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 you to bring your baby into the world. We have beautiful, nature-themed 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.
Our birth center provides a safe and nurturing environment where you are free to explore many different options in labor. You may:
- Choose who will be present at the birth
- Wear your own clothes
- Eat and drink in labor
- Labor and birth in whatever position you choose
- Labor in Jacuzzi tubs
- Keep your baby skin-to-skin (no routine mother-baby separation)
- Water birth in one of our two new birth suites
- Use nitrous oxide as an aide for coping with labor
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. You DO NOT need to have had previous prenatal/childbirth care at The Midwife Center to schedule a primary gynecological appointment. You are welcome to call The Midwife Center for gynecological services at 412.321.6880.
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 an annual gynecological exam is an hour and return annual visits are 40 minutes long.
The word “midwife” comes from Middle English and literally 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.
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 birthweight and prematurity. Learn more about our statistics.
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
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
The Midwife Center accepts Highmark insurance for all of its services at The Midwife Center, including a birth in our facility. However, our primary referral hospital, UPMC Mercy, is not in-network with Highmark. You may have the option to pay out-of-network rates should you need hospital care (unless you have Highmark Community Blue, which offers no coverage for UPMC hospitals). Please check with your insurance. Our primary referral hospital for clients with Highmark insurance is West Penn Hospital.
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, you have the option of transferring your care to the Allegheny Women’s Health Midwifery Practice at Jefferson 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, you will have the option of a transfer to the Allegheny Women’s Health Midwifery Practice at Jefferson Hospital. You may also choose to transfer to physician care 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.
- If you would like a VBAC (vaginal birth after cesarean), The Midwife Center does not do VBAC births at the birth center. We recommend you establish care with The Allegheny Women's Health Midwifery Practice at Jefferson Hospital.
We encourage all of our clients who have Highmark insurance to contact West Penn or Jefferson Hospital 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 (West Penn) or 412.330.4469 (Jefferson).
Midwives are well-trained to recognize any complications that may affect the health and safety of you and your baby 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.
** If you have Highmark insurance, please see “What hospitals does TMC have a relationship with?” 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).
The Midwife Center believes in the right to have a Vaginal Birth After a Cesarean section (VBAC). If you've had one previous cesarean, our midwives can provide prenatal care at TMC and help you have a VBAC at UPMC Mercy. If you have Highmark insurance and you are seeking a VBAC, we recommend planning care with physicians or the midwife practice at West Penn Hospital.
If you have Highmark insurance, please see “What hospitals does TMC have a relationship with?” above. **
Many people have health issues that can be well-controlled by lifestyle or medication, and can still birth safely at the birth center.
- 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
- Age 35 years or older
- History of miscarriage
- Rh negative blood
- Mitral valve prolapse
- Medical conditions which do not affect pregnancy or medical problems which may affect pregnancy, but are well-managed with a plan ofcare
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 five 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:
- 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
Once you contact us for prenatal care, our intake process will include questions about your health history.
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 you to the hospital for continuous fetal monitoring.
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.
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 your primary support person must accompany children.
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
- 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
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. Clients who labor in upright positions with the support of family and the TMC team report that labor is far more manageable and empowering.
We are pleased to be one of the few places in Pittsburgh and the surrounding area to offer Nitrous Oxide for pain relief. Nitrous is an odorless, tasteless gas-mixed with oxygen. It is widely used in several countries including the UK, Finland, Sweden, Canada, Australia, and New Zealand. It is inhaled through a mask during contractions and provides a feeling of euphoria that dulls the intensity of the labor pain and reduces anxiety. Women remain awake and alert, using the gas as needed. There are no negative effects on labor and no risk to baby. One study showed it decreased the length of labor.
Since we began using it in 2016, our midwives report that it is an excellent tool to be used when women might have otherwise transferred for an epidural. Unfortunately, at this time insurance does not cover Nitrous Oxide. The out-of-pocket cost is between $50-$200 depending on the length of time spent using it. Learn more about Nitrous Oxide.
We also have short acting pain medication available that can be given through an IV or as an injection. It is often given for sleep/rest, but can be useful for pain relief as well.
Our new birth suites offer the option of laboring and birthing in
water for clients who are eligible. The Meadow and Mountain rooms have
free standing birthing tubs that may be used for laboring in water and
birthing in water, and the Forest Room offers a jet Jacuzzi that may be
used for laboring in water. The benefits to laboring and birthing in
- A decrease in episiotomy rates
- A decrease in 3rd and 4th degree tears
- Increased maternal satisfaction
- Possibly shorter labors
- Possibly less intervention needed to help labor along
- Possibly less anesthesia
The midwives will discuss this in detail during your prenatal care. Learn more about Hydrotherapy from the American College of Nurse-Midwives (PDF)
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.
At the birth center, the midwife 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.
- Newborn Metabolic Screening (these are done at the home visit).
- Newborn Hearing Screening (same as above).
- Congential heart disease screen
Antibiotic eye ointment and the vitamin K injection are recommended and available at the birth center. Both procedures are mandated by the state, but families may decline them with informed consent.
Clients typically leave the birth center between 4-12 hours after giving birth. Because clients and their support people are well-prepared before the birth they are usually ready to go home before 12 hours postpartum. You may stay up to 12 hours if medically necessary.
Our nursing staff will provide thorough teaching for care of you and your baby before discharge. Our nurses also provide home visits to check on you and your baby.
- 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 your 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.
We do not perform circumcisions in-house, but we can provide a list of healthcare providers who do.
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.
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. If you have Highmark your services at The Midwife Center will be covered. However, if you need hospital care, your care will be handled by our referral midwives or physicians at West Penn Hospital.
Please speak with your insurer to find out if they cover our care.
Please click here to see our Maternity Fee Schedule which has payment and insurance information. [Maternity_Free_Schedule.pdf, "The Midwife Center's Maternity Fee Schedule"]