FAQ

The Midwife Center offers primary gynecological care and prenatal, childbirth and postpartum care to clients of all ages.

To learn about The Midwife Center’s mission, vision and our values please click here.

How are birth centers different?

The American Association of Birth Centers defines a birth center as a home-like facility existing within a healthcare system with a program of care designed in the wellness model of pregnancy and birth. Birth centers are guided by principles of prevention, sensitivity, safety, appropriate medical intervention, and cost effectiveness.

Birth centers provide family-centered care for healthy clients before, during, and after normal pregnancy, labor and birth. Many birth centers, including The Midwife Center, also provide primary gynecological care (annual exams, birth control, STI testing and more) to clients of all ages.

The Midwife Center is a nonprofit, free-standing birth center designed for healthy clients with a low-risk pregnancy who are interested in preparing for a natural birth, with medical intervention only used when necessary and not as routine. We provide a warm, personal and safe environment for families to bring a baby into the world. We have three beautiful birth suites available with safety equipment and medications tucked away if they are needed. Most of the time, only one client is in labor at a time at the birth center. In the event that more than one client is laboring at a time, additional staff members may be called in as indicated. The staff of The Midwife Center welcomes doulas and additional support people as desired by the client in labor and her family.

Birth centers provide a safe and nurturing environment where the client is free to explore many different options in labor. At The Midwife Center, our clients may:

• Choose who will be present at the birth
• Wear their own clothes
• Eat and drink in labor
• Labor and birth in whatever position they choose
• Labor in Jacuzzi tubs
• No routine mother-baby separation

What is a midwife and what kind of education, training and licensure do midwives receive?

The word “midwife” means “with woman.”

A Certified Nurse-Midwife (CNM) is trained as a nurse and as a midwife. Most CNMs have Master’s degrees, and all are certified by examination through The American College of Nurse Midwives. CNMs in Pennsylvania are licensed by the Pennsylvania Board of Medicine and carry malpractice insurance. They provide care in birth centers, hospitals and in the home. Many other states also provide licensure for Certified Professional Midwives. At this time, Pennsylvania only provides licensure for Certified Nurse-Midwives.

What is midwifery care?

Midwives are dedicated to the belief that the milestones and phases of many peoples’ lives, including growing into adulthood, pregnancy, childbirth and menopause are normal life processes. Midwives provide personalized, compassionate and thorough care. This includes comprehensive reproductive care for clients of all ages, including physical and emotional care for a mother and her baby through pregnancy, labor, birth and postpartum period. Our midwives are present during the labor and birth.

Appointments at The Midwife Center tend to be longer than other providers, including an hour for the first prenatal visit to allow for plenty of time for questions and information sharing. Similarly, a first visit for primary gynecological care is an hour and return GYN visits are 40 minutes long.

Click here to learn more about our prenatal services.

Click here to learn about our primary gynecological services.

I’m not pregnant. Does The Midwife Center provide gynecological care?

Yes! Our Certified Nurse-Midwives and Nurse Practitioner take care of the reproductive health needs of clients of all ages – including annual exams, contraceptives, STI tests and more. Clients do not need to have had prenatal/childbirth care with The Midwife Center in order to schedule a primary gynecological appointment. New clients are welcome to call The Midwife Center for gynecological services at 412.321.6880.

Click here to learn more about our primary gynecological services.

How safe is midwifery and birth center care?

Numerous studies have documented the safety of midwifery of birth center birth, including the 2013 National Birth Center Study II (NBCSII) and in 2014, The Lancet’s “Series of Midwifery.” The Midwife Center’s outcomes statistics are consistent with the NBCSII and are consistently better than national averages for c-sections, low birth weight and prematurity. Learn more about our statistics.

Who can give birth at a birth center?

More than 80% of women are low risk for complications for pregnancy and birth, so most women are good candidates for midwifery and birth center care. Midwifery and birth center care is best for healthy women who are ready to take an active role in their health care. We ask that clients work with The Midwife Center staff to keep healthy and low risk for the entire pregnancy and birth by:

• Attending all appointments.
• Eating a healthy, well balanced diet.
• Continuing to exercise in preparation for birth and recovery.
• Attending required classes as necessary.
• Becoming educated by reading from many different resources.
• Asking questions during prenatal visits.
• Taking advantage of community resources

What hospitals does TMC have a relationship with?

Relationship with UPMC Mercy

** If you have Highmark insurance please read the section below about West Penn Hospital **

UPMC is The Midwife Center’s primary referral hospital. TMC midwives have admitting privileges which allows them to be involved at every level of our clients’ care.

TMC midwives at UPMC Mercy:

• Attend births at the birth center for clients who are low-risk according to established risk criteria.
• Attend the birth of low-risk clients who choose a hospital birth.
• Co-manage clients who begin their labors at the birth center and transfer to the hospital during labor. The midwives admit the client and continue care at the hospital. Vaginal births are attended by the midwives. Vacuum or forceps deliveries or cesarean births will be supported by the midwife but attended by one of our consulting physicians.
• Co-manage clients who develop a risk factor during pregnancy that necessitates birth at the hospital.
• A transfer of care from The Midwife Center to a physician may occur for clients who develop a risk factor during pregnancy that makes them high-risk and out of the scope-of-practice of a certified nurse midwife.

To schedule a tour of UPMC Mercy, call 412.802.8299.

Relationship with West Penn Hospital

For our clients with Highmark insurance, our primary referral hospital is West Penn Hospital.

If you are currently pregnant with Highmark insurance we welcome you to plan your birth at our birth center. The Midwife Center still accepts Highmark insurance for all of its services at The Midwife Center. However, UPMC Mercy’s contract with Highmark recently ended and Highmark consumers no longer have in-network access to UPMC Mercy for labor and delivery. You may have the option to pay out-of-network rates (unless you have Highmark Community Blue, which offers no access to UPMC hospitals). Please check with your insurance.

What happens if you need hospital care:
– If you develop a complication during pregnancy and are no longer eligible for a birth center birth, but are still appropriate for midwifery care, we will recommend that you transfer to The Allegheny Women’s Health Midwifery Practice at West Penn Hospital.
– While in labor at our birth center, if you develop a routine complication that requires hospital care though you are still appropriate for midwifery care, we will transfer you to The Allegheny Women’s Health Midwifery Practice at West Penn Hospital.
– If you’re in labor at our birth center and need immediate physician care, we will transfer you to physicians at West Penn Hospital

We encourage all of our clients who have Highmark insurance to contact West Penn to schedule a tour of their labor and delivery facilities in the event that they need hospital care. You can schedule a tour by calling 412-578-7030.

What happens if there is a problem and I am no longer low-risk?

Midwives are well-trained to recognize any complications that may affect the health and safety of a mother and/or her infant and will consult with physicians as needed for complications.

** If you have Highmark insurance, please see “Relationship with West Penn Hospital” above. **

If your pregnancy is no longer eligible for a birth at the birth center, you may continue to be cared for by our midwives. Most of your appointments will still take place at the birth center. Your birth will take place at our primary referral hospital, UPMC Mercy, where our midwives have admitting privileges and collaborating agreements with physicians.

What if I need to transfer to the hospital during labor?

** If you have Highmark insurance, please see “Relationship with West Penn Hospital” above. **

If complications arise, clients are transferred to our primary referral hospital, UPMC Mercy and continue to be cared for by our midwives. (The exception is for our clients who have Highmark, whose care is transferred to our collaborating physicians at West Penn Hospital). If a c-section, forceps or vacuum delivery is needed, it will be performed by our collaborating physicians. The midwives will remain a part of the care in a supportive role.

In most cases, transfers to the hospitals are not emergency situations (prolonged labor, pain management).

What if I had a previous c-section?

The Midwife Center believes in the right to have a Vaginal Birth After a Cesarean section (VBAC). Our midwives can provide prenatal care at TMC and do VBACs for clients who have had one previous cesarean at UPMC Mercy. For women with Highmark insurance, we recommend planning care with physicians or the midwife practice at West Penn Hospital.

Can I still come to The Midwife Center if I have risk factors?

** If you have Highmark insurance, please see “Relationship with West Penn Hospital” above. **

Many people have health issues that can be well-controlled by lifestyle or medication, and can still birth safely at the birth center. Examples are:

• Thyroid disorders managed with medication
• Mild asthma
• Depression managed with counseling or medication
• Abnormal pap smears or surgery on the cervix
• Pregnancy with a prior history of infertility
• Women 35 years old or older
• Women with a history of miscarriage
• Women with Rh negative blood
• Women with mitral valve prolapse
• Women with medical conditions which do not affect pregnancy or medical problems which may affect pregnancy, but are well-managed with a plan of care

Some conditions make a birth center birth potentially unsafe, or the extra support of a hospital is preferable or necessary for some clients. The following is a partial list of common medical conditions that would make a client not eligible for a birth center birth, but TMC midwives can provide collaborative care at UPMC Mercy:

• Clients who have had a cesarean delivery in the past (VBAC)
• Development of high blood pressure at term with or without preeclampsia
• Large or small for gestational age babies as clinically indicated
• Too much or not enough amniotic fluid
• Very low platelet count
• Severe anemia
• Gestational diabetes requiring oral medication.
• Labor before 37 weeks or after 42 weeks
• Smoking more than 5 cigarettes per day

Some situations (either pre-exisiting medical conditions or pregnancy induced) may risk a client out of TMC for the prenatal period and birth care:

• Twins
• Gestational diabetes requiring insulin
• Bleeding or blood-clotting disorders
• History of a blood clot
• Placenta previa
• BMI over 40
• High blood pressure before pregnancy or early in pregnancy
• Breech presentation in labor
• History of seizure disorder
• History of 2 previous cesarean births

Our intake process includes questions about your health history, over the phone or online.

How is the baby’s heartbeat monitored during labor?

The baby’s heartbeat is monitored throughout labor using a hand-held ultrasound device called a doppler. A midwife or nurse will listen intermittently depending on what stage of labor you are in. If at any time TMC staff hears a heart rate that is non-reassuring, they will transfer to the hospital for continuous fetal monitoring.

Can I transfer to The Midwife Center in the middle of my pregnancy?

In many cases, you can transfer your care to The Midwife Center during the middle of your pregnancy. It is required that you present your medical record for review by TMC’s Clinical Director so that you can be deemed appropriate for TMC care.

Can my children, friends, or family members attend appointments with me and be at the birth?

Children, friends, doulas, and family members are welcome at appointments at The Midwife Center. Any adult you would like in the room during your birth at the birth center is welcome. However, an additional adult who is not the primary support person must accompany children.

What tests will be done during my pregnancy? Are they required?

There are two times that routine lab work is done during pregnancy: after the initial visit and at approximately 28 weeks. Most lab work is done at a lab and is covered by insurance. Additional tests may be done if necessary.

Tests that are normally done include:

• Complete blood count
• Blood type, Rh, Antibody screen
• Hepatitis B
• RPR (State required Syphillis test)
• Rubella titer
• Urinalysis
• HIV
• Gonorrhea and Chlamydia

At 28 weeks:

• Complete blood count
• Antibody screen (if Rh negative)
• 1-hour glucose test (screens for gestational diabetes)

At 35-37 weeks:

• Screening culture for Group B Strep

How do I schedule an ultrasound?

If you are unsure of where to schedule an ultrasound procedure, our Client Service Associates at the front desk can help you by giving you the proper phone number and location information. Please call 412.321.6880.

Our providers would provide you with a prescription to take to your ultrasound appointment once it has been made.

What pain management options are available?

We will support the techniques learned in your childbirth classes to help you cope with pain in labor. We also have birth balls and lotions for massage available. Most clients get some relief in the Jacuzzi. We do have short acting pain medications that can be given through an IV or as an injection for clients who request them. Clients who labor in upright positions with the support of family and the TMC team report that labor is far more manageable and empowering.

Is water birth available at the birth center?

We do not do water births at this time. However, each birth suite at the birth center is equipped with a Jacuzzi that women may use for comfort and pain management during labor.

What if I test positive for Group B Strep (GBS)?

Studies so far have not found that treating pregnant women for GBS before they go into labor is effective.

The more effective treatment is to give clients antibiotics during labor with intravenous (IV) antibiotics. The CDC recommends this treatment for all women who test positive for GBS. This treatment greatly decreases but does not eliminate risk to the baby from GBS. The treatment is recommended by the nurse-midwives in either the birth center or the hospital. Ideally, the client will receive two doses of antibiotics before the birth.

The majority of babies who get early-onset GBS disease show signs in the first 12 hours. If a client tests positive for GBS, the family may be asked to stay the full 12 hours after birth. The CDC recommends that all babies whose mothers carry GBS be observed for 48 hours after birth. This can be accomplished by home nursing visits.

Who examines the baby after birth?

At the birth center, the CNM will perform a newborn physical exam before discharge. In addition to faxing a copy of the exam to the chosen pediatric provider, a written copy will be given to the family. For those delivering in the center, it is required that infants to be seen by a pediatric provider by 72 hours of age.

For those delivering in the hospital, a pediatrician will examine the baby and will make a plan for follow up with a pediatric provider after discharge.

What tests are recommended for the baby after birth? Are they available in the birth center?

• Newborn Metabolic Screening (these are done at the home visit).
• Newborn Hearing Screening (same as above).
• Congential Heart disease screen

What procedures are recommended for the baby? Are they available in the birth center?

• Antibiotic eye ointment
• Vitamin K injections.
• Both are mandated by the state, families may decline them with informed consent.

How long do I stay at the birth center after the baby is born?

Clients typically leave the birth center between 4-6 hours after giving birth. Clients stay up to 12 hours when medically necessary. Because clients and their support people are well-prepared before the birth, they are usually ready to go home before 12 hours postpartum. TMC’s nursing staff provides thorough teaching for care of the mother and baby before discharge and our nurses also provide home visits to check on the mother and baby.

What kind of care can I expect for me and my baby after I leave the birth center?

• Home visit by TMC nurse
• All screening required by the PA Department of Health is performed at home visit, including newborn screen, hearing test, and congenital heart disease screening
• Visit to the chosen pediatric care provider with in 72 hours of birth.
• Phone calls from a TMC nurse for first time mothers and others in need of additional support

What if I want my baby to be circumcised?

TMC staff members do not perform circumcisions in-house, but can provide a list of healthcare providers who do.

How do I obtain the birth certificate and social security number for my baby?

If your birth is at the birth center, you will be given paperwork to fill out after your birth. Staff will process your birth certificate and social security number request.

If your birth is at the hospital, the process is similar but the hospital staff will do this for you.

Will my insurance cover my care at The Midwife Center?

The Midwife Center accepts most private and public (Medical Assistance) insurance plans for pregnancy, childbirth and primary gynecological (well-woman) care. For people who do not have private insurance, our staff can provide guidance for applying for Medical Assistance. For those who are not eligible for Medical Assistance, we can make arrangements for self payment. In some self-pay cases, we can also offer discounted services depending on the client’s household size and income.

The Midwife Center’s primary referral hospital, UPMC Mercy, also accepts most insurance plans, excluding Highmark. For clients who have Highmark, their services at The Midwife Center will be covered. However, if they need hospital care, it will be handled by our referral midwives or physicians at West Penn Hospital.

Clients should always verify with their insurance what will be covered.

Please click here to see our Maternity Fee Schedule which has payment and insurance information.

Please speak with your insurer to find out if they cover our care.

How will the expansion/construction affect my care?

The Midwife Center is planning to double its space to provide 2 new birth suites, more family space, 3 new exam rooms, a classroom, an elevator and parking lot. More information is at transform.midwifecenter.org.

How long will it take? Construction will start the week of July 11, 2016 and is expected to be completed by Spring 2017. We will keep our clients updated via our website, Facebook and emails. You can sign up to be on our email list at midwifecenter.org.

Will construction be disruptive? Our construction management team, Massaro Corporation, assured us that there will be minor disruptions during construction. The most disruptive (i.e. noisy) times will be during the first few weeks (mid-July – mid-August) when the excavation is taking place, and later this fall when they are making the connection from the existing building to the new building. Massaro is committed to keeping the disruptions to a minimum and for the most part, should not affect your experience at The Midwife Center.

Safety: The front entrance will have a protective structure around it to shield people from potential debris. There will be protective fencing around the construction site and barriers on the sidewalk. If you are walking from 29th Street, you will need to walk down the opposite side of the street to 28th Street to get to our building. Please be safe while crossing the street at 28th and Penn.

Parking: Parking for our clients will still be provided by Savoy. Please DO NOT try to park in our back lot or Mulberry Way.

How you can help: We are still raising funds to complete the expansion! Donate at transform.midwifecenter.org

We will be having PR and fundraising events throughout construction time and the media and funders often want to talk to our clients! If you’re interested in helping with this, please contact Christine Haas, Executive Director at c.haas@midwifecenter.org

Useful Links

American Association of Birth Centers
American College of Nurse-Midwives
National Birth Center Study II
The Lancet’s “Series of Midwifery”
UPMC Mercy Hospital
West Penn Hospital