• Will a physician be available?
• Will a midwife be with me through my labor and delivery?
• Natural Childbirth ... or epidural?
• What about the new Birthing Inn experience?
• What about safety concerns?
• Who is NOT appropriate for CNM care?
• What about Vaginal Birth After Cesarean VBAC?

Will A Physician Be Available?
At Inova Loudoun's Birthing Inn, Obstetricians are in-house 24 hours a day, to consult with the nurse-midwives regarding any complex issues and to respond to emergencies. Most midwife patients have had uncomplicated pregnancies, and also have uncomplicated deliveries, which the nurse-midwives attend without any need for physician assistance-- but help is available any time it is needed. The best outcomes 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 we note anything unusual. The physician-midwife team meets weekly for chart reviews for any cases in which questions concerns may arise, or for any cases which need co-management or referral to doctor-care. If patients wish to meet our OB-GYN consultant prior to their delivery, an appointment will be made for a doctor visit at no cost.

Labor and Delivery
When women in labor are admitted to the hospital in active phase of labor, our on-call OB-GYN is notified by the midwife and briefed on her status. If problems arise, the CNM is qualified and authorized to begin management while the doctor is coming. We can begin the process toward a Caesarean quickly, and participate in the surgery if needed. Please see more information in the Please see more information in  the “Safety”section.

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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.

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Natural Childbirth or Epidural?

Midwives are undisputed experts at helping women with unmedicated, 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. About half our clients complete their labors without pain medication, and about half choose to use some. 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, unmedicated 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
• Epidural

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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 1,200 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/

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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 at www.mymidwife.org.

Loudoun Community Midwives offers 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 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 newly-built State-of-the-Art Birthing Inn facility at Loudoun Hospital, including a High-quality Neonatal Intensive Care Unit,  an In-house Neonatology Staff, & In-House Anesthesiologist.

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Who is NOT appropriate for CNM care?

Loudoun Community Midwives' Program of Care is influenced by several sets of professional standards and clincial 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:

• Weight > 300 lbs, pre-pregnant
• 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 conditon requiring ongoing physician intervention
• Multiple pregnancies

What Other Requests Can We NOT Fulfill?

• Waterbirth (Labor in Water is great, but delivery in water is not permitted at Loudoun Hospital)
• Home Birth
• Birth after 41 weeks and 4 days of pregnancy

For more information, see our "Low Technology" patient handout sheet.

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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. Once, 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 c/section. For a while, many managed-care plans advocated that NO women should be offered repeat C-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 artificaly induced or augmented, rather than normal, spontaneous labor at term.

Nowadays, VBAC has 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 Trial of Labor/Vaginal Birth after C/section to 2 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 vaginal birth or VBAC, in addition to their C/section delivery-- whether in LCM care or not-- may be candidates for VBAC as well.

With this policy, we are having increased success with VBAC's and supporting women's choices in birth.

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