirty minute prenatal sessions and most families who have experienced natural childbirth before, find these sessions more than fullfill their learning needs.  Families who have not experienced either a natural childbirth experience or a homebirth are encouraged to attend the homebirth preparation course offered at a local bed & breakfast. 

The state of Indiana recognizes Certified Nurse Midwives as independent practitioners that work within a system of collaboration (scroll down to page 48).  Clients who seek care with Believe Midwifery Services, LLC rarely require physician collaboration, although many are referred for chiropractic support. 

Penny Lane CNM has non-admitting physician privileges at St. Vincent Hospital in Indianapolis and Carmel, so if a pregnancy concern arises or additional observation is indicated, clients will typically be provided a consultation by the Maternal Fetal Medicine physicians at St. Vincent. 

It is our belief that ALL pregnant mothers benefit from midwifery care, yet not all women are appropriate candidates for primary care with a midwife or homebirth.  If this proves to be the case, your midwife will work with you to find a physician that best matches your medical needs and one that supports your decisions. 

I would like to first ask you to consider what safety you find in hospital birth?  It is a misconception to believe that a physician is immediately available in each and every hospital.  Only in the rare tertiary center might  this be the case.  Rather, hospitals require on-call staff be available within thirty minutes of an emergency call.  Following their arrival, the emergency team would then require time to assemble themselves and manage the emergency situation. 

Nurses are the primary care provider in hospital births and unfortunately are frequently understaffed, managing several laboring women who most always have high risk interventions such as pitocin augmentation and epidural anesthesa.  These sorts of interventions not only bring significantly more risk to each birth scenario, but often mask warning signs that are easily observed in homebirth while mother and baby still have enough reserve to escape any long-term damaging effects.  Once your hospital nurse does observe signs of impending danger, she would notify your on-call obstetrician, the anesthesiologist, the pediatrician and the operating room staff who are either in their offices, which are rarely located on site, or in the privacy of their own homes.  In a homebirth scenario, we would simply meet them at the hospital.  In our experience, we have arrived prepped for potential emergency management and awaited the arrival of the on-call medical team.

Homebirth is not a guarantee of safety.  Birth itself, is only as safe as life gets.  An environment that supports the normal course of labor and birth lends itself to the most optimal outcomes.  Many taxi drivers have claimed the glory of a successful birth because they simply caught a baby in an otherwise noninterventive birth.  On the rare occasion that a birth emergency or challenge presents itself, homebirth can only be safe if your provider has sufficient training, experience, proper equipment and seamless transport arrangments.  Believe Midwifery Services, LLC has worked diligently to provide the utmost of professional care for these specific events.  

As mentioned previously, Certified Nurse Midwives in the state of Indiana are licensed as independent practitioners; therefore clients do not require physician care unless a medical consultation proves necessary.  In the event of an emergency, you would transfer to the nearest hospital and be cared for by the on-call physician.  If you have already established a relationship with a physician, it would be exceptionally rare for this physician to come in for your labor and/or emergency.  No matter your birth environment, mothers are routinely cared for by the on-call physician. 

From a homebirth transfer, this care can not be denied.  You have the right to be treated in a hospital if you arrive in active labor.  You are to be cared for from the time of contractions through the delivery of the baby and the placenta.  This is established by federal law.  Your midwife would accompany you and provide the staff an immediate copy of your prenatal and intrapartum paperwork.  Her presence would be as labor support.

Regarding presciption priviledges, ironically in spite of legislature recognizing Nurse Midwives as independent practitioners, our legislative body has required a written collaboration with a physician to obtain prescription privileges.  At this time, while the practice has worked with several physicians that are supportive of our mission and grateful for the services we provide, none have overcome the barrier that presents them from entering into a written collaboration with a homebirth midwife.

Gratefully, the practice has established relationships with providers holding prescription privileges that are supportive of midwifery and the pharmacetical needs of our clientele.  However, we encourage each client to communicate to area providers our current barriers in hopes of increasing our collaborative relationships. 

All medical equipment is provided by Believe Midwifery Services, LLC.  At your home visit, you will be provided a "birth kit" which includes your sterile instruments and supplies, cord clamp, cord blood tubes, sterile gloves, scrub brush, bulb syringe, etc.  Your midwife will bring all other vital equipment to the birth itself.  This briefly includes a birthing stool, a gram-sensitive newborn scale, two oxygen canisters with resuscitation including intubation supplies, suctioning equipment, newborn care items, IV equipment, foley catheters, suturing equipment, emergency medications, herbs, aromatherapy, massage oils, comfort tools, dopplers, stethoscopes, and additional assessment tools.  We also bring air mattesses in the event we will stay with you for a while.

We provide a list of items for our clients to organize, which almost entirely can be found with in your home, including: towels, washrags, baby blankets, frozen meals, thermometer, sheets, hygiene items and so forth.

This is discussed thoroughly within our services page.  Briefly, you will be seen either by a birth assistant, our Registed Nurse and/or your Nurse Midwife at 48 hours, one week, two weeks and six weeks.  This follows extensive postpartum care that is provided immediately until both mom and baby are stable, have been fed, and your birthing environment has been cleaned.

Certified Nurse Midwives are trained to care for newborns through six weeks of age in the primary provider role.  Penny Lane MSN, CNM has earned an undergraduate degree in maternal and child health: lactation consulting that further offers her knowledge and experience in caring for newborns, infants and children.  She will provide your newborn care, including a thorough assessment at birth, 48 hours, two-weeks and six weeks, in addition to the Registered Nurse's assessment at one week.  At your six week appointment, a copy of your labor and birth summary,  your newborn's metabolic screening, hearing screening and growth chart will be provided for you to share with the family practitioner or pediatrician with which you choose to transfer care.

You will be provided a worksheet asking pertinent information required for your newborn's birth certificate, which will be picked up at the 48 hour postpartum visit.  Your midwife will then submit this information on-line to the state.  The social security card arrives in the mail, typically around two weeks, and this notifies you that you can pick up your baby's birth certificate at  your local health department.

If you are unmarried and would like to have a paternity affidavit completed, we can offer this service as well.  Penny is a notary and can assist you in completing the necessary paperwork prior to submitting your baby's birth certificate.

Your home is full of your germs, with which your body is accustomed.  Your baby will then be exposed to only your germs and antibodies will be immediately present in your breastmilk.  Hospital born babies are exposed to a plethora of bacteria, many of which are highly dangerous.  Your newborn's  normal flora will initially be that of the nurse or hospital, and will take up to two weeks to transition to that of your own.  Hospitals are not sterile environments, not even within the operating room.

Your birth assistant and midwife will stay with you following your birth, not only until you and baby are stable, but until your birthing environment is clean and shows no signs that a birth had just occurred.  Laundry is often completed and folded prior to our departure.  We have found the magic antidote for removing blood from even your most precious linen and carpets.  Our only stain-removal challenge is meconium; however, rarely does this present itself in homebirth.

Homebirth is legal with a licensed midwife.  At this time, the state of Indiana only licenses Certified Nurse Midwives.  Nearly all insurance plans cover our services, with exception of HMOs.  We are in-network for some insurance plans, and out-of-network for others.  A large number of our clientele have received an in-network exception because there were no other contracted CNMs in their service area.  Believe Midwifery Services provides a client registration form in which you can use to call your insurance company to determine your deductible and out-of-pocket responsibility for our services.  This expense will be what is required for payment prior to your 36-week visit.  Following your birth, Believe Midwifery Services will bill your insurance provider. 

Penny and Paula have both experienced cesarean births personally, as well as successful VBACs.  We are passionate in this regard.  VBAC mothers are counseled and screened to determine their appropriate candidacy for homebirth; however, VBAC in itself does not pose a higher risk in most cases, than any other unforseeable birthing event such as a cord prolapse, simply because we do not intervene in your labor and birth process.  We do not provide pain medication, induction or augmentation medications, and we are continually monitoring the well-being of mother and baby. 

It is our belief that most all VBAC mothers are safer in the homebirth enviornment than the hospital simply because the high risk interventions that increase the risk of uterine rupture simply aren't offered in the homebirth environment. 

Any hospital that says they can not support a VBAC mother because they aren't prepared to handle the consequences of a uterine rupture, are not safe places for any birthing mother to give birth.

Our practice serves three to five birthing families a month. 

AWHONN supports the International Confederation of Midwives' definition of a midwife, also endorsed by the ACNM and the Canadian Association of Midwives.  This definition states that successful completion of a recognized midwifery educational program and acquisition of the applicable legal requirements in the country of practice are essential components for a midwife to be recognized for clinical practice.  In the U.S. this means:

• Education - graduation from a program accredited by an agency recognized by the U.S. Department of Education. One such accrediting agency is the ACNM Accreditation Commission for Midwifery Education.
• Certification - pass a nationally-recognized midwifery certification examination.  In the U.S., certification is by an agency accredited by the National Commission for Certifying Agencies.  Once such certification agency is the American Midwifery Certification Board.
• Licensure - complete requisite qualifications to be registered and/or legally licensed to practice midwifery in the midwife's legal jurisdiction.

In the U.S. there are a range of providers who engage in the practice of midwifery.  The majority are Certified Nurse Midwives (CNMs), who are educated in the two disciplines of nursing and midwifery and who practice legally in all 50 states and the District of Columbia.  Other categories of midwives in the U.S. have different educational pathways and their legal status varies by state.  Indiana currently recognizes only Certified Nurse Midwives and their licensure can be verified through the State Board of Nursing.