Informed Disclosure for Midwifery Care and Home Birth

Ideally, giving birth is a joyful deeply personal experience which leaves a woman in awe of her own strength and in love with her baby. As midwives we are privileged to support women and their families through this experience. Our role as midwives is to encourage a woman in her own ways of moving through pregnancy, labor, and birth. We work with her to promote a healthy pregnancy, and provide education to help her make informed decisions about her own care. Together with our clients, we carefully monitor the progress of the pregnancy and labor, and recommend appropriate management if complications arise. The key elements of this education, monitoring, and decision making process are based on Evidence-Based Practice and Informed Consent. 

Evidenced-Based Practice refers to a thoughtful integration of the best available evidence, coupled with clinical expertise. As such it enables midwives and their clients to address healthcare questions with an evaluative and qualitative approach. Evidence based decisions flow from a process that includes the assessment of current and past research, clinical guidelines, and other information resources in order to determine the best course of care. 

Typically, Informed Consent refers to the rights of healthcare consumers to be fully informed with the best possible evidence that includes risks and benefits about testing or treatment options so that they can then make a shared decision with their provider among those options. This is in contrast to a model of care in which the health professional decides for the patient what treatment is in her best interest. 

As certified professional midwives we provide complete care for normal pregnancy, labor, homebirth and the postpartum period. We generally begin care between 8-12 weeks and see women for 60 minute prenatal visits every month until 28 weeks. Between 28-40 weeks, we see women every two weeks and sometimes as frequently as weekly in the last month of pregnancy. At least one midwife and an assistant will attend your birth. We will see you and your newborn in your home for at least 3 postpartum visits (usually 24 hours and 3&10 days) and for two further postpartum visits in our office. During prenatal visits there will be time set aside for discussion, and a physical evaluation of health. 

There are both advantages and disadvantages to home birth, and each family must decide which birth setting feels best for them. Home birth allows women more control over their environment; over how they will birth and who will be with them. The main disadvantage of home birth is the limited or delayed availability of emergency equipment and procedures. Most obstetrical complications are not emergencies and many are predictable beforehand. Complications are best minimized with a healthy mother who maintains good nutrition and receives skilled screening and consistent prenatal care. True emergencies are rare and usually allow for sufficient time to get to a hospital, but there are no guarantees. 

Each woman must weigh for herself the risks of birthing outside an emergency facility against the risks of in-hospital birthing, where the risks of unnecessary interventions, emergency-mentality, and hospital borne infections present their own dangers. Babies (and very rarely, mothers) do sometimes die in spite of the best care and great love. It happens at home and in the hospital. Please feel free to ask us questions regarding our experience with complicated births. We want you to have confidence in the care you have chosen. Ultimately, this will create a comfortable environment in which to birth your baby. 

The majority of studies on the safety of homebirth show that homebirth is safe for low risk pregnant women, provided there is a skilled attendant present. Homebrith studies also demonstrate that good outcomes are achieved with very low rates of intervention, such as labor induction, labor augmentation and cesarean section. These procedures are used at very high rates in low risk hospital births. We personally believe, and evidence shows, that home birth is safe, but we are not against hospitals. Hospitals are vital for women and babies with complications, and for those who simply feel uncomfortable at home. Ultimately the choice is yours. 

The practice of midwifery in Missouri as a Certified Professional Midwife (CPMs) requires that midwives maintain their national certification through the North American Registry of Midwives (NARM). This requires continuing education, neonatal resuscitation certification, and adult CPR certification. Also as part of our certification, CPMs are required to participate in a peer review process. During peer review, client health information will be shared in confidence with other midwives. 

Precious Thoughts Midwifery is a solo midwife practice. Caeli Werner is a CPM and has attended home and birth center births since 2020. Originally from Missouri, she migrated to Virginia to receive her training to return back to the St Louis area to practice midwifery. She received her national certification in 2022 and is the owner of Precious Thoughts Midwifery.

Most CPMs train through a combination of formal education and apprenticeship. Traditionally, midwifery training was passed down from woman to woman as a sacred art.  We hold this model of training to be the hallmark of midwifery and to that end strive to incorporate apprentices into our practise. When an apprentice is in training at Precious Thoughts, she will attend most prenatal visits and births. She will act as a birth assistant gradually taking on greater responsibilities as she progresses. All care provided by our apprentices or birth assistants will be under the supervision of a senior midwife and with the permission of our clients. As part of the certification process through NARM, students will need to disclose health information of our clients to NARM as a way to verify their participation in care. This will be done only with the permission of our clients.

As Certified Professional Midwives we are most comfortable transferring care to Missouri Baptist Medical Center in St Louis. We will make arrangements for transfer with the attending physician and accompany you to the hospital. In our experience, we have always remained with our clients during the course of their care in hospital. We have found the physicians and staff to be respectful of our position as midwives and families desire for homebirth. A specific emergency transport plan will be developed with each individual client. 

Any complaint that may arise about care received is encouraged to be addressed directly with the midwives at Precious Thoughts. At any point within the first 24 months from the last received care, a complaint can be filed to NARM, our certifying body. Whether you received the care or witnessed the care, you can file the complaint to North American Registry of Midwives Accountability Committee 888-842-4784 (fax) accountability@narm.org along with a records release and Accountability Form. Further details can be found on NARM’s website: narm.org. 

After the birth of your baby, we would like to celebrate this even with others in the Precious Thoughts Midwifery community. We do this by posting a birth announcement with a photograph on our Facebook account, displaying an ink footprint on our office wall and adding a photo of your baby to our album along with your birth story. 

Under our certification we are required to establish practice guidelines, which serve as an outline for the scope of our practice. Our practice guidelines document is available to all of our clients upon request. 

You will be given an opportunity to ask us questions about this document. Please feel free to request a copy of this document for your records and return the following signature page at your next visit.