June 2nd, 2005
Alexandria & Roberto
Frequently Asked Questions
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Most families have similar questions when they inquire about midwifery services and
out-of-hospital birth. We hope this page answers your initial questions and we're happy
to help you in your quest to find the right midwife and location to birth your baby.
out-of-hospital birth. We hope this page answers your initial questions and we're happy
to help you in your quest to find the right midwife and location to birth your baby.
Escape the ordinary...
Pursue the extraordinary!
Pursue the extraordinary!
Ancient Paths Midwifery
What makes APM different than a hospital birth?
Through the time spent during prenatal visits, you will become familiar with both the midwifery
staff and the facility, which feels more like a nice bed & breakfast than a hospital. The people you
see during your prenatal appointments are the people who will be at your birth. All our practices,
including privacy, quiet, low-lighting and minimal interventions, are geared to promote the
physiological processes of birth. You won’t have to fight to get the things you want or worry that
we’ll do things you don’t want. No hassles--just loving support of the midwives to guide you
through the process.
Is an out-of-hospital birth safe?
The health of the mother, comprehensive prenatal visits, risk screening, referral and/or transfer to
the hospital when appropriate, continuous support and care during labor and birth is what makes
birthing with APM safe. Out-of-hospital birth (at the birth center or in your own home) is as safe
as, or safer than, a hospital birth for the majority of women. Multiple studies show 85%-90% of
out-of-hospital births occur without complications as well as having fewer interventions and
cesarean sections and more satisfying experiences.
You can print out the following handout from Citizens Midwifery to share with your family and
friends: http://www.cfmidwifery.org/pdf/safety.pdf
Why should I choose Ancient Paths Midwifery?
Because there are no do-overs in birth! You’ll always remember the sound of that first cry as
your baby is born. You will cherish the first time you felt the tiny hand grasp your finger and the
first time you nuzzled your baby’s velvety head and looked into her eyes. The birth of your child is
an experience unlike any other and shouldn’t be rushed or unnecessarily clinical. At APM, we
value the human aspect of birth and know that you don’t have to sacrifice the special moments or
safety to have the birth of your dreams!
What is your cesarean section rate?
Our cesarean section rate is very low, ranging from 4-8%. Most birth centers have c-section
rates less than 12% and the national hospital average is 30%. At some of the local hospitals it is
as high as 45%.
Why do you have such good outcomes?
First of all, we don’t care for high-risk women or babies and we are not providing services that
increase your risk (induction, continuous fetal monitoring, pain meds, etc). Holistic care begins
with your first visit and continues throughout with one-on-one care, education, and complimentary
services such as massage therapy, OMM (Osteopathic Manipulative Medicine) and chiropractic.
Our focus is on prevention of problems; we catch the little things before they become big things.
Birth, breastfeeding and recovery are all better when the woman is prepared, well-nurtured, calm,
confident and well-supported!
How do I know if I’m a good candidate for an out-of-hospital birth?
The majority of women are good candidates for out-of-hospital birth. A healthy lifestyle, including
diet and exercise, are important, but so is having a positive outlook about the birthing process and
a willingness to reduce stress in your life. Ask yourself these questions about your beliefs about
the human body and the process of birth, and if you answer yes to a few of these, you owe it to
yourself and your baby to visit us!
What is Meet the Midwife?
Meet the Midwife is a time where you are invited to come tour the birth center, meet the midwife
and learn about your birthing options. This is an excellent opportunity for you to get a feeling of
how our personalities and philosophies blend together, pick your birthing suite and find out how to
get started with your care. We won’t give you hardcore sales pitches or pressure you to
immediately sign up! See the calendar for the next gathering. Please be sure to let us know if you
are coming. We’ll need your due date and a phone number we could reach you at in the event
we have a baby on the way and need to reschedule.
What are LM and CPM after the midwife’s name?
LM stands for Licensed Midwife and CPM is Certified Professional Midwife. Lori Luyten is both
a California Licensed Midwife (LM) and nationally Certified Professional Midwife (CPM). She
has been extensively trained in academics and hands-on training. The North American Registry of
Midwives (NARM) is the national organization that registers midwives and Lori has met the strict
standards set by NARM.
How soon should I begin my care?
Most women schedule a first appointment between the 8th and 10th week of pregnancy. Statistics
show that women who start early prenatal care have fewer complications and better outcomes.
We can also hopefully help you get a grip on morning sickness. If you want to hear the baby’s
heartbeat on that first visit, then we’ll schedule the visit during your 12th week.
I’ve already been seeing another practitioner; can I still come to the
birth center?
Absolutely! We will help you make an easy transition. All you need to do to transfer your care is
make an appointment with us and then get a copy of your medical records from your previous
provider by completing a Medical Records Release form. It’s that simple.
If I’m seeing a midwife, do I also need to see a doctor?
We provide complete prenatal care as long as you remain low risk. If a situation requiring medical
attention arises, we will refer you to one of several qualified physicians or you may visit a doctor
of your choice. Most of our clients like to schedule one or two visits with our consulting OB to
establish a relationship. This way, in the event of transport you have an OB to accept you into
care.
Why do your packages all include massage therapy?
We take a holistic approach and have found that massage therapy is a wonderful compliment to
midwifery care. During pregnancy, a woman's body undergoes many changes, some of them
stressful and uncomfortable. Massage is a perfect way to reduce stress and promote general well-
being. You’ll be amazed how much better you’ll feel after an hour with Tanya!
While pregnancy massage has all the same benefits as ‘regular’ massage, it is tailored to address
more specifically the conditions and issues pregnant women experience. Tanya will spend more
time on methods that relieve low back and hip pain, nausea and heartburn, swelling and
constipation. A study published in the Touch Research Institute’s Journal of Psychosomatic
Obstetrics & Gynecology, showed that women who received regular massage had decreased
anxiety and stress hormones, better sleep and less back pain. They also had shorter labors and
fewer complications including premature birth, high blood pressure and postpartum depression.
So, in addition to making you a happier and more comfortable mama, pregnancy massage is good
for you and your baby’s health!
Other Benefits of Pregnancy Massage:
What can I expect during a pregnancy massage?
Our massage therapist, Tanya Sissoyev is a licensed massage therapist with over a thousand hours
of massage training. She completed Kate Jordan’s Bodywork for the Childbearing Year®
training which approaches the concerns of the pregnant, laboring, and postpartum woman with a
comprehensive program of advanced massage techniques and specific pregnancy, labor, and
postpartum support measures.
Birth packages include massage sessions lasting sixty minutes and can be scheduled before or
after prenatal appointments or at other times during the week, including Saturdays and evenings.
It is best to avoid eating a large meal or drinking large amounts of water before the massage. The
room will be warm and quiet with soft music playing in the background. Tanya will use your
favorite aromatherapy and has many scents to choose from such as milk and honey, lavender and
citrus blends. You’ll lie comfortably, supported with pillows and draped with snuggly sheets.
Only the body part that is being worked will be exposed. Tanya will use long, smooth strokes,
knead and other slow movements focusing on the superficial layers of your muscles with luxurious
massage oils.
Is the massage therapy only for pregnant women?
Tanya is a certified massage therapist and provides massage therapy for everyone who wants to
improve their health, feel better and reduce stress and tension. She serves women and men, the
younger and the older, the healthy and those with chronic ailments such as diabetes, MS,
Fibromyalgia, arthritis and autoimmune disorders. Massage therapy is also wonderful for children
involved in competitive sports or with disorders such as ADD, ADHD and autism.
If you've never had a massage, don't put it off -- not for a minute. In our stress-worn world, a
therapeutic body massage might be just what you need! It makes a great anniversary or birthday
gift! Check out the calendar page for our monthly massage specials.
I read you only care for ‘low risk’ pregnancies. What is considered
'high risk'?
We only do births for women who are expected to have a good, normal outcome for both mother
and baby. By maintaining healthy lifestyles – eating right, exercising, avoiding harmful substances
such as drugs, alcohol, tobacco, artificial additives and pesticides - most of our clients remain low-
risk. Age and number of prior pregnancies are less important than your health status.
We cannot accept clients who conceived with IVF or have conditions such as diabetes, epilepsy,
HIV, hepatitis, heart disease requiring ongoing treatment or medications, placenta previa (the
placenta is over the cervix), or a medical problem with the baby (such as heart defect, etc) that
will require special care. Conditions occurring during pregnancy such as anemia, gestational
diabetes, pre-eclampsia or baby in a breech position (bottom or feet first) could also cause you to
‘risk-out’, although these conditions can often be prevented or even reversed with proper prenatal
care and/or nutrition. The focus of midwifery is to prevent problems from occurring, not just treat
problems as they occur. Very few of our clients have required complete transfer of care due to
risk factors. If you have a question about your “risk status”, please contact us.
Do you take women late in their pregnancy?
Yes, as long as they have had regular prenatal care, have taken good care of themselves during
the pregnancy, we feel they are good candidates for out-of-hospital birth and we have the
availability.
What about lab work and ultrasound?
We have lab privileges and can order any lab work or ultrasound that you may need. Blood will
be drawn by the midwife at the birth center or ordered for a lab near you. For women wanting
ultrasound, we utilize a mobile sonography company that comes to the birth center. You can opt
for as many or few interventions as you like as long as you understand the risks and benefits of
accepting or declining. Midwives are not anti-technology; we believe in the appropriate use of
technology and informed choice and consent.
Are there books or DVD’s you recommend for us?
There are so many great books but we highly recommend that you read Gentle Birth, Gentle
Mothering by Sarah Buckley, MD. This book covers the physiological processes and describes
best how we practice. Other great books to read are Gentle Birth Choices by Barbara Harper,
Ina May’s Guide to Childbirth by Ina May Gaskin, The Christian Childbirth Handbook by
Jennifer Vanderlaan, The Birth Book by Williams Sears, MD and The Thinking Woman’s Guide
to a Better Birth by Henci Goer. Great DVDs include the Business of Being Born, Orgasmic
Birth and Birth in America.
We have an extensive lending library with books, videos and DVDs covering many topics,
including pregnancy, labor and birth, nutrition, massage, breastfeeding, parenting, immunizations,
circumcision, herbs and books for children.
Do you offer childbirth classes?
Yes, we have several childbirth class options at the birth center including full Bradley Method®
Childbirth series and HypBirth® classes. Both classes are specifically geared for unmedicated
birth and are not just for APM clients.
The Bradley® series is designed for small classes with lots of individual attention. Classes are 10-
12 weeks; include lecture, Q&A, couple and group discussions, interactive learning activities and
labor rehearsals. Focus is on nutrition, exercise, labor and birth with instruction on massage and
other relaxation techniques and non-pharmacological pain management strategies for labor and
birth. Birth plans, baby care, breastfeeding and complications are also covered. A 130 page
Student Workbook with over 75 pictures and illustrations is included in classes.
The HypBirth® program utilizes a 90-minute training video and a series of CDs to help you learn
deep relaxation techniques similar to what is taught in Bradley®. You will learn how to eliminate
the stress hormones responsible for pain and how to elevate your body’s own natural pain
relievers. It’s a great class for couples who have already given birth before and want a refresher
or don’t have enough time for a full Bradley® class. HypBirth® focuses on daily relaxation that
creates the discipline needed to birth in less time and in less pain. If you’re suspicious of childbirth
hypnobirthing programs that promise "pain free" childbirth then HypBirth is perfect for you.
Do you allow birth plans?
Of course, but many of the things you’d have to special request and negotiate at the hospital are
routine with us. Our staff will take the time to help you understand your options and have you
complete a Birth Choice Worksheet where you can list the things that will make your birth special
and help us remember your wishes.
What is the APM Third Trimester class?
This is a free, one-time class geared for our clients in their last 2-3 months of pregnancy. It’s
meant to compliment your regular childbirth classes and covers things that are specific to our
practice. We’ll discuss the physiology of labor, the ‘birth hour’ and baby-led breastfeeding as
well as when to call and come in labor, water birth, early discharge & home care, what happens in
a transport and how to get the birth certificate. We expect all our clients who have not had a birth
with us before to attend one of these classes and if you’re planning on having a support person or
doula with you during your labor, they are welcome to attend as well. Classes are held once a
month on a Friday night or Saturday morning.
Do you do home births?
Yes, we offer birth in your home or ours. We provide a birth tub for your use and have you
purchase a birth kit with all the necessary birth supplies. We’ll bring our portable birth center
when we come to the birth. Homebirth is limited to two per month and within a certain radius.
I can’t find a doctor that does VBAC’s, do you?
We do offer midwifery care and birth services for women with one prior, low-transverse cesarean
section. It’s best if you have had a year between pregnancies and understand the risks and
benefits of VBAC versus the risk and benefits of repeat cesarean. Just to get you started: The
risk of uterine rupture after one “bikini cut” cesarean is 0.2% – 0.4% and the risk of infant death
or injury is 0.05%. (Landon 2004, Gonen 2006, Cahill 2006). Risk of miscarriage from an
amniocentesis is 5 – 20 times greater than the risk of infant death or injury from a VBAC. (March
of Dimes, Landon 2004). A repeat cesarean section lowers your risk of uterine rupture in your
current pregnancy, but it does not eliminate it. Additionally, the risk of complications increases
with each repeat c-section including your risk of uterine rupture in future pregnancies, whereas the
risk of rupture decreases by 50% after your first VBAC. (Mercer 2008) (excerpt from
VBACFacts.com)
Who can be at my birth?
You can share your birth with anyone that you choose. Some families choose to include their
older children, supportive grandparents, other family and close friends. Many hire a professional
labor doula to assist them. Others prefer a very quiet birth with only the father and the midwives.
It’s your birth!
How do you feel about children attending appointments and births?
As a mother, Lori encourages family-centered care. She adores children and relates to them
throughout your prenatal care so they are familiar with her by the time you have your baby. We
also have books and videos to help you prepare them to be at the birth if that’s your choice. It’s
our experience that even small children do wonderfully at births. Children do need to have a
familiar adult to supervise and care for them and should know that they can choose to leave if they
want to. You may not want to have small children come to the birth center until you are close to
birthing because labor can be, well, boring to young children!
How will I know when it’s time to come to the birth center in labor?
Before you ever go into labor we will help you to know when the right time to join together is.
During our Third Trimester class we’ll talk about when to call, when to come so you have a good
idea, and all labor instructions are in the APM book we give you on your first visit.
Throughout early labor we keep in phone contact, which gives us an idea of how your labor is
progressing. We evaluate each woman individually and take into consideration whether this is
your first baby or if you’ve given birth before, your distance to the birth center or if you’ve had a
prior cesarean. Most women typically arrive when they are in good, active labor and about 5-7
cm dilated. If you arrive and are found to be less than 4 cm, you may be encouraged to go home
and continuing laboring in your own environment because we know in most instances this would
be physiologically beneficial to your labor.
Can I eat during labor?
Yes, we encourage eating and drinking as your body is working hard and needs energy.
If you are planning a birth center birth you can bring your favorite snacks and meals or plan to
have someone bring your food. Our kitchen is fully equipped with dishes, pots, pans, cups and
silverware, fridge, stove and microwave. Waiting family can make themselves at home with a pot
of coffee or have fun cooking up a celebration meal.
How do you monitor the baby during labor?
We use a hand-held Doppler to listen to the baby’s heartbeat during labor. This is called
intermittent auscultation. Research shows that listening intermittently is equally as effective as
continuous electronic fetal monitoring (EFM) in identifying problems during labor and delivery. In
fact, studies show that intermittent auscultation results in lower rates of c-sections with the same
neonatal outcomes. Monitoring can occur with the mama in or out of the water.
Can my baby be born in the water?
Absolutely! The buoyancy, warmth and relaxation of the water are very helpful during labor.
Many women relaxing in the tub go on to give birth there. Mothers and babies love it.
Lori has advanced water birth training from Germany and is a certified water birth provider with
Waterbirth International. She has given lectures and seminars on birthing in water at midwifery
conferences, mother’s groups and chiropractic colleges. She is a waterbirth mama herself and in
September, 2009, she attended her 400th waterbirth!
Do you cut episiotomies?
Although we are trained to cut episiotomies, we rarely do so. Our current episiotomy rate is less
than 0.5%. Instead, we encourage gentle pushing as the baby is crowning and provide perineal
support using warm compresses and oils during birth. This eases the passage of the baby’s head,
thereby minimizing tears. If you do have a tear requiring sutures we will repair it using a local
anesthetic.
Will I be confined to a bed during labor?
Certainly not! Moving about during labor actually helps with your comfort level and improves the
labor process. We encourage you to move, change positions, or even to go outside for a breath
of fresh air. The birth center is peaceful and secluded so you can easily enjoy a stroll outdoors in
our beautiful gardens
How involved can the father be?
As involved as he wants to be. Most fathers cut the cord and join with the mother in announcing
the sex of the baby to everyone else at the birth. Some fathers even want to be in the tub during
the birth and help "catch" their babies. Others just want to be present. We support your choices.
Can I get pain medication or an epidural?
All medications increase the risks of complications for you and your baby; therefore, we believe
that pain medication is best received in the hospital setting. We don’t have narcotic drugs or
epidurals but we do have something that helps most moms not even think about needing pain
meds – the loving support of midwives, the freedom to labor at your pace as well as a
comfortable place that has become familiar during your pregnancy. Since research shows that
stress hormones increase pain and slow labor, we try to make things as low-stress and quiet as
possible for you. During labor we take our cues from both mommies and daddies as to what they
need. Some just need a hand to hold, eye contact and reassurance. Others need “Verbal
Anesthesia” - talking them through the contractions, reminding them to breathe, reassuring them
and praising their work. We also encourage mobility and frequent changes of position, rhythmic
and repetitive movements, making noise, aromatherapy and homeopathies. Of course, nothing
compares to an “Aqua-dural” (using deep water immersion). Sterile water papules injected in the
low back can help relieve severe back pain. When needed, we lavishly use coaching and support
for mother-to-be and her family so that labor, while challenging, is a good experience for all.
What position will I be in for the delivery?
There is no one perfect position in which to birth a baby. Some women prefer to sit or recline on
the bed, the birth stool or on the floor. Others stand up or squat down, kneel or lay on their side.
Many choose the birthing tub. We can also suggest positions which may help with comfort or
enhance delivery. Perineal support, counter pressure, warm compresses and oil can be used in
most positions.
What happens when the baby is born?
We place the baby where she belongs - on your tummy, where she makes her gentle transition
into the world, begins to breastfeed and integrates into your family. There is no rush to cut the
umbilical cord and we never separate the two of you. After you’ve had time to bond we will
examine you and do the newborn assessment. We make sure you have something to eat, assist
you with the bathroom and showering and monitor both of you.
What else do you do for the baby?
First, we keep babies with their mothers and give them plenty of time for bonding and
breastfeeding. We monitor the baby and then after you’ve had plenty of time for cuddling and
nursing we will do a newborn baby exam on the bed right next to you. The midwife will explain
what she is looking for and what she finds. There’s time for making cute foot prints and family
photos. Follow-up care on the baby, California Newborn Screening and further breastfeeding
assistance is done at your postpartum visits. Note: We do not give vaccines such as hep-B or
provide newborn hearing screening at the Birth Center.
How long do I stay at the Birth Center?
Women stay an average of four to five hours after the birth. After that, most moms are ready to
get home to their own beds. Before you leave the birth center, we show you how to monitor both
mom and baby. If you have a home birth the midwives typically stay 3-4 hours until both mama
and baby are stable.
Do you provide care after we leave?
Breastfeeding support and postpartum exams of the mother and baby through six weeks after
birth are part of the total package. Parents are encouraged to call if they have any questions or
concerns. We examine both mother and baby within 2-3 days and again at one week. An
additional postpartum visit is performed when the baby is about six weeks old. By this time the
midwife is practically a part of the family!
Why should I have a Postpartum Massage?
During postpartum massage, Tanya focuses on helping to restore the body to its pre-pregnancy
condition and to address the demands of breastfeeding and of course, the physical and emotional
stresses of carrying and caring for a newborn. Getting a massage in the weeks following birth
helps to speed recovery by restoring tone to the muscular and connective tissue, tones
overstretched areas of skin, realigns body weight to its original distribution, increases circulation
which assists in the removal of excess fluids, reduces swelling and nourishes the body. As with all
massage, postpartum massage eases muscle tension and stress. Sleep deprivation, hormonal
changes, and postpartum blues can all be reduced through postpartum massage.
All birth packages include one postpartum massage but you can arrange to have as many as you
like!
What happens if everything doesn’t go ‘perfectly’?
Although out-of-hospital birth is statistically safer, it does not guarantee a problem-free birth. That
being said, dangerous deviations from normal usually have early warning signs which permit time
to transport to the hospital. Our midwives are trained to detect and manage complications. We
have all the necessary medical equipment and supplies as well as alternatives such as herbs, that
may help mother and baby and allow them to safely stay at the birthing center. We’ve discreetly
tucked away all necessary equipment for infant resuscitation, oxygen, IV therapy as well as
medications to control excessive bleeding after delivery if needed. Should you have a tear that
requires suturing, we can do that, first numbing the area with a local anesthetic.
What if a transfer to the hospital becomes necessary?
If complications arise during labor or birth that are beyond the scope of care of the midwives,
mother and baby would be transported to the hospital. Most transports to the hospital are not
emergencies, but rather arise from long, slow labors and tired mothers. In these cases, the client,
support people and midwives travel by car to the hospital.
In the event of an emergency situation we call 911 and the transfer will occur by ambulance. The
local firemen and paramedics are familiar with what we do and they provide fast and professional
emergency services if it’s ever needed. We make every effort to accompany you to the hospital
and stay with you until you are admitted and settled in.
If I have insurance, can we bill for your services?
We are not contracted with any third-party payers at this time. This means that you pay the
package fees and your insurer will reimburse you. We contract with Larsen Billing Service LLC
so only families with insurance pay for this service. Stacey, our representative, can help you
determine your benefits and after the birth will provide the coding and electronic claims processing
to your insurer. Most PPO insurance will pay some or the entire fee at the out-of-network rates
and we’ve had a few instances of them paying the in-network rate (due to a network gap).
Although your policy may cover midwifery care, many insurance companies do not pay the total
fee for services, in spite of what they claim to do. Larsen Billing Service, LLC will work hard to
help you get the maximum reimbursement from your insurance company.
Do you accept MediCal?
No, we are not MediCal providers.
How do I get started?
Give us a call or e-mail and come to our Meet the Midwife and tour. We’ll help you from there!
Through the time spent during prenatal visits, you will become familiar with both the midwifery
staff and the facility, which feels more like a nice bed & breakfast than a hospital. The people you
see during your prenatal appointments are the people who will be at your birth. All our practices,
including privacy, quiet, low-lighting and minimal interventions, are geared to promote the
physiological processes of birth. You won’t have to fight to get the things you want or worry that
we’ll do things you don’t want. No hassles--just loving support of the midwives to guide you
through the process.
Is an out-of-hospital birth safe?
The health of the mother, comprehensive prenatal visits, risk screening, referral and/or transfer to
the hospital when appropriate, continuous support and care during labor and birth is what makes
birthing with APM safe. Out-of-hospital birth (at the birth center or in your own home) is as safe
as, or safer than, a hospital birth for the majority of women. Multiple studies show 85%-90% of
out-of-hospital births occur without complications as well as having fewer interventions and
cesarean sections and more satisfying experiences.
You can print out the following handout from Citizens Midwifery to share with your family and
friends: http://www.cfmidwifery.org/pdf/safety.pdf
Why should I choose Ancient Paths Midwifery?
Because there are no do-overs in birth! You’ll always remember the sound of that first cry as
your baby is born. You will cherish the first time you felt the tiny hand grasp your finger and the
first time you nuzzled your baby’s velvety head and looked into her eyes. The birth of your child is
an experience unlike any other and shouldn’t be rushed or unnecessarily clinical. At APM, we
value the human aspect of birth and know that you don’t have to sacrifice the special moments or
safety to have the birth of your dreams!
What is your cesarean section rate?
Our cesarean section rate is very low, ranging from 4-8%. Most birth centers have c-section
rates less than 12% and the national hospital average is 30%. At some of the local hospitals it is
as high as 45%.
Why do you have such good outcomes?
First of all, we don’t care for high-risk women or babies and we are not providing services that
increase your risk (induction, continuous fetal monitoring, pain meds, etc). Holistic care begins
with your first visit and continues throughout with one-on-one care, education, and complimentary
services such as massage therapy, OMM (Osteopathic Manipulative Medicine) and chiropractic.
Our focus is on prevention of problems; we catch the little things before they become big things.
Birth, breastfeeding and recovery are all better when the woman is prepared, well-nurtured, calm,
confident and well-supported!
How do I know if I’m a good candidate for an out-of-hospital birth?
The majority of women are good candidates for out-of-hospital birth. A healthy lifestyle, including
diet and exercise, are important, but so is having a positive outlook about the birthing process and
a willingness to reduce stress in your life. Ask yourself these questions about your beliefs about
the human body and the process of birth, and if you answer yes to a few of these, you owe it to
yourself and your baby to visit us!
- Are you a healthy person?
- Do you want a low-interventive, natural birth?
- Are you educated about your body and birth?
- Do you want to make decisions about your birth?
- Are you comfortable having control of decisions if you have a knowledgeable supportive
professional to help educate you? - Can you trust yourself to make the best decision for you and your baby if you are given
enough information?
What is Meet the Midwife?
Meet the Midwife is a time where you are invited to come tour the birth center, meet the midwife
and learn about your birthing options. This is an excellent opportunity for you to get a feeling of
how our personalities and philosophies blend together, pick your birthing suite and find out how to
get started with your care. We won’t give you hardcore sales pitches or pressure you to
immediately sign up! See the calendar for the next gathering. Please be sure to let us know if you
are coming. We’ll need your due date and a phone number we could reach you at in the event
we have a baby on the way and need to reschedule.
What are LM and CPM after the midwife’s name?
LM stands for Licensed Midwife and CPM is Certified Professional Midwife. Lori Luyten is both
a California Licensed Midwife (LM) and nationally Certified Professional Midwife (CPM). She
has been extensively trained in academics and hands-on training. The North American Registry of
Midwives (NARM) is the national organization that registers midwives and Lori has met the strict
standards set by NARM.
How soon should I begin my care?
Most women schedule a first appointment between the 8th and 10th week of pregnancy. Statistics
show that women who start early prenatal care have fewer complications and better outcomes.
We can also hopefully help you get a grip on morning sickness. If you want to hear the baby’s
heartbeat on that first visit, then we’ll schedule the visit during your 12th week.
I’ve already been seeing another practitioner; can I still come to the
birth center?
Absolutely! We will help you make an easy transition. All you need to do to transfer your care is
make an appointment with us and then get a copy of your medical records from your previous
provider by completing a Medical Records Release form. It’s that simple.
If I’m seeing a midwife, do I also need to see a doctor?
We provide complete prenatal care as long as you remain low risk. If a situation requiring medical
attention arises, we will refer you to one of several qualified physicians or you may visit a doctor
of your choice. Most of our clients like to schedule one or two visits with our consulting OB to
establish a relationship. This way, in the event of transport you have an OB to accept you into
care.
Why do your packages all include massage therapy?
We take a holistic approach and have found that massage therapy is a wonderful compliment to
midwifery care. During pregnancy, a woman's body undergoes many changes, some of them
stressful and uncomfortable. Massage is a perfect way to reduce stress and promote general well-
being. You’ll be amazed how much better you’ll feel after an hour with Tanya!
While pregnancy massage has all the same benefits as ‘regular’ massage, it is tailored to address
more specifically the conditions and issues pregnant women experience. Tanya will spend more
time on methods that relieve low back and hip pain, nausea and heartburn, swelling and
constipation. A study published in the Touch Research Institute’s Journal of Psychosomatic
Obstetrics & Gynecology, showed that women who received regular massage had decreased
anxiety and stress hormones, better sleep and less back pain. They also had shorter labors and
fewer complications including premature birth, high blood pressure and postpartum depression.
So, in addition to making you a happier and more comfortable mama, pregnancy massage is good
for you and your baby’s health!
Other Benefits of Pregnancy Massage:
- Swelling in hands, feet and ankles is reduced
- Pain relief including sciatica and headaches
- Eases muscular tension and discomforts
- Flexibility increased
- Improved and deeper sleep
- Increases blood and lymph flow which can help increase the elimination of toxins through
the circulatory and lymphatic systems - Immune system strengthened
- Glandular secretions stimulated, which helps stabilize hormone levels
- Stimulates the release of endorphins, the body's natural pain killers, into the brain and
nervous system. - Less anxiety, stress and depression
- Increases blood circulation, which in turn delivers more oxygen and nutrients to the mother
and baby - Relaxed mothers have happier, healthier pregnancies and easier childbirth
What can I expect during a pregnancy massage?
Our massage therapist, Tanya Sissoyev is a licensed massage therapist with over a thousand hours
of massage training. She completed Kate Jordan’s Bodywork for the Childbearing Year®
training which approaches the concerns of the pregnant, laboring, and postpartum woman with a
comprehensive program of advanced massage techniques and specific pregnancy, labor, and
postpartum support measures.
Birth packages include massage sessions lasting sixty minutes and can be scheduled before or
after prenatal appointments or at other times during the week, including Saturdays and evenings.
It is best to avoid eating a large meal or drinking large amounts of water before the massage. The
room will be warm and quiet with soft music playing in the background. Tanya will use your
favorite aromatherapy and has many scents to choose from such as milk and honey, lavender and
citrus blends. You’ll lie comfortably, supported with pillows and draped with snuggly sheets.
Only the body part that is being worked will be exposed. Tanya will use long, smooth strokes,
knead and other slow movements focusing on the superficial layers of your muscles with luxurious
massage oils.
Is the massage therapy only for pregnant women?
Tanya is a certified massage therapist and provides massage therapy for everyone who wants to
improve their health, feel better and reduce stress and tension. She serves women and men, the
younger and the older, the healthy and those with chronic ailments such as diabetes, MS,
Fibromyalgia, arthritis and autoimmune disorders. Massage therapy is also wonderful for children
involved in competitive sports or with disorders such as ADD, ADHD and autism.
If you've never had a massage, don't put it off -- not for a minute. In our stress-worn world, a
therapeutic body massage might be just what you need! It makes a great anniversary or birthday
gift! Check out the calendar page for our monthly massage specials.
I read you only care for ‘low risk’ pregnancies. What is considered
'high risk'?
We only do births for women who are expected to have a good, normal outcome for both mother
and baby. By maintaining healthy lifestyles – eating right, exercising, avoiding harmful substances
such as drugs, alcohol, tobacco, artificial additives and pesticides - most of our clients remain low-
risk. Age and number of prior pregnancies are less important than your health status.
We cannot accept clients who conceived with IVF or have conditions such as diabetes, epilepsy,
HIV, hepatitis, heart disease requiring ongoing treatment or medications, placenta previa (the
placenta is over the cervix), or a medical problem with the baby (such as heart defect, etc) that
will require special care. Conditions occurring during pregnancy such as anemia, gestational
diabetes, pre-eclampsia or baby in a breech position (bottom or feet first) could also cause you to
‘risk-out’, although these conditions can often be prevented or even reversed with proper prenatal
care and/or nutrition. The focus of midwifery is to prevent problems from occurring, not just treat
problems as they occur. Very few of our clients have required complete transfer of care due to
risk factors. If you have a question about your “risk status”, please contact us.
Do you take women late in their pregnancy?
Yes, as long as they have had regular prenatal care, have taken good care of themselves during
the pregnancy, we feel they are good candidates for out-of-hospital birth and we have the
availability.
What about lab work and ultrasound?
We have lab privileges and can order any lab work or ultrasound that you may need. Blood will
be drawn by the midwife at the birth center or ordered for a lab near you. For women wanting
ultrasound, we utilize a mobile sonography company that comes to the birth center. You can opt
for as many or few interventions as you like as long as you understand the risks and benefits of
accepting or declining. Midwives are not anti-technology; we believe in the appropriate use of
technology and informed choice and consent.
Are there books or DVD’s you recommend for us?
There are so many great books but we highly recommend that you read Gentle Birth, Gentle
Mothering by Sarah Buckley, MD. This book covers the physiological processes and describes
best how we practice. Other great books to read are Gentle Birth Choices by Barbara Harper,
Ina May’s Guide to Childbirth by Ina May Gaskin, The Christian Childbirth Handbook by
Jennifer Vanderlaan, The Birth Book by Williams Sears, MD and The Thinking Woman’s Guide
to a Better Birth by Henci Goer. Great DVDs include the Business of Being Born, Orgasmic
Birth and Birth in America.
We have an extensive lending library with books, videos and DVDs covering many topics,
including pregnancy, labor and birth, nutrition, massage, breastfeeding, parenting, immunizations,
circumcision, herbs and books for children.
Do you offer childbirth classes?
Yes, we have several childbirth class options at the birth center including full Bradley Method®
Childbirth series and HypBirth® classes. Both classes are specifically geared for unmedicated
birth and are not just for APM clients.
The Bradley® series is designed for small classes with lots of individual attention. Classes are 10-
12 weeks; include lecture, Q&A, couple and group discussions, interactive learning activities and
labor rehearsals. Focus is on nutrition, exercise, labor and birth with instruction on massage and
other relaxation techniques and non-pharmacological pain management strategies for labor and
birth. Birth plans, baby care, breastfeeding and complications are also covered. A 130 page
Student Workbook with over 75 pictures and illustrations is included in classes.
The HypBirth® program utilizes a 90-minute training video and a series of CDs to help you learn
deep relaxation techniques similar to what is taught in Bradley®. You will learn how to eliminate
the stress hormones responsible for pain and how to elevate your body’s own natural pain
relievers. It’s a great class for couples who have already given birth before and want a refresher
or don’t have enough time for a full Bradley® class. HypBirth® focuses on daily relaxation that
creates the discipline needed to birth in less time and in less pain. If you’re suspicious of childbirth
hypnobirthing programs that promise "pain free" childbirth then HypBirth is perfect for you.
Do you allow birth plans?
Of course, but many of the things you’d have to special request and negotiate at the hospital are
routine with us. Our staff will take the time to help you understand your options and have you
complete a Birth Choice Worksheet where you can list the things that will make your birth special
and help us remember your wishes.
What is the APM Third Trimester class?
This is a free, one-time class geared for our clients in their last 2-3 months of pregnancy. It’s
meant to compliment your regular childbirth classes and covers things that are specific to our
practice. We’ll discuss the physiology of labor, the ‘birth hour’ and baby-led breastfeeding as
well as when to call and come in labor, water birth, early discharge & home care, what happens in
a transport and how to get the birth certificate. We expect all our clients who have not had a birth
with us before to attend one of these classes and if you’re planning on having a support person or
doula with you during your labor, they are welcome to attend as well. Classes are held once a
month on a Friday night or Saturday morning.
Do you do home births?
Yes, we offer birth in your home or ours. We provide a birth tub for your use and have you
purchase a birth kit with all the necessary birth supplies. We’ll bring our portable birth center
when we come to the birth. Homebirth is limited to two per month and within a certain radius.
I can’t find a doctor that does VBAC’s, do you?
We do offer midwifery care and birth services for women with one prior, low-transverse cesarean
section. It’s best if you have had a year between pregnancies and understand the risks and
benefits of VBAC versus the risk and benefits of repeat cesarean. Just to get you started: The
risk of uterine rupture after one “bikini cut” cesarean is 0.2% – 0.4% and the risk of infant death
or injury is 0.05%. (Landon 2004, Gonen 2006, Cahill 2006). Risk of miscarriage from an
amniocentesis is 5 – 20 times greater than the risk of infant death or injury from a VBAC. (March
of Dimes, Landon 2004). A repeat cesarean section lowers your risk of uterine rupture in your
current pregnancy, but it does not eliminate it. Additionally, the risk of complications increases
with each repeat c-section including your risk of uterine rupture in future pregnancies, whereas the
risk of rupture decreases by 50% after your first VBAC. (Mercer 2008) (excerpt from
VBACFacts.com)
Who can be at my birth?
You can share your birth with anyone that you choose. Some families choose to include their
older children, supportive grandparents, other family and close friends. Many hire a professional
labor doula to assist them. Others prefer a very quiet birth with only the father and the midwives.
It’s your birth!
How do you feel about children attending appointments and births?
As a mother, Lori encourages family-centered care. She adores children and relates to them
throughout your prenatal care so they are familiar with her by the time you have your baby. We
also have books and videos to help you prepare them to be at the birth if that’s your choice. It’s
our experience that even small children do wonderfully at births. Children do need to have a
familiar adult to supervise and care for them and should know that they can choose to leave if they
want to. You may not want to have small children come to the birth center until you are close to
birthing because labor can be, well, boring to young children!
How will I know when it’s time to come to the birth center in labor?
Before you ever go into labor we will help you to know when the right time to join together is.
During our Third Trimester class we’ll talk about when to call, when to come so you have a good
idea, and all labor instructions are in the APM book we give you on your first visit.
Throughout early labor we keep in phone contact, which gives us an idea of how your labor is
progressing. We evaluate each woman individually and take into consideration whether this is
your first baby or if you’ve given birth before, your distance to the birth center or if you’ve had a
prior cesarean. Most women typically arrive when they are in good, active labor and about 5-7
cm dilated. If you arrive and are found to be less than 4 cm, you may be encouraged to go home
and continuing laboring in your own environment because we know in most instances this would
be physiologically beneficial to your labor.
Can I eat during labor?
Yes, we encourage eating and drinking as your body is working hard and needs energy.
If you are planning a birth center birth you can bring your favorite snacks and meals or plan to
have someone bring your food. Our kitchen is fully equipped with dishes, pots, pans, cups and
silverware, fridge, stove and microwave. Waiting family can make themselves at home with a pot
of coffee or have fun cooking up a celebration meal.
How do you monitor the baby during labor?
We use a hand-held Doppler to listen to the baby’s heartbeat during labor. This is called
intermittent auscultation. Research shows that listening intermittently is equally as effective as
continuous electronic fetal monitoring (EFM) in identifying problems during labor and delivery. In
fact, studies show that intermittent auscultation results in lower rates of c-sections with the same
neonatal outcomes. Monitoring can occur with the mama in or out of the water.
Can my baby be born in the water?
Absolutely! The buoyancy, warmth and relaxation of the water are very helpful during labor.
Many women relaxing in the tub go on to give birth there. Mothers and babies love it.
Lori has advanced water birth training from Germany and is a certified water birth provider with
Waterbirth International. She has given lectures and seminars on birthing in water at midwifery
conferences, mother’s groups and chiropractic colleges. She is a waterbirth mama herself and in
September, 2009, she attended her 400th waterbirth!
Do you cut episiotomies?
Although we are trained to cut episiotomies, we rarely do so. Our current episiotomy rate is less
than 0.5%. Instead, we encourage gentle pushing as the baby is crowning and provide perineal
support using warm compresses and oils during birth. This eases the passage of the baby’s head,
thereby minimizing tears. If you do have a tear requiring sutures we will repair it using a local
anesthetic.
Will I be confined to a bed during labor?
Certainly not! Moving about during labor actually helps with your comfort level and improves the
labor process. We encourage you to move, change positions, or even to go outside for a breath
of fresh air. The birth center is peaceful and secluded so you can easily enjoy a stroll outdoors in
our beautiful gardens
How involved can the father be?
As involved as he wants to be. Most fathers cut the cord and join with the mother in announcing
the sex of the baby to everyone else at the birth. Some fathers even want to be in the tub during
the birth and help "catch" their babies. Others just want to be present. We support your choices.
Can I get pain medication or an epidural?
All medications increase the risks of complications for you and your baby; therefore, we believe
that pain medication is best received in the hospital setting. We don’t have narcotic drugs or
epidurals but we do have something that helps most moms not even think about needing pain
meds – the loving support of midwives, the freedom to labor at your pace as well as a
comfortable place that has become familiar during your pregnancy. Since research shows that
stress hormones increase pain and slow labor, we try to make things as low-stress and quiet as
possible for you. During labor we take our cues from both mommies and daddies as to what they
need. Some just need a hand to hold, eye contact and reassurance. Others need “Verbal
Anesthesia” - talking them through the contractions, reminding them to breathe, reassuring them
and praising their work. We also encourage mobility and frequent changes of position, rhythmic
and repetitive movements, making noise, aromatherapy and homeopathies. Of course, nothing
compares to an “Aqua-dural” (using deep water immersion). Sterile water papules injected in the
low back can help relieve severe back pain. When needed, we lavishly use coaching and support
for mother-to-be and her family so that labor, while challenging, is a good experience for all.
What position will I be in for the delivery?
There is no one perfect position in which to birth a baby. Some women prefer to sit or recline on
the bed, the birth stool or on the floor. Others stand up or squat down, kneel or lay on their side.
Many choose the birthing tub. We can also suggest positions which may help with comfort or
enhance delivery. Perineal support, counter pressure, warm compresses and oil can be used in
most positions.
What happens when the baby is born?
We place the baby where she belongs - on your tummy, where she makes her gentle transition
into the world, begins to breastfeed and integrates into your family. There is no rush to cut the
umbilical cord and we never separate the two of you. After you’ve had time to bond we will
examine you and do the newborn assessment. We make sure you have something to eat, assist
you with the bathroom and showering and monitor both of you.
What else do you do for the baby?
First, we keep babies with their mothers and give them plenty of time for bonding and
breastfeeding. We monitor the baby and then after you’ve had plenty of time for cuddling and
nursing we will do a newborn baby exam on the bed right next to you. The midwife will explain
what she is looking for and what she finds. There’s time for making cute foot prints and family
photos. Follow-up care on the baby, California Newborn Screening and further breastfeeding
assistance is done at your postpartum visits. Note: We do not give vaccines such as hep-B or
provide newborn hearing screening at the Birth Center.
How long do I stay at the Birth Center?
Women stay an average of four to five hours after the birth. After that, most moms are ready to
get home to their own beds. Before you leave the birth center, we show you how to monitor both
mom and baby. If you have a home birth the midwives typically stay 3-4 hours until both mama
and baby are stable.
Do you provide care after we leave?
Breastfeeding support and postpartum exams of the mother and baby through six weeks after
birth are part of the total package. Parents are encouraged to call if they have any questions or
concerns. We examine both mother and baby within 2-3 days and again at one week. An
additional postpartum visit is performed when the baby is about six weeks old. By this time the
midwife is practically a part of the family!
Why should I have a Postpartum Massage?
During postpartum massage, Tanya focuses on helping to restore the body to its pre-pregnancy
condition and to address the demands of breastfeeding and of course, the physical and emotional
stresses of carrying and caring for a newborn. Getting a massage in the weeks following birth
helps to speed recovery by restoring tone to the muscular and connective tissue, tones
overstretched areas of skin, realigns body weight to its original distribution, increases circulation
which assists in the removal of excess fluids, reduces swelling and nourishes the body. As with all
massage, postpartum massage eases muscle tension and stress. Sleep deprivation, hormonal
changes, and postpartum blues can all be reduced through postpartum massage.
All birth packages include one postpartum massage but you can arrange to have as many as you
like!
What happens if everything doesn’t go ‘perfectly’?
Although out-of-hospital birth is statistically safer, it does not guarantee a problem-free birth. That
being said, dangerous deviations from normal usually have early warning signs which permit time
to transport to the hospital. Our midwives are trained to detect and manage complications. We
have all the necessary medical equipment and supplies as well as alternatives such as herbs, that
may help mother and baby and allow them to safely stay at the birthing center. We’ve discreetly
tucked away all necessary equipment for infant resuscitation, oxygen, IV therapy as well as
medications to control excessive bleeding after delivery if needed. Should you have a tear that
requires suturing, we can do that, first numbing the area with a local anesthetic.
What if a transfer to the hospital becomes necessary?
If complications arise during labor or birth that are beyond the scope of care of the midwives,
mother and baby would be transported to the hospital. Most transports to the hospital are not
emergencies, but rather arise from long, slow labors and tired mothers. In these cases, the client,
support people and midwives travel by car to the hospital.
In the event of an emergency situation we call 911 and the transfer will occur by ambulance. The
local firemen and paramedics are familiar with what we do and they provide fast and professional
emergency services if it’s ever needed. We make every effort to accompany you to the hospital
and stay with you until you are admitted and settled in.
If I have insurance, can we bill for your services?
We are not contracted with any third-party payers at this time. This means that you pay the
package fees and your insurer will reimburse you. We contract with Larsen Billing Service LLC
so only families with insurance pay for this service. Stacey, our representative, can help you
determine your benefits and after the birth will provide the coding and electronic claims processing
to your insurer. Most PPO insurance will pay some or the entire fee at the out-of-network rates
and we’ve had a few instances of them paying the in-network rate (due to a network gap).
Although your policy may cover midwifery care, many insurance companies do not pay the total
fee for services, in spite of what they claim to do. Larsen Billing Service, LLC will work hard to
help you get the maximum reimbursement from your insurance company.
Do you accept MediCal?
No, we are not MediCal providers.
How do I get started?
Give us a call or e-mail and come to our Meet the Midwife and tour. We’ll help you from there!