Alma Midwifery Frequently Asked Questions (FAQs).jpg




+ I have read that birth center's have significantly lower cesarean birth rates, without increasing risk or poor outcomes, how is that possible?

Please check out a side-by side comparison to how labor is tended in a birth center vs hospital management.

Birth has it's own timetable. Cesarean reduction means we give people plenty of time to gently warm up, labor and push. Birth is a process that requires a peaceful safe environment to unfold.

Our methods also allow for free movement without being tethered to several wires, pumps and machines. Without an epidural restricting movement, people can autonomously squat, stand and sway hips, dance and move about intuitively. When Mom is moving freely in many positions beyond just being rolled from side to side, babies do better too. Many cesarean births occur because the baby's heartbeat is concerning, which is much less likely without an epidural effecting Mom's blood pressure and movement.

Alma midwives are not anti-epidural. Epidurals are a wonderful tool to use for women who choose or require them. An epidural does increase both the cesarean rate and vaginal laceration rate.

+ Can any pregnant person birth at Alma?

All pregnant people can be part of our community and join our various support groups. Out-of-hospital birth is safe vecause we serve only low risk people. Do you wonder if you are low risk? If you desire midwifery care and a birth center birth it is worth askig if you are a safe candidate for cafe. Just give us a call 503-233-3001.

+ How did Alma get its name?

Almeda (Alma) Moon, Laura Erickson’s (founder of Alma) great Aunt, was a midwife who influenced Laura’s decision to become a midwife. The Birth Center is named for her. Alma also means "soul" in Spanish and "nurture" in Latin.

+ Is it safe to give birth in the out-of-hospital setting?

Yes, birth center birth is very safe for healthy, low risk people. Check out our Safety Page for more information.

+ Do Alma midwives attend VBACs (Vaginal Births after Cesarean) or HBACs (Home Birth after Cesarean)?

According to the latest center for disease control the cesarean birth rate inthe US is 31.9% (2017), with such a high surgical birth rate, the question of how to give birth after a previous cesarean is a frequent question. The short answer is, yes! We can attend a TOLAC for a person who has had one uncomplicated birth by surgery, with at least 18 months spacing from the surgical birth to this baby’s due date, surgical records available and willingness to have a birth in the birth center (in order to increase safety we cannot attend an at home VBAC/TOLAC).

Have you had two or more cesarean births and now wish to have midwifery care? Yes, we can provide prenatal care, hospital labor support and postpartum care. We cannot attend you in the birth center though.

+ Are you in-network with insurance companies?

We sure are! BCBS, United Health Care and Moda are the first progressive companies to see the value of our care.

+ Can I birth at Alma if my company is not in network

We are also superstars at billing your insurance company, even if out-of-network. Let’s work together!

+ How many monthly births do the Alma midwives accept?

With three to four primary midwives we are able to greet 15-20 new humans each month. Call as soon as you get that positive pregnancy test to make sure you hold a spot. Some months are open long enough to accept people late in their pregnancy, as long as they have records of care from their previous midwife or MD.

+ Do you have an ultrasound machine?

Yes, we do “bedside” in-office ultrasounds and also refer out for ultrasounds to be read by a radiologist. We offer no-charge ultrasounds to gather basic info, like: How many babies, viability in early pregnancy, head or butt down?

+ Do you do genetic screening?

Yes, we are able to discuss genetic screening and do some in-house labs and refer out for others. The field of genetic testing is a rapidly growing technology, and a visit to a geneticist may be the best option for you. If you are over 35 years old, your insurance is likely to pay for genetic screening.

+ What is the difference between seeing an obstetrician and seeing a midwife? And a midwife in-hospital versus a midwife out-of-hospital?

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. Also, check out the 7 tethers used in a typical hospital birth.

Here are some other differences:

  • Shorter waiting room time at Alma
  • Longer prenatal visits with Alma midwives (45 minutes to an hour)
  • Home visits
  • 24/7 call line with an Alma midwife to talk about pregnancy concerns and to also let us know when labor starts. No 3rd party answering service to deal with
  • Ample time for your questions, bountiful discussion about choices and true informed consent for procedures and tests - all important features of our care
  • Attention to your lifestyle: nutrition, supplements, exercise, workload, and relationships make your care more holistic with the Alma crew
  • Alma midwives believe in the mind/body connection which science is just beginning to validate
  • We embrace non-western medical modalities: referrals to Naturopaths, Chiropractors, Acupuncturists, Homeopaths, Yoga classes, etc. if you desire
  • We rely on supports beyond drugs and surgery such as: deep listening, waterbirth, birth stools, herbal medicine, gravity, time, massage, upright empowering positions, and trusting you as an expert on you
  • Alma midwives also judiciously use medical modalities, such as laboratory tests, vital sign monitoring, doppler intermittent fetal heart monitoring, IV fluids, pharmaceutical drugs, and referral to hospital-based providers when a higher level of intervention becomes necessary. We sing the praises for a life-saving cesarean birth or the use of drugs to reduce blood pressure in a woman with pregnancy-induced hypertension.
  • Alma midwives are not anti-allopathic medicine. We do not believe pregnancy is an illness. We do understand pregnant people become ill and need medical care.
  • Midwives can provide care for the newborn and the mother together for the first 6 weeks of the baby’s life. Several of these visits are at home.
  • Midwives believe in the “Law of the Sphincter” - its a real thing!

+ Law of the Sphincter - Ina May’s Guide to Childbirth

  • Excretory, cervical and vaginal sphincters function best in an atmosphere of intimacy and privacy-for example, a bathroom with a locking door or a bedroom where interruption is unlikely or impossible.
  • These sphincters cannot be opened at will and do not respond well to commands (such as “push!” or “relax!”).
  • When a person’s sphincter is in the process of opening, it may suddenly close down if that person becomes upset, frightened, humiliated, or self-conscious. Why? High levels of adrenaline in the bloodstream do not favor (sometimes they actually prevent) the opening of the sphincters. This inhibition factor is one important reason why women in traditional societies have mostly chosen other women (except in extraordinary circumstances) to attend them in labor and birth.
  • The state of relaxation of the mouth and jaw is directly correlated to the ability of the cervix, vagina and the anus to open to full capacity.

+ I know medical waste is a problem. How does Alma stay as green as possible?

Alma is green! We continuously make an effort to minimize our environmental impact. Currently, the ways we are doing that are:

  • Reducing, reusing, and recycling!
  • Active recycling program, including composting paper towels
  • Reusable, washable ‘chux’ underpads used at birth as much as possible
  • Earth-friendly cleaning products
  • High-efficiency washers and dryers
  • Changing our lighting to be more up-to-date and earth friendly
  • Battery recycling program
  • Using recycled paper products as much as possible
  • Encouraging cloth diapering

+ Is there a certain diet you recommend?

Nutrition in pregnancy is one element you may be ablet to control. Each of us comes with a blue print--think genetics. Newer research is showing that blue print can change when higher quality "building materials" are available--think epigenetics. Your baby could still be on the planet in 90+ years if he/she is built to last. No pressure! Just do your best. Eating while nauseated or with gestational diabetes can be challenging. People also wonder if their diet is adequate; vegan, vegetarian, meat and potatoes, paleo... so many questions! Let the Alma midwives guide you through optimal nutritin in pregnancy while honoring your own diet preference.


Labor & Birth

+ Can I labor AND birth in the water?

Yes, if you are pregnant at this moment, please consider that your baby is completely underwater, and nobody is too concerned! Your baby is getting oxygen from the umbilical cord and in late pregnancy will practice breathing with water. A water birth is just a short extension of the womb. Once the face hits the air, the baby will take deep breaths, the small amount of amniotic fluid naturally found in the lungs is pushed out by oxygen. The lung tissue itself becomes perfused with oxygen. This is a radiant process. Most babies are born with a dusky tone and soon will pink up (this is true of all babies regardless of skin color).

The water birth is for the birthing person’s comfort and may reduce vaginal tearing. It has been called the natural epidural.

Some birth centers will allow you to labor in water but want you out of the tub for birth, if a water birth is important to you, Alma is the better choice.

+ Who may come to my birth? Are children allowed? Pets?

You may have whoever you choose at your birth. Our advice on choosing guests is to limit it to people who will be 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, ensure you are asking them to be there for you. Having people there who you don’t really want, feel comfortable with, or who are negative/scared about an out-of-hospital birth often creates a challenging experience. Remember the law of the sphincter and only invite people to your birth whom you are just fine pooping in front of. :0

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 and who is unattached to witnessing the birth so that they may leave with the child if necessary. Sadly, pets are not allowed in the birth center.

+ What do you do for pain relief or pain medication?

“The more cultured the races of the earth have become, so much the more positive have they been in pronouncing childbirth to be a painful and dangerous ordeal”. - Grantly Dick-Read, Childbirth without Fear

We do not have pharmaceutical pain relief: epidurals or narcotics.

Prepare: For American women, birth needs preparation! Take childbirth education, read positive books like Ina May’s Guide To Childbirth, watch films like The Business of Being Born, stretch your body in yoga, dance, make love, get out in nature, have quiet time, teach yourself to be patient (take breaks from your cell phone), meditate, and do nothing at times. WHAT? If birth is such a normal, natural process why do I need so much preparation for my first unmedicated birth? Because most of us live soft lives compared to people of other times and places. Birth has fierce energy. Preparation teaches you to ride the wave of labor and meet it with your own fierce, wild self. You can do it! But you must prepare. Without preparation birth may be perceived as a terrible painful ordeal instead of the powerful and wondrous force that will bring your child into your arms.

Support: Active labor support from the midwives or a doula lessens the impression of pain and shortens labor. By hiring Alma midwives you will have support for your labor no matter which way nature decides to lead you. If a cesarean becomes the safest way for the baby to be born, our role becomes even more vital in providing loving postpartum support. Having a birth is an intense and challenging life event. While it can definitely be interpreted as painful, most women’s interpretation of pain is greatly affected by their environment, relationship with care provider, level of feelings of safety or fear, and so many other factors. We have many tools for pain management, including the built relationship of trust, water, herbs, homeopathics, nitrous oxide (see below) and massage. We also have relationships with local chiropractors and acupuncturists who may be available to help with various challenges (including pain management) if we think they may be helpful.

+ Nitrous Oxide or N20

Another tool to reduce pain and anxiety is N20. “It’s a gas!” Also known as laughing gas or gas and air, it is a chemical compound that is breathed for a reduction in anxiety and also as an analgesic. According to the American College of Nurse Midwives (ACNM), “Research has supported the reasonable efficacy, safety and unique and beneficial qualities of N20 as an analgesic for labor and its use as a widely accepted component of quality midwifery care.” Alma has nitrous oxide available for your birth center birth but we cannot offer it for home births. We have found it to be a useful tool to use at the end of labor and also if a person needs sutures after birth.

We do not have pharmaceutical pain relief (epidurals or narcotics). In early labor, we use hydroxyzine (Vistaril) to help a person sleep in early labor. Hydroxyzine is a 1st generation histamine H1 antagonist - like a strong Benadryl - and makes most women very sleepy. We try that only after the more gentle modalities aren’t helping.

+ What happens in an emergency? What if I need a Cesarean section?

Approximately 90% of women who choose to give birth at Alma or at-home with Alma midwives do so without a complication. If something comes up in your pregnancy, labor, birth, or postpartum that indicates it would be safer to be in a hospital setting, we do not 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 in that setting. If there is an actual emergency where time is of the essence (less than 1% of births that we attend), we may choose to transport by ambulance. Your midwives will discuss this possibility with you as your due date approaches.

In the case of a transport during labor, upon discharge from the hospital you will continue your postpartum care with the Alma midwives as planned.

It is one of the privileges of living in the US in the 21 century that cesarean birth is available to us when it may save the life of a mother or baby. Alma midwives believe that a cesarean birth rate of 30+% is improper use of this incredible surgery. Our cesarean rate is 10% or less most years. The World Health Organization recognizes the overuse of cesarean birth as a costly health crisis. Midwifery reduces unnecessary surgical births! We also send empathy & strength to our sister midwives all over the world that continue to watch women & babies die for want of a surgical birth.

+ What if the cord is around the baby's neck at birth?

This is the most frequently asked question of all! It is a fearful thought to think of a nooselike experience for a baby, in most cases the cord around the neck is more like a necklace and does no harm. The cord is around the neck (nuchal cord) in about 30% of births. We simply loop it over the head during the birth process. It is a tragic, but rare event when a cord accident occurs. There are 7.5 billion people on the planet and we all negotiated our umbilical cords.

+ Are Alma midwives the authorities on pregnancy and birth?

The root word, "authority" means "power to enforce obedience"...Eww! We are not the authority on you or your needs. We don't expect you to be an obedient patient! Our intention is to guide, encourage and inform. When we give advice, we hope you run it through your own intuition. Does it feel true to you? Although, sometimes the information is black and white, "Jane, your lab work shows that you are anemic". In this case there is no reason for Jane to turn inward and vibe out the truth in that statement!

We believe in egalitarian midwifery care. Let's work together on your baby project!



+ What resources do you recommend?

See our resource page for our latest recommendations and classes (Coming Soon!).

+ What prenatal supplements do you recommend?

We always recommend a good-quality prenatal vitamin. 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 Vitamin D or fatty acids) depending on your individual needs and current research.

Some individuals with MTHFR, a genetic mutation that affects the absorption of certain vitamin and minerals, may steer some midwives to recommend a prenatal with folate vs. folic acid - more on that during your care with us.

+ Do you use herbs or homeopathy in pregnancy?

We may. 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 attend births anywhere between 36 and 42 weeks gestation. Most births occur between 38 and 42 weeks and, in our experience, births before those dates (though legally permitted) require further discussion with your individual midwives. After 42 weeks, there can be more complications for the baby and we refer you to hospital based practitioners.

Alma Midwifery Frequently Asked Questions (FAQs).jpg
Alma Midwifery Frequently Asked Questions (FAQs).jpg


+ How long do people stay at the birth center?

As with all of our care, this varies from person to person. Most people choose to stay for one night or less, though some have chosen to leave a few hours after the birth. Take a look at the birth center to get more information about the benefits of the pampering care you will receive while 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. We no longer provide a pediatrician list as who you choose will depend upon your insurance company.

+ Do you perform circumcisions?

We do not. New research has deemed it medically unnecessary. We'd be glad to provide you with more information if you have questions. If you decide to circumcise, we will give your baby a vitamin K shot as is required and refer you out for the surgery. Half of the young boys in Portland area left intact, so if you decide to leave your child intact he will be in good company. The foreskin crew! We have zero judgement if you do decide to circumcise your child, once you have all the info.

+ Does Alma Carry Malpractice insurance?

Yes, unlike many small homebirth practices we do have liability insurance. It is a cost that we decided was worth it and it also allows us to be in-network with insurers and work in the hospital setting as needed.