Frequently Asked Questions
Will A Physician Be Available?
At Inova Loudoun’s Birthing Inn, Obstetricians are in-house 24 hours a day. They can consult with the nurse-midwives regarding any complex issues and respond to emergencies. Our patients typically have uncomplicated pregnancies and uncomplicated deliveries attended only by their midwife and nurses, but help is available any time it is needed. The best outcome for mothers and babies and the highest quality care is achieved when Certified Nurse-Midwives and Physicians work together as a team.
Consultation/Collaboration Throughout Pregnancy
During the course of prenatal care, we can consult with our physicians any time anything unusual is noted. The physician-midwife team meet, as needed, to address medical questions or concerns during pregnancy, or in case co-management or referral to doctor-care is needed.
Labor and Delivery
If problems arise, the CNM is qualified and authorized to begin management. We can begin the process toward a Caesarean quickly, and participate in the surgery if needed.
Will a midwife be with me through my labor and delivery?
YES… we’ll be there!
Loudoun Community Midwives was founded upon the idea of being “with woman”, to be totally present and actively involved with the birth of your child. We know that women seek our care because they are looking for that kind of sensitive and committed support.
A Loudoun Community Midwife is assigned to hospital duty for 24 hours, every day. When a mother is admitted to the hospital in the active phase of labor, the CNM soon arrives to evaluate the client’s condition, help make the plan, and offer support and guidance. The Midwife explains events and choices, offers suggestions and hands-on support, and monitors progress. If more than one woman is in labor, our time must be shared; however, we will be present for support, information, advice, and safety. If a C-section becomes necessary, we will assist in the Operating Room.
We won’t leave until your baby is in your arms.
Natural Childbirth or Epidural?
Midwives are undisputed experts at helping women with non-medicated, natural childbirth, but it is certainly not a requirement with in-hospital midwife care. It’s a very personal choice and we don’t make it for you, either way. Many of our clients complete their labors without pain medication. During the pregnancy, we discuss with each woman her desires and intended approach to the birth experience, and make up the Birth Wish List which goes in her chart to the hospital. Women who wish low-intervention, non-medicated birth are supported, as are women who desire epidural or other pain management.
Labor-coping options include:
- Deep, warm-water soaking tubs
- Breathing & Relaxation techniques
- Massage, position changes, and walking
- Intravenous medication
What about The Birthing Inn Experience?
Loudoun Community Midwives were the first Certified Nurse-Midwives to have privileges at Inova Loudoun Hospital Center, and we have attended over 3,000 births there since 1999. We choose to attend births at the Birthing Inn because the staff and management are so supportive of nurse-midwifery patients and their families.
Birthing Inn features include:
- Wireless, waterproof, fetal monitoring – enables women to move freely and bathe during labor
- High-tech security system
- Deep soaking tubs in all labor rooms
- All postpartum rooms are private
- In-House Neonatology
- In-house Anesthesia
- Neonatal Intensive Care Unit
- Lactation Consulting Services
To visit the official Birthing Inn website, go to http://www.thebirthinginn.org/
What about Safety Concerns?
A large body of research done over 70 years of Certified Nurse-Midwife practice has shown that Certified Nurse Midwives are comparable in safety to doctors for normal, low-risk women. For a closer look at this research, visit the website of the American College of Nurse-Midwives, at www.mymidwife.org.
Loudoun Community Midwives offer many features that help our patients feel their care is safe and of high quality.
These features include:
- OB-GYN consultation available on-site, 24 hours a day. Please see our section “Will a Physician be Available?”
- A Certified Nurse-Midwife is present for the entire active phase of labor and the birth.
- Women receive care not only from the Birthing Inn’s excellent nursing staff, but a CNM is present for constant hands-on support, expertise, and safety. See “Will a Midwife be with Me?”
- All births take place at the state-of-the-art Birthing Inn facility at Loudoun Hospital, including a high-quality Neonatal Intensive Care Unit, in-house Neonatology staff, & an in-house anesthesiologist.
Who is NOT Appropriate for CNM Care?
Loudoun Community Midwives’ Program of Care is influenced by several sets of professional standards and clinical guidelines. Since our training qualifies us to care for essentially healthy women, some factors will make a potential client inappropriate for CNM care. Some of these factors include:
- Pre-pregnant BMI greater than 40 (between 35-40 is case-by-case, with input from our physicians)
- History of Cesarean or uterine surgery, when not in our care, and without a record of a vaginal delivery
- Insulin-dependent diabetes of any type
- Seizure disorders requiring medication
- Any unstable medical condition requiring on-going physician intervention
- Multiple pregnancy
What Other Requests Can We NOT Fulfill?
- Home Birth (we can make referrals if you wish this option)
- Birth after 41 weeks and 4 days of pregnancy
For more information, see our Low Tech Birth patient handout sheet.
What about Vaginal Birth After Cesarean (VBAC)
LCM staff and midwives are often asked “What about VBAC? (Vaginal Birth After Cesarean)?” Can Loudoun Community Midwives attend a birth for a woman with a history of previous C-section delivery?
VBAC is controversial. The adage was “once a Cesarean, always a Cesarean” due to fears of the uterus rupturing in a subsequent delivery. In the late 1980’s and early-mid 90’s, the pendulum swung the other way, with research showing many successful vaginal births after a C-section. For a while, many managed-care plans advocated that NO women should be offered repeat Cesarean section unless they tried VBAC first. Then, more research was published that increased concerns over the dangers of VBAC and showed a higher rate of uterine rupture and fetal deaths than previously associated with VBAC. These bad outcomes were particularly associated with labors that were artificially induced or augmented, rather than normal, spontaneous labor at term.
VBAC has now become much less popular, associated with many lawsuits, and many physicians and practitioners prefer repeat C-section, or limited trials of labor/VBAC only for certain women meeting narrow criteria. At LCM, we want to support women’s choices and also support normal vaginal birth as much as is safe and manageable for our practice. While many women desire VBAC, we have chosen to offer it on a limited basis, for women who have a high probability of safety and success. We offer a trial of labor/vaginal birth after C-section to two groups of women:
1) Women who had their first C-section while in our care. The client and the LCM midwife who attended her review notes and discuss her previous labor/birth, the woman’s wishes, the factors that led to her C-section, and whether those may repeat. Then, together, they decide if a trial of labor seems reasonable.
2) Women who have had an uncomplicated VBAC, after having a C-section delivery, whether in LCM care or not, may be candidates for VBAC as well.
With this policy, we are experiencing increased success with VBAC’s and supporting women’s choices in birth.