Labor & Birth
What is the difference between seeing an obstetrician and seeing a midwife? And what, for that matter, is the difference between seeing a midwife in the hospital versus a midwife out of the hospital?Good question! The short answer is that midwives care for low-risk women, both in and out of the hospital. Obstetricians do that too, but they also take care of high-risk women, and can use forceps, vacuums, and do surgical deliveries (Cesarean sections) when necessary. For more information about what our particular care is like, please see our midwifery care, home birth, and birth center pages.
Can you bill insurance for my birth?
Yes, please contact us for more information on your individual insurance company.
What is informed choice?
Informed choice is the practice of educating and informing women so they can make choices in an evidence-based way. Much of the reason we have hour-long prenatal visits is so that we can spend time discussing different choices as they come up, and helping you to make the right decision for your family. We offer all the same screenings, lab-work, and ultrasounds as you would have in hospital-based care, but the way we approach those things is very different. Weeks before the decision is to be made, we give you a hand-out with detailed information, including: recent studies, the CDC (Center for Disease Control) and ACOG (American College of Obstetrician and Gynecologists) recommendations, and the risks and benefits involved in making your choice. We believe that doing this, rather than making choices for you about what is or isn't necessary, is a crucial difference in the way that we care for people.
What is the biodynamic birth model?
This model of care, originated by Michel Odent, suggests that both farming and childbirth have been remarkably industrialized in the 20th century. Caring for women biodynamically means treating them in a way that is biologically appropriate, but also dynamic in its view of women as individuals with different needs, desires, and strengths. By approaching birth in a biologically appropriate way, we practice with a philosophy of minimizing interventions while maximizing safety. This means that sometimes we are very hands-off and non-interventive, and other times we transport to the hospital for Cesarean sections. And either scenario is safe and appropriate, depending on the situation. For more reading on biodynamic birth, read Michel Odent, particularly:
The Farmer and the Obstetrician
Birth and Breastfeeding:
Rediscovering the Needs of Women During Pregnancy and Childbirth
The Scientification of Love
How did Alma get its name?
Almeda (Alma) Moon, Laura Erickson's great Aunt, was a midwife who influenced Laura's decision to become a midwife. The Birth Center is named for her. After naming the center, more interesting facts about Alma have been discovered: alma in Spanish means soul, and alma in Latin means to nurture.
According to the article "Sufi Healing" by Kamil Nash in the April 2005 "Natural Awakenings" magazine, the Arabic language gives meaning to sounds. The "A" sound is the primary sound. It has an energetic action of opening. How perfect for a birth center! There are two acupuncture meridians which are called the Ren (or conception vessel) and the Du (governor vessel). These meridians run up the midline of the body, and the gap between the upper and lower lips. The "L" sound, which is made by applying the tongue to the roof of the mouth, connects these meridians.
Do Alma midwives attend VBACs (Vaginal Births after Cesarean) or HBACs (Home Birth after Cesarean)?
We do, and we love VBACs! In Oregon, it is legal to do these at home or in the birth center as long as there is eighteen months between the surgery and the new baby's due date. Our VBAC success rate is close to 90% (but varies by year). When you compare this to a national average of less than 10% of women having successful VBACs, it is pretty obvious that something in that system isn't right.
If you are interested in having a VBAC, we ask that we have the records for your previous surgery to help make sure you are an appropriate candidate. We may also ask you to have more ultrasounds to determine if your placenta is anywhere near your scar, and to check scar integrity.
Do Alma midwives attend breeches or twins?
The short answer for that is that it depends. We are allowed to attend those births at home but not at the birth center. Because twins and breeches present an elevated risk, we evaluate those births on a case-by-case basis, and we’ll make a plan together with you about whether home is the best place to have your baby (or babies).
How many monthly births do the Alma midwives accept?
This varies from midwife to midwife, and from month to month. The average is four, though some of us take as few as two and as many as six.
Do you have an ultrasound machine?
No, we don’t. We refer to several different imaging places and are glad to refer you for an ultrasound if needed or desired.
Do you do genetic screening?
We offer all the same genetic screening options as you would have if you were seeing a hospital-based practitioner.
How can I get involved in furthering the cause of midwifery and helping to ensure my right to birth the way I want to is maintained?
Thank you for your desire to be involved! Midwifery needs consumers who are dedicated to helping maintain their right to birth where and with whom they choose. We work tirelessly to uphold those rights, but we need your voices too—and they are received even better than ours.
Ways to be involved:
Contact your senator. Click here to find the contact information for your senator and ask that they uphold your right to birth where you choose. Stories about your births, or how you are personally affected by this are always helpful.
Contact the Health Licensing Board. As our regulatory agency they need to keep hearing from consumers to know what you want.
The Oregon Midwifery Council (OMC) is the most important midwife organization in the state. It pays for our lobbyist who fights to maintain midwifery the way we hope it will be. This includes things like ensuring we are autonomous practitioners, maintaining our right to attend VBAC, twins, breeches, post-dates and so many other types of births. The OMC is glad to receive donations to help pay for the lobbyist and further the cause of midwifery in this state.
back to top
What childbirth education classes do you recommend?
We think childbirth education is important, especially for first-time parents or parents having a natural birth for the first time. We offer a discounted childbirth education series HERE, and we’ve worked to develop this basic class to be appealing to most people. We also recommend The Yoga Way to Birth Series, Birthing from Within, or Hypnobirthing classes. Each of these has a slightly different approach, and you can get more information about each of them by checking out their websites. Feel free to ask your midwives which classes they have found to be the most beneficial.
What books do you recommend?
There are lots of pregnancy books that we love, and some we love a lot less. One of the ones we would not recommend is the ever-popular “What to Expect When You’re Expecting”. That book is pretty fear-based and not the most appropriate for those planning out-of-hospital births.
Some we love are listed below.
The Thinking Woman’s Guide to a Better Birth - Henci Goer
Gentle Birth Choices - Barbara Harper
The Birth Partner - Penny Simkin
Ina May’s Guide to Childbirth - Ina May Gaskin
Special Delivery - Rahima Baldwin
Immaculate Deception - Suzanne Arms
Breastfeeding - Suzanne Arms
The Womanly Art of Breastfeeding - La Leche League International
The Nursing Mother’s Companion - Kathleen Huggins
Parenting & other Postpartum:
Vaccinations - Aviva Jill Romm
You are Your Child’s First Teacher - Rahima Baldwin
The Continuum Concept - Jean Liedloff
Your Amazing Newborn - Marshall & Phyllis Klaus
Some authors we can recommend:
Ina May Gaskin
Aviva Jill Romm
If you’re curious about midwifery:
Baby Catcher - Peggy Vincent
Heart & Hands - Elizabeth Davis
Holistic Midwifery Vol.I & Vol.1I - Anne Frye
Birthingway College has a great list that can be found here.
What prenatal supplements do you recommend?
We always recommend a good-quality prenatal vitamin, though one you take is always better than one you can’t stand. Starting them when you are thinking about getting pregnant is even better!
During pregnancy, we may advise using any number of different herbs, minerals, or supplements (including thigs like Vitamin D or fatty acids) depending on your individual needs and on the current research.
Do you use herbs or homeopathy in pregnancy?
We do, and as individuals we all have different levels of training and comfort with them.
What happens if my baby is early (or late)?
As licensed midwives in the state of Oregon, we can serve attend births anywhere between 36 and 43 weeks gestation. Most births occur between 38 and 42 weeks, and in our experience births before or after those dates (though legally permitted) require further discussion with your individual midwives.
back to top
Labor & Birth:
What happens if someone from my team is on vacation or at another birth when I go into labor?
As midwives, we plan our vacations far in advance, usually before people even get pregnant for the month in question. If we are on vacation for a particular month, we will not even take interviews or accept clients for that month. If the vacation is a shorter one and it is anywhere near your due date your midwife will let you know at the interview or as soon as she knows herself. If it is the junior midwife or apprentice, you will be informed very early in your care as well. One of the benefits of working in a group practice is that we are available to cover for each other if something comes up. If your midwife has a vacation planned near your due date, you will meet the person covering for her and get to know them a bit as well.
Because we take so few births a month, it is a rare occurrence for us to have more than one client in labor at the same time. If that does happen, we again can call on the resources of our group to cover for each other.
Who may come to my birth? Are children allowed? Pets?
You may have whomever you choose at your birth. Our advice on choosing guests to invite is to limit it to people who you want there for a specific reason. Do they have anything in particular to offer? Will they give you good labor support, acupuncture, massage? Try not to ask people to be at the birth for them and ensure you are asking them to be there for you. Having people there who you don’t really want, don’t feel comfortable with, or who are negative or scared about out-of-hospital birth is a recipe for a more challenging experience.
As for children, we are glad to have children of all ages at your birth! We ask that your child have an adult there who is responsible for them. That person should be unattached to witnessing the birth so that they may leave with the older child if necessary.
Sadly, pets are not allowed in the birth center.
What do you do for pain relief? Do you have pain medication?
Having a birth is an intense and challenging life event. While it can definitely be interpreted as painful, most women’s interpretation of pain can be greatly affected by their environment, their relationship with their care provider, their level of feeling safe or scared, and so many other factors. We have lots of tools for pain management, including our relationship of trust that we’ve built up throughout your pregnancy, and things like: water, herbs, homeopathics, and massage. We also have relationships with local chiropractors and acupuncturists who are on call to help with various challenges (including pain management) if we think they may be helpful.
So, no, we don’t have pharmaceutical pain relief: no epidurals or narcotics.
What happens in an emergency? What if I need a Cesarean section?
Depending on the year, somewhere around 90% of women who choose to birth at Alma or at home with the Alma midwives do so. If something comes up in your pregnancy, labor, birth, or postpartum that indicates it would be safer to be in a hospital setting, we don’t hesitate to go there. Our relationship with local hospitals is such that your midwife is able to join you in the hospital and continue to provide labor support there. If there is an actual emergency where time is of the essence (about 1% of births that we attend), we may choose to transport there by ambulance. Your midwives will discuss this possibility with you as your due time approaches.
In the case of a transport during labor, upon discharge from the hospital you will continue your postpartum care at the birth center as planned.
back to top
How long do people stay at the birth center?
Like all of our care, this varies from person to person. Most people to choose to stay for two nights, though some have chosen to leave a few hours after the birth. Take a look at the birth center to get more information about benefits of being at the birth center.
When should I see a pediatrician?
Your midwives will care for you and your baby for the first 6 weeks of life. Most people choose to make their first appointment with a pediatrician when their baby is 8 weeks old. It’s helpful to decide on a pediatrician in late pregnancy because it’s a lot easier to meet and get to know their philosophies on different issues when your baby is on the inside!
What is your opinion on vaccination?
Vaccination is a hot topic! We like Aviva Jill Romm’s “Vaccinations: A Thoughtful Parents’ Guide”
It offers even-haded information on risks, benefits and alternatives. We also offer a bi-monthly class on vaccinations, check our calendar for details.
Do you perform circumcisions?
We do not. New research has deemed it medically unnecessary, and we’re glad to provide you with more information if you have questions.
back to top