Frequently Asked Questions

About Midwives Back to Top

What kind of training do midwives have?

Midwives are experts in normal, natural birth. They are trained to recognize complications and either correct them or refer them to other more specialized providers. Many midwives (including those at BetterBirth, LLC) are specially trained in out-of-hospital birth, such as at home or in a birthing center.

There are two types of midwives in Utah: certified nurse-midwives (CNMs) and direct-entry midwives (DEMs). Nurse-midwives must train as and become Registered Nurses, then they go on to their midwifery education. Direct-entry midwives, as the name implies, go directly to their midwifery training without training for another profession first, such as nursing. Generally speaking, in Utah, certified nurse-midwives deliver babies in the hospital, and direct-entry midwives deliver in birthing centers and in homes (although there are exceptions to this rule). The midwives at BetterBirth, LLC are direct-entry midwives.

Utah has a voluntary licensure law for direct-entry midwives. If she is licensed, you know that your midwife has completed the requisite training and testing required by the North American Registry of Midwives for the Certified Professional Midwife credential, and has had additional training in pharmacology and neonatal resuscitation. The training of unlicensed midwives is not regulated by the state and varies widely, so is up to you to determine the qualifications of an unlicensed midwife.

All the midwives at BetterBirth, LLC are licensed, and have far exceeded the minimum training required for national certification. We continue to advance our knowledge and skills with regular continuing education.

How do I find a qualified midwife?

Of course, if you’re reading this, you’ve already found qualified midwives! But if you’re looking around and want to interview several midwives, you can search the internet, look in the phone book, ask friends and neighbors for names. Once you have some names, it is very important you ask direct questions to make sure the midwife is qualified to care for you and is a good match for your personality.

About Our Practice Back to Top

How do I get started?

First, schedule a free consultation appointment to ask any questions and make sure you feel comfortable with us and our services. (If you’re not sure you want an appointment just yet, call us to ask questions and get any information you need.) You may want to read about our midwives and you may want to compare our Midwife Program with our Student Program to determine which will be best for you.

Fill out a History Form, then print it and bring it with you to your appointment. This helps us determine whether you have any conditions that would make it unwise for you to deliver out-of-hospital, and to ensure you are an appropriate candidate for the services we provide. Once we're all comfortable we'll schedule your first regular prenatal appointment and you're in!

What if I'm not sure?

If you are not sure out-of-hospital birth with BetterBirth, LLC is for you, we suggest you keep learning, thinking, exploring. If safety is a concern, try our links and search the internet on your own for more information. Discuss your options with your partner if you have one, or if not, with a close friend or relative you trust. It is important you feel comfortable with your birth choices. You only get to have this baby once, and we want you to have the very best birth you possibly can, whether or not we are a part of it. If we can help you, please call, e-mail, or come in to talk with us at a free consultation appointment. We welcome all your questions and will help you find the answer that works for you.

Will I have one midwife or do midwives rotate call?

Our midwives work in small teams, a concept we call Team Midwifery. You will get to know your small group of midwives, and they will know you. One of them will attend your delivery, or if you have chosen the Student Package, one of them will supervise the student managing your birth. Our teams are not like "midwife roulette," where any one of several providers you barely know will show up to deliver your baby.

Will my whole team of midwives attend my birth?

No, only one midwife on your team will attend your delivery unless your labor is very long. In this case another member of your team may take over for the first so you always have a fresh midwife managing your birth.

How will I meet the midwives on my team?

We will rotate your prenatal visits so you have some with each midwife, but that's not the only contact you will have with your team. When you have questions you can call in and talk to your midwives, and we will follow up with you. You may also meet the midwives on your team through virtual consultations about any problems you might be having during your care.

Will I have to repeat myself?

No. Each member of your team will communicate with the others any important issues regarding your care so you only have to ask questions, express concerns, or make arrangements once.

Who do I call if I am in labor or need help?

Call your team's hotline number which we will provide to you. This system will automatically route your call directly to the midwife on your team who can help you.

How do I reach the midwife?

Our midwives and students are available by cell phone 24 hours a day, seven days a week, and you can call anytime.

What happens if my midwives are on vacation, sick, or attending other women in labor when I deliver?

One of the purposes of our Team Midwifery concept is to always have available to you a midwife on your team, a midwife you know well. In the extremely rare case that you need a midwife and none of your team is available, we will provide another equally qualified midwife to assist you. (This has never happened in our practice.)

Can I deliver in a birthing center?

Yes! We deliver at BellaNatal Birthing Suites and at our own birthing suites.

Can I deliver in a hospital?

No, sorry. We do not deliver in hospitals. Of course, if we transfer you to the hospital during labor, your midwife will accompany you.

How do I deal with family members who are hostile to my birth plans?

This is a tough question, because each family is different. Your family members are welcome to come with you to your appointments and talk over any concerns with the midwife. Often this puts fears to rest. You can check out books and videos from our library if you think they are open to reading about birth and midwifery. Some clients choose not to tell their family or friends the specifics about their birth plans until after the birth is done. But ultimately, you know your family best, and therefore know best how to interact with them on this topic.

Will I get a birth certificate for my baby?

Yes. BetterBirth will file a birth certificate with the State just like any hospital or other provider. Once filed, you can order a copy online or use the customized order form we will send you to order a copy.

About Prenatal, Postpartum, Newborn, and Well-Woman Care Back to Top

Do midwives do prenatal and postpartum care too?

Yes, midwives provide routine prenatal and postpartum care as a regular part of our services. In the event you have a complication during your pregnancy for which your team feels you need consultation or which they know they cannot handle themselves, your midwives will refer you to another appropriate provider. Generally, however, your team can provide all the care you need.

How soon should I be seen?

Many providers do not want to see you until you have completed your first trimester at about 12 weeks. We’re not sure why that is. There are many questions and problems we can help with during those early weeks, and we encourage you to come in whenever you are ready. Some of our clients come in the first day they miss their period, and that’s fine by us.

How often will I have prenatal visits?

Unless you have complications that would require more frequent visits, our prenatal schedule is every 4 weeks until you are 28 weeks along, then every 2 weeks until you are 36 weeks along, then every week until you have the baby.

Where do prenatal appointments occur?

Prenatal appointments occur at either our Salt Lake office or our Orem office. If you have a complication, we may arrange a visit at your home or we may accompany you to another provider's office or to the hospital.

Can I get an ultrasound?

Yes. We work with a variety of other care providers, including sonographers. We do not require any ultrasounds during your pregnancy. If we suspect a complication and feel an ultrasound may be helpful, we might recommend one. Many of our clients feel more comfortable with their plan for an out-of-hospital birth if they have an ultrasound to make sure the baby is all right and we are happy to support you in that approach. Some parents just want to see gender, and that's ok too. We can make arrangements for your ultrasound, schedule your appointment for you, and a midwife will attend as long as her schedule permits it. We offer ultrasounds through our office at a great cash discount, or we can order them at other facilities if you want to use your insurance to pay for it.

Do you offer childbirth classes?

We do not offer childbirth classes ourselves, but we do recommend a variety of independent childbirth educators whom we feel provide excellent classes. Please see our list of childbirth education resources for more information on methods, classes, and instructors.

What happens at a prenatal visit?

At these visits we will check your vital signs, weight, and urine. As it becomes possible to do so, we will check the baby’s heart rate and the position and growth of the baby. We do not normally do vaginal or pelvic exams at these visits because they yield little useful information, although if there is a need or you want us to, we will. After your first visit (which lasts an hour), subsequent visits are scheduled for 30 minutes so there is plenty of time to ask questions and discuss any concerns. If you would like more time, just let us know and we'll schedule it.

What happens at a postpartum visit?

The first postpartum visit occurs between 24 and 72 hours after delivery. Subsequent visits are usually at two weeks and six weeks after delivery. We will check both you and the baby to be sure you are recovering normally, and we will perform a hearing screening for the baby. You'll also have a chance to discuss any concerns or questions you may have. If we are doing the Newborn Metabolic Screening for you, we will do them at the first and second postpartum visits.

Do you provide non-pregnancy related gynecologic care such as pap smears, premarital exams, and birth control?

We do perform routine pap smears, and we provide counseling regarding various methods of birth control. We do not prescribe hormonal birth control methods, place IUDs or perform premarital exams, although we are happy to refer you to other providers for these services.

About Labor Back to Top

When during labor should I call the midwife?

You should call the midwife whenever you want her to attend you. Our goal is to support you at the level you need and want, so we can come as early or late in labor as you desire. If you are looking for a guideline, however, we like to get a call by the time contractions are 5 minutes apart, a minute long, and you can't talk or walk through them.

How many people will attend my birth?

From your side, you may invite anyone you want to attend your birth. From our side, we usually have a midwife and one or two student midwives at the birth. There is much work to be done, and for safety reasons, it is important to have the right number of trained hands to handle any complications that could arise. If you feel strongly that you do not want three people at your birth, please speak to your midwife about it.

What if something goes wrong?

A midwife is an expert in normal birth. She is trained to keep things normal, and if complications do occur, to recognize and correct them. The most common complications in birth can be safely handled by the midwife. In the rare case that a complication arises she cannot correct, the midwife will quickly get you to a hospital where you can get medical attention. A good midwife has working relationships with a variety of health care providers and knows when to transfer your care to one of them.

Pregnancy and birth are as safe as life gets. What would you do if, during the course of your normal life, a need for medical care arose? You would seek it, wouldn't you? That is what you should do in pregnancy and birth also. You do not live in a hospital because a need for medical care may arise at any moment. Likewise, you do not need to birth in a hospital because a need for medical care may arise at some point. Birth is a normal part of life.

Can my partner catch the baby?

Of course! We will be happy to coach your partner through the process. Just let us know that is what you’d like and we’ll make sure it happens that way.

Can/should my children attend?

Of course your children (and anyone else you want) may attend, but whether you want them to depends on both you and your children. Most children do very well at births, especially if they are prepared (through books and videos, which you can check out from our library). However, very young children may be too little to understand and may be frightened, frustrated, or bored. Often children sleep right through the birth (it’s true what they say about babies being born at night), and we don’t recommend you wake up small children in this case. Often they are disoriented and can’t appreciate the experience anyway, and they may require your partner’s attention just when you want it most.

Most important is that you are able to concentrate on your own needs and your own birth, and not feel like you must attend to the needs of your children. Most moms also want their partner to attend to their needs, so we recommend if you want to have children at the birth that you also invite an adult your children know and trust whose job it is to attend to them during the birth. Make it clear that this is their primary responsibility, so that if the children do not want to be in the room at the all-important moment, they must leave also to be with the children. We recommend you follow the desires of the child, as well. Ask your children if they would feel comfortable watching the birth. Some will, some won’t. We do NOT recommend that you pressure or force children to be present.

Can I invite other people to my birth?

Of course! This is your birth. You may invite anyone you wish to be there. However, there are good reasons and bad reasons to invite people to your birth. Only invite people who are supportive of you and your plans for your birth. (We’ve had hostile mothers-in-law calling 911 because they are just sure something is wrong!) Do not invite people to whom you want to “prove” you can do it, or that your way of birthing birth is wonderful. You need strong support and encouragement during your labor. You do not need to meet other people’s needs, and you do not need to perform for them.

Some people like to have a lot of people there and they gather great strength from the crowd. But you may find you feel watched and pressured. What if it takes 36 hours? Are you going to feel like you have to entertain or feed these people? Certainly do not invite people just because THEY want to be there. Protect your birth experience. It is precious and yours, and you only get it once. Do what YOU want. This is one time it is ok to be selfish.

Will the baby be monitored?

Yes. There are two ways to monitor a baby–continuous and intermittent. Continuous electronic monitoring (with a machine where paddles are strapped to your abdomen) is used in hospitals so the nursing staff can monitor you right along with all the other women in labor. Intermittent monitoring is done at regular intervals throughout labor, but does not require you be strapped to a machine or your movement restricted.

The American College of Obstetricians and Gynecologists, in Fetal Heart Rate Patterns: Monitoring, interpretation, and Management, Technical Bulletin Number 207–July 1995, stated: “Well-controlled studies have shown that intermittent auscultation of the FHR is equivalent to continouous electronic monitoring in assessing fetal condition...” Your midwife will follow guidelines for monitoring your baby intermittently so you will be free to move about or assume any position you like, and with a minimum disturbance to you. If you are choosing the birthing suites, a continuous electronic fetal monitor is available for use if the intermittent monitoring detects an abnormal fetal heart rate pattern that we want to confirm or rule-out.

Do I have to have an IV?

No. Although IVs are available for things like emergencies and treatment of group B strep, we do not routinely use an IV in labor.

Will I have an episiotomy (a cut to enlarge the vaginal opening)?

No. There is now extensive data to show that a natural tear will be less extensive, hurt less, and heal better than a cut. Besides, we will do our utmost to prevent any tear to your perineum, and that is certainly less that the definite damage of an episiotomy. In our opinion, an episiotomy should only be done as an emergency measure, when you must deliberately sacrifice the mother to get the baby out very quickly. This situation is extremely rare in our practice.

How early is too early to have the baby?

We will not deliver a baby before 37 weeks gestation (3 weeks before your due date) because there is a significant risk that the lungs will not be mature enough for the baby to breathe without help, and other organ systems may also be underdeveloped.

What if I go overdue?

Many times babies are overdue, especially first babies. Contrary to popular opinion, the risks of postmaturity do not begin to increase significantly until to at least 2 weeks after the due date. We are content to let babies come when they will. Induction by any method entails risk. However, there are times when a health problem or other issue makes it worth it to take those risks. If you find yourself in this situation, speak with your midwife team about your options.

Do you have a birth ball?

Yes. Both BellaNatal and BetterBirth’s birthing suites have birth balls. If you are birthing at home, the midwife will bring a birth ball with her to your delivery. The birth ball is very helpful to lean over while in hands-and-knees position, to sit on, or to push against.

Do you have a birth stool?

Yes. Both BellaNatal and BetterBirth’s birthing suites have birth stools. If you are birthing at home, the midwife will bring a birth stool with her to your delivery. The birth stool is very helpful because it simulates a squat (which creates the largest diameter birth canal and allows gravity to assist) without requiring you to support yourself.

Do you do waterbirth? What is the tub like?

Yes! We love waterbirth. The birthing suites have wonderful jetted tubs, and we have great inflatable tubs for our homebirthing clients. Please see our waterbirth page for all the details.

Is pain relief available?

We do not offer pharmacological (drug) pain relief (such as the epidural). However, we do offer extremely effective natural (non-drug) pain relieving techniques. For example, water labor and waterbirth are often called the “natural birth epidural” because they feel so good. There are many other techniques we use to make the discomfort of labor manageable for you.

What is a doula, and do I need one?

A doula is a professional labor support person. We love doulas! While we highly recommend you hire a doula if you are planning a hosptial birth, the type of labor support offered by a doula is an inherent part of the services your BetterBirth team will provide, and it is not necessary to hire a separate doula. However, if you prefer to have someone specifically focusing on that role, or if you have a special person you want to be your doula at your birth, we welcome her as part of the team. For more information about doulas and how to find one, click here.

About Home Birth Back to Top

Is home birth safe?

Yes. There have been scores of studies from around the world which have shown home birth with a competent midwife to be as safe as, or safer than, hospital birth for normal pregnant women. The Utah State Department of Health Bureau of Vital Records confirmed the safety of home birth in a 1995 report comparing neonatal death rates of planned home births with those of hospital births. That report showed that for 1989-1990 the neonatal death rate of home births was roughly half that of hospital births, and that while the rate for hospitals remained at about 2 per 1000 births in 1991-1992, it dropped to zero for births at home. See our page on home birth for more references to safety studies.

Is home birth legal in Utah?

Yes. Section 58-77-304 of the Utah State Code assures “the right of parents to deliver their baby where, when, how, and with whom they choose.” Home birth has been practiced in Utah since before it was a state, and it continues uninterrupted and legal through today.

How common is home birth?

About 1% of all births occur at home in Utah, and the figures are similar nationwide.

What geographical areas do you serve?

We serve all of Salt Lake and Utah counties, as well as western Wasatch and Summit counties, and eastern Tooele county. For a map of our service area, click here.

Isn't it messy?

Generally, there isn’t much mess. The midwife will take steps to protect your furniture, carpets, and other belongings, and she will make sure any spills that may have escaped these precautions are completely cleaned before she leaves. You may end up with a few stained towels and sheets.

How much room do you need for a home birth?

Not very much. We like to say if you can make a baby there, you can have a baby there. We have delivered babies in tiny bathrooms in tiny trailers, and in large mansions we never saw the end of. Of course, a little space is nice. But we can work around almost anything. Don’t let the size of your home limit your birth choices.

Is there any special preparation of my home needed for a home birth?

No. Have your birthkit (supplies) in a handy place, have food and juice you like on hand, and have diapers, clothes and a receiving blanket for the baby. Your house does not have to be spotless, and you do not have to sterilize anything (your midwife will bring any necessary sterile items pre-sterilized). As long as your home is in a condition where you are comfortable laboring there, you’re ready.

Can I do a waterbirth at home?

Yes! We have portable tubs available for your use at home, or if you have a nice garden or jacuzzi tub, you are welcome to use that.

How much space do I need for the birth tub?

Our portable birth tubs measure 5 feet in diameter, so you’ll need a 6' x 6' square area to allow us room to move around it. This can be a carpeted area if you wish, or any other floor surface as the tub does not leak, and we will put plastic down to catch any drips. Most families can shift furniture around to make this much space somewhere in their home.

Can I birth in an apartment or student housing?

Yes. Any landlord who tries to restrict you from birthing in your home is way out of line. No one can tell you where you can birth. Utah law actually guarantees your right to birth wherever you want. There will be no mess, no damage. We recommend you not even tell the owner of your dwelling your plan, as it is none of his or her business, unless the landlord lives with you. In this case it is advisable that they be forewarned since you will have people coming and going, and you may make some noise. We have never had a problem with floors supporting the birthing tub, so that should not be an issue.

What if I make noise?

You may make some noise during the intense part of your birth, however most moms’ perception of it is much greater than reality. Usually the noise is much softer and for a much shorter period than you think. Just because you're sure the entire neighborhood can hear you doesn’t mean they can.

What is the difference between birthing at home and at the birthing suites?

The fundamental difference is whether you want to deliver at our place or yours. Some moms really want to get away from their home (children, pets, neighbors, whatever) to birth, and some really want to be in their own space with their own bed, and they don’t want to drive anywhere during labor or after the birth. There is no safety difference between the two with one small exception: we do not have an electronic fetal monitor at home to confirm any problems turned up by our regular monitoring like we do at the birthing suites. Some moms who live far from a hospital prefer to deliver in the birthing suites so they can have the out-of-hospital birth they desire, but they are close to a hospital in the event of complications. It really comes down to where you feel comfortable having your baby.

What do I do with my kids during the birth?

We recommend if you want to have children at the birth that you also invite an adult your children know and trust whose job it is to attend to them during the birth. Make it clear that this is their primary responsibility, so that if the children do not want to be in the room at the all-important moment, they must leave also to be with the children.

We recommend if you have children who are not to be present during the birth you 1) leave them asleep if the birth occurs during the night, 2) find a willing friend, neighbor, or relative whom you trust with the children who will pick them up and take them to another location until you are ready to have them back, or 3) find a person with whom you and the children feel comfortable to come and care for the children at your home but out of the birth room.

About Special Risk Categories Back to Top

I'm Rh negative. Will you take me? Can I get RhoGAM?

Yes, and yes. We will perform lab tests to check your sensitization status and administer RhoGAM as appropriate. For more information, see our resource on Rh- and RhoGAM.

What if I'm beta strep positive (GBS+)?

We can care for you. Please see our resource on Group B Strep for detailed information on this bacteria. We have several options available to you (including IV antibiotics) to deal with this situation.

What if I have had a prior cesarean section? Can I do a VBAC?

Yes, we can help you have a VBAC as long as your incision was low transverse ("bikini type") and you meet certain other risk criteria. The vast majority of women seeking VBAC meet this criteria. Be sure to discuss this with the midwife during your initial consultation appointment.

What if the baby is breech?

Breech deliveries are riskier than vertex (head first) . We will check the baby’s position at every prenatal visit during your last two months. If your baby turns breech, we will do everything we can to return it to a head down position. For example, we will give you various exercises and techniques you can use to help encourage the baby to turn. If the baby is still breech by 36 weeks, we will seek a consultation and ultrasound and see if the baby can be turned in what is called an “external version.” In a version, the baby is manipulated from the outside of your belly and turned into the head-down position. If even that is unsuccessful, then we must transfer your care to another provider.

Do you do twins?

Twins are higher risk than a singleton pregnancy and delivery, and we do not knowingly deliver them out-of-hospital.

About Money Matters Back to Top

How much does it cost?

That will depend on the package and services you want. See our packages page for more information.

Will my health insurance cover my birth?

We do not accept insurance. However, we can prepare a claim for you to submit to your insurance company for reimbursement after the birth. You can call our office to find out our payment history with your insurer. Many clients find our fees, though they are not covered by insurance, are actually less than they would pay out-of-pocket if they use their insurance elsewhere. Try using our cost calculator to estimate what your portion will be using your insurance for a hospital birth. You may be surprised! Health Savings Accounts and Flexible Spending Accounts do generally reimburse for our services.

What if I can't afford it?

We realize it can be tough to pay for your maternity care. We have tried to implement several options to make it easier: 1) You can create your own payment plan within our 25% by 20 weeks, 50% by 28 weeks, balance by 36 weeks structure. 2) We take credit cards (Visa, M/C, Discover, Amex) so you can extend out your payments as long as your card issuer will let you. 3) Our Apprentice Package can reduce the total due substantially. If you strongly desire to birth with us and are not able to pay the cost using the above, please talk with us and we’ll see what we can do.

Do you give a discount if I enter care late in my pregnancy?

No. We have found if we offer a discount to latecomers, some women choose to delay or skip prenatal care in order to save money. We do not want to encourage this practice because we believe good prenatal care is fundamental to a good birth outcome. So, we offer our services in packages that include prenatal care, whether it be many visits or few.

What is your refund policy?

Generally, if you withdraw from our care for any reason prior to the onset of labor, you are entitled to a refund of all monies paid minus the non-refundable deposit, $41.00 per prenatal visit, and the price of any other services you have already received (such as lab work). Once labor has begun (whether or not you call the midwife to attend you), there are no refunds. For a complete statement of our refund policy, see our payment agreement. The refund policy on your payment agreement always governs over this general statement.

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