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A Guide on Postpartum Thyroiditis for New Moms

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Women go through a lot of changes after pregnancy. Some are physical, some are emotional and others cognitive. These changes can be attributed to the pregnancy itself or postpartum depression, which is very common for women in this time period. However, what if these symptoms are actually signs of something more serious like Postpartum Thyroiditis?

Postpartum Thyroiditis is a condition that primarily affects women and it has many symptoms that overlap with pregnancy-related issues such as fatigue, weight loss struggles, hair loss, anxiety, and trouble sleeping. This article will explore all you need to know when you’re expecting.

Know the Symptoms of Postpartum Thyroiditis

It is extremely common for women, especially new mothers, to experience postpartum depression following the birth of their baby. Some of the symptoms are mood swings, withdrawal, loss of appetite, insomnia, and fatigue. Oftentimes, mothers feel extremely depressed as a result of the excess weight they may have gained during their pregnancy.

On the other hand, these symptoms are very similar to what one may feel if one is experiencing postpartum thyroiditis. Some of the common symptoms of both postpartum depression and signs of postpartum thyroiditis are; weight gain, depression, lethargy, muscle weakness, and trouble sleeping. Although it is uncommon for many women to develop postpartum thyroiditis, it can happen and be missed. Due to the similarities in symptoms, many women can have the misconception that they are only experiencing postpartum depression when something much more severe is occurring.

Can It be Detected

Postpartum thyroiditis is a condition that impacts postpartum women. This can occur after the birth of your child and most commonly arises in the first trimester or early second trimester. If you test positive with this antibody during early pregnancy, there is a 40% to 60% higher risk of developing postpartum thyroiditis. Thus, more reason to get checked by your healthcare provider early on.

Types of Postpartum Thyroiditis

It is important for mothers to be aware that they may be experiencing one of the two types of thyroiditis. These being:

  • Hyperthyroidism
  • Hypothyroidism

Knowing and being aware of symptoms of both types is important to be aware of during your term. Although it is easy to miss diagnose these symptoms as something less severe, it is important to report all of them to your healthcare provider.

Hyperthyroidism

This type of postpartum thyroiditis refers to an overactive thyroid. This means the thyroid gland is producing too much thyroid hormone. Thus,  causing the body’s metabolism to speed up, in turn, speeding up other parts of the body.

The symptoms of hyperthyroidism include:

  • Nervousness/ anxiety
  • Spead up heartbeat/ palpitations
  • Weight loss
  • excessive sweating/ heat flashes
  • Increased appetite
  • Insomnia
  • Fatigue
  • Frequent or loose stools

Hypothyroidism

Exactly opposite of hyperthyroidism, hypothyroidism is when the gland is deficient in thyroid hormones. When an expecting mother has this type of postpartum thyroiditis, the body functions a lot slower.

The symptoms of hypothyroidism include:

  • Depression
  • Extreme fatigue
  • Decreased milk volume
  • Muscle weakness
  • Constimaption
  • Dry or brittle hair/ nails
  • Hair loss
  • High cholesterol
  • Always cold
  • Weight gain

When mothers experience either type of postpartum thyroiditis it can feel as if they aren’t able to fully enjoy their new baby. The symptoms are hard to overcome making everything feel stagnant.

Prevention

One form of therapy that has worked to help prevent postpartum thyroiditis in women who have high antibodies during pregnancy is giving selenium. Selenium is an essential trace mineral that helps to support many bodily processes. When taken during pregnancy, selenium acts as an anti-inflammatory, helping to reduce the chances of developing postpartum thyroiditis. 

Other helpful prevention ideas can include changing your diet to a more anti-inflammatory diet. Reducing or stopping gluten intake can help reduce inflammation. Choosing BPA-free, phthalate-free, and paraben-free also helps avoid toxins that can be a factor in causing thyroid issues.

More Questions?

If you are looking for more information about thyroid issues and the threats of postpartum thyroiditis, talk to your healthcare provider or give us a call at Midwife360. We are a holistic evidence-based practice for women’s care, family planning, pregnancy care, and birthing throughout South Florida. Our practice is designed to meet the individual needs of each woman and family we care for. We believe women should be informed and educated about their healthcare options and empowered to make their own choices.

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Medicinal Herbs for a Safe Holistic Pregnancy

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The midwives at MidWife360 in West Palm Beach, Florida have gathered our collective knowledge and experience in order to provide you with an introduction to using herbs during pregnancy.

Initial Thoughts on Modern Medicine

As a certified nurse midwife, I’m forever grateful for the medical advancements in obstetric gynecology. Thanks to these technologies, the outcomes of high-risk pregnancies and complications in birth and pregnancy have vastly improved. This has saved countless lives. 

There are two sides to every coin, and unfortunately some of these advancements have been, and are continuing to be overused. For example, about 1 in 3 women in the United States gives birth via cesarean delivery. Many experts agree that this is far too high.

Furthermore, the use of pharmaceutical medications for pregnant women is also excessive, and carries risks like cesarean deliver. Many medications that were thought to be safe, like Tylenol and common yeast infection medications, have been found to carry significant risks. 

Are Herbs Safe?

In comparison, the usage of herbs during pregnancy appears mild and safe. Just like anything, it’s important to be extra informed and safe when using any herbs or medications during pregnancy. The desire toward more natural and holistic solutions has been growing. At MidWife360 we aim to incorporate more gentle and herbal solutions whenever necessary. 

Using herbs for common pregnancy symptoms and discomforts is very commonplace. Using herbs for medicinal purposes dates back to the ancient Egyptians.  In all fairness, scientific research and formal evaluations of many herbs are not available or priority. 

However, pharmaceutical medications are often in the same boat. In the U.S. almost 90% of all pregnant women will be prescribed some kind of medication during their pregnancy. 

As far as herbal and botanical medicine, most of what we know is based on historical, empirical, and observational evidence. There have been some formal and animal studies. Generally, most herbs have no evidence of harm and natural remedies may be safer than typical prescription medications. 

Adverse effects are few and far between, and when they do happen it is often because the individual is uninformed. Some herbs can be toxic or are only appropriate in small doses. Keep in mind, many experts have different opinions on the use of herbs. Just because something does not have proven adverse effects, does not mean it is proven to be safe. 

Some symptoms or illnesses should always call for prompt medical care, and should not be treated at home with herbs. They are as follows:

  • Continuous bleeding
  • Initial herpes blisters or outbreak 
  • Serious pelvic or abdominal pain
  • Continuous serious mid-back pain
  • Hand and face edema
  • Membranes rupture before 37 weeks
  • Regular contractions before 37 weeks
  • Serious headaches, blurred vision, and epigastric pain
  • Fetal movement stopping

Commonly Used Herbs in Pregnancy

There are different lists and opinions among medical professionals. Some of the most common herbs used for pregnancy concerns are: raspberry leaf, evening primrose, garlic, aloe, chamomile, peppermint, ginger, echinacea, St. John’s wort, fennel, wild yam, meadowsweet, pumpkin seeds and ginseng. 

Common ailments pregnant women seek complimentary or natural remedies for are anxiety, nausea or vomiting, urinary tract problems, or lower GI problems. 

This chart is a helpful tool but always work with your doctor or midwife to be safe. The midwives at MidWife360 are well-versed in the safety and use of herbal remedies. 

Herbs for Birth Preparation

Red raspberry leaf tea and red dates are common for birth preparation. Two cups of red raspberry tea daily is safe in pregnancy. 

Additionally, studies have shown the tea causes labor to be more comfortable and reduces need for medical interventions. There are even benefits for babies! Newborns are less likely to require resuscitation. 

Red dates consumed regularly in the last trimester are safe, and also cause labor to be more comfortable. 

The good news is, both the tea and dates are delicious. Making it easy to incorporate into your daily diet and routine. This vegan red raspberry tea latte is a great way to enjoy the tea. Snacking on dates by themselves or adding a few in a smoothie is an easy way to eat them. 

Final Thoughts

Herbal remedies can offer significant relief and benefits for some common discomforts and symptoms of pregnancy and childbirth. Just like anything during pregnancy, use herbs with caution and under the supervision of your midwife or doctor. 

At MidWife360 in West Palm Beach, Florida we offer herbal recommendations for our patients when needed. Though nothing can replace a healthy diet, exercise, positive mindset, and support system. 

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A Complete Guide to Miscarriage at Home

miscarriage_at_home

Is Miscarriage Normal?

Pregnancy and miscarriage carry a ton of emotions, and one may feel devastated or uneasy when going through a natural miscarriage. Although this is can be an extremely tough time mentally and physically, it may be comforting to know you’re not alone. 

An estimated 10%-20% of women who know they are pregnant will have a miscarriage. Also, most women (87%) who do experience a miscarriage will have a successful pregnancy and birth following that miscarriage. 

Maybe your pregnancy test was positive after missing your period, or some women have that gut feeling without having missed a period yet. Feeling excited, scared, happy, nervous, or just numb are all in the normal range of emotions when you first discover a pregnancy. Or maybe you’ve been trying for months to get pregnant and now you finally are. 

Just when you feel like you are beginning to get comfortable with your pregnancy, you start to have some spotting, maybe a little red bleeding, and then some light cramping. 

Next Steps

Contacting your health care provider and making them aware of what is going on is important. They may offer to have an ultrasound or blood work done. The bleeding becomes heavier and the cramping gets stronger and you no longer have the pregnancy symptoms you were starting to feel prior. Unfortunately, you are most likely experiencing a miscarriage. 

If your body is already starting to bleed and cramp, this is a sign your body is getting ready to expel the products of conception. Sometimes there’s not an actual fetus present. This means it could be a chemical pregnancy with no fetus, just a gestational sac. 

If there are no complications, you can safely miscarry at home. You may want to have some ibuprofen on hand and a hot water bottle. Soaking in a warm bath can also be very soothing. The worst of it can take about 2 hours with some pretty intense cramping and heavy bleeding. 

When to Seek Help

You would need to seek out medical care if you have pain that you cannot tolerate, or if you begin to hemorrhage. The definition of a hemorrhage is, soaking a maxi pad to where you can wring it out, and doing this for 2 hours. Of course, if the bleeding is much heavier than that or you feel unsafe, don’t wait to get medical help. 

Missed Miscarriage

A ‘missed miscarriage’ is where the fetus stops growing but there’s no signs of bleeding or cramping right away. It’s usually during the first ultrasound that this will be diagnosed. Or if you were following the beta HCG hormone, and it isn’t doubling or rising appropriately in the first 10 weeks, a miscarriage can be diagnosed this way, as well. 

If you do have a missed miscarriage, do not wait before seeing your provider for an intervention. It is dangerous for the pregnancy to sit in your womb for months, as it can cause some dangerous bleeding when the natural miscarriage begins. You will most likely be given several options, depending on the preference of the provider. It is always best to be informed ahead of time, in case your provider does not offer all the common or available options. 

Intervention Options for Missed Miscarriage

  • D&C or Dilation and Curettage

A D&C is a fairly common procedure to eliminate uterine lining and pregnancy contents. This procedure is very safe and complications are rare. Light spotting and cramping is common in the first few days after a D&C. 

  • Medications

Medications like Misoprostol are also an option, which cause your uterus to cramp. This process usually takes about 24 hours to complete. This option is also very safe and complications are rare.  

Miscarriage is Common

Miscarriage is very common, you would have to have 3 in a row before it is considered a medical problem. An option is to see a Maternal Fetal Medicine doctor to have a consult regarding any specific blood tests needed to determine if you have a genetic predisposition to miscarriage. These may include: Anticardiolipin, TSH, Lupus anticoagulant, beta 2 glycoprotein, and maternal karyotype. 

Some providers will recommend taking a baby aspirin every day to reduce the risk of miscarriage. And sometimes they may recommend taking progesterone to help you maintain the pregnancy. These all depend on the results of the blood tests and the actual medical diagnosis that is causing the miscarriages.

Next Cycle and/or Pregnancy After Miscarriage 

You can have your beta HCG levels checked, or simply wait for your next cycle. You should have a period by 4-6 weeks after the miscarriage. If you don’t have your cycle within 4-6 weeks, contact your care provider for further testing or ultrasounds. It is recommended to actively prevent pregnancy for 2 cycles following a miscarriage to lower your risk of having another miscarriage right away.

Holistic Gynecology and Pregnancy Services

If you are looking for holistic gynecology and pregnancy services, including home birth and water birth in South Florida, contact Midwife 360 for all of your questions and needs.

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Headaches During Pregnancy

headaches_during_pregnancy

Headaches are one of the most common discomforts during pregnancy, especially during the first and third trimester. As a pregnant woman, our bodies go through so much physical and mental change. During pregnancy, a woman’s body experiences changes in hormone levels and heightened blood volume. These changes can trigger more frequent headaches. Other triggers can also bring on headaches like stress, dehydration, lack of sleep and not having your normal cup of joe each morning.  

Unfortunately, when most will gravitate towards using over the counter headache medication, pregnant women are normally hesitant. If you are experiencing severe or frequent headaches, always consult with your doctor. There are different types of headaches that you may experience during your pregnancy. Continue reading to learn more about these and how you can treat these headaches in the safest way for you and your baby. 

Different Types of Headaches

More times than not, the headaches women may experience during pregnancy are primary headaches, meaning that the pain doesn’t come from another underlying issue. Experiencing these during pregnancy are common and should not bring alarm. Letting your doctor know you are frequently experiencing headache pain is important to find out what can best help relieve your discomfort. 

 The three most common types of headaches experienced during pregnancy are:

  • Tension headaches
  • Migraines
  • Sinus headaches

Tension headaches are the most common type of headache you will experience. This can be brought on by stress, hunger or if you are carrying tension in your neck and shoulders. When suffering from a tension headache, you may experience mild or moderate dull pain behind the eyes on both sides of the head. Oftentimes, tension headaches will go away within an hour or two. 

Migraines are a more intense sensation of pain that throbs, and can be felt on one side of the head and neck. These types of headaches tend to last for hours and sometimes days. Migraines can also bring on other symptoms like blurred vision, light sensitivity, numbness and nausea. 

Lastly, some women can experience sinus headaches during pregnancy. With a sinus headache, women will experience intense pressure around the eyes, cheeks and forehead area. These types of headaches can also trigger a stuffy nose and occur when someone has a sinus infection. Like migraines, these headaches get worse with more movement and light exposure. 

Is Tylenol Safe?

When most people experience headaches or muscle pain, oftentimes, without second thought, they grab a bottle of Tylenol to relieve this pain. Tylenol contains the drug acetaminophen or paracetamol. Most doctors recommend the use of Tylenol rather than other over the counter medications like Ibuprofen and Aspirin. If your doctor recommends the use of Tylenol during your pregnancy to relieve headache pain, it is important to only take the dose recommended. 

Due to the fact that you are now fueling two bodies, many pregnant women choose to take the holistic route. They make healthy changes in their diet and exercise habits to ensure the health of their baby throughout their pregnancy. Oftentimes, women choose to opt out from putting things like Tylenol into their bodies to stay as natural as possible, but what are alternative options to dealing with the pain?

What Are Safe/Holistic Remedies? 

Many people choose to avoid medication if they can, especially women who are pregnant. What happens when a pesky headache comes on and the pain is not bearable? Here are some home remedies that can help relieve headache pain without all the pills. 

  • Lying in a dark room with eyes closed and minimal light
  • Cold compress over eyes and neck
  • Heating pad/ steam to relieve any pain
  • Drinking plenty of water and eating enough protein
  • Getting an ample amount of sleep 
  • Taking a warm bath with Epsom salt
  • Essential oils
  • Drinking tea (without caffeine) 
  • Meditation
  • Pregnancy massages 

These home remedies are known to help relieve headaches whether you are pregnant or not. If your pain becomes more severe or too frequent, consult with your doctor or OBGYN and discuss what the best and healthiest options are. If you are looking for holistic gynecology and pregnancy services, including home birth and water birth in South Florida, visit Midwife 360 for all of your questions and needs.

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Midwife360 Turns 7!

Insurance Midwife360 Updates

On April 1st, Midwife360 will be celebrating it’s 7th year of practice. As I sit here savoring my morning cup of herbal tea, enjoying the sunshine and beautiful weather only south Florida springtime can bring, I am remembering the early days – my big ‘why’, the successes and setbacks, the various people who helped (or hurt) along the way and the current state of affairs. 

MIDWIFE360 OVER THE YEARS

I started this practice to offer something different to the women and families of my community. After working in the hospital and OB office for 8 years, I know that many women, especially the millennials, want something different when it comes to the care of their gyn health and pregnancies. And I wanted something different and better for the babies. They don’t have a voice; I am their voice and I am shouting that babies want to come into this world gently, with love and respect.

“We” started out as “I” for years, along with various students that worked with me along the way. Most notably, I was able to help Rosalia Cannava become licensed after 3 long years of apprenticeship. Mandy Rojas (currently owner of Palm Beach Maternity Center) trained with me for a bit. And then in 2018 Lauren Danella, CNM moved to Florida to begin working with me. Last February Lauren left to work with Bliss Birth Center, but came back in November when we were getting so busy. Marlie Honorat started with us in September, and will continue having 2 office days a week. In addition, the people that have helped with keeping all of the details working smoothly have been essential to our success. These include Vanessa Scoz, Sandra Alandete, Kayleigh Taylor and Bruna Possobon. 

CHALLENGE IN BIRTH SERVICES

One of the consistently biggest challenges has been dealing with insurance companies. Like any business that sells services, the key to success is being able to charge appropriately for those services and to get paid for that work. Sometimes when I’m driving around and I see a landscaping truck or construction vehicles with the company logo or even the pool guy, I am envious that those people are providing services and getting paid. The healthcare industry is unique in the world of business in that most providers (if they work with insurance) do not do the work and then get paid. I am constantly shaking my head at the system that we have inherited from the last century. 

HOW INSURANCE WORKS WITH MIDWIFES

In case you didn’t know, here’s how it works. A provider has to go through a lengthy application process to become credentialed with an insurance company. They may have to wait 60-120 days to be approved. And one can be credentialed, but not invited into the network. If they are out of network, some folks with that insurance cannot see them and use their benefits or a request can be filed to have the services covered as if the provider were in network – this is called a GAP exception or single case agreement. This usually only works if the service is something no one else is providing – like home birth with a Certified Nurse Midwife (CNM). And this can be beneficial as the provider is allowed to balance bill the client for the difference between the contracted rate and the actual charges.

That’s another eye-opener. The provider’s charges are not what the insurance company pays. For instance, my charge for self pay full journey for pregnancy care with birth at home is $7000. This covers everything, no hidden fees. The rates that have been offered to me from insurance companies vary from $2300 – $3600 for what is called Global Maternity. AND the provider may not bill for the services until after the birth. So we provide 8-9 months of regular services, but cannot get paid until well after the main event and are lucky to receive half of our normal fees. In addition, some companies require us to apply for authorizations in order to qualify to be paid for certain services – services that are part and parcel of what we do, that they cover, and are part of our contract to be compensated. 

In addition to all of this, the system for filing claims is complicated, CPT (procedure) and ICD10 (diagnosis) codes must be accurate and present, and they only accept electronic claim filing through an electronic data clearinghouse. Therefore, a provider has to turn over a percentage of the already low amount of money they receive to a third party to file the claims and appeal any denials – which happen regularly. I’ve been told that insurance companies deny a percentage of all claims in the hopes that some of them won’t get appealed. It’s all part of the game. These are some of the headaches and drawbacks for the provider when playing the insurance game.

DOWNSIDE FOR PRIVATE INSURANCE PATIENTS

From the client’s point of view it’s just as bad. People get insurance thinking that they will be covered if they get sick or, I don’t know, have a baby. They are paying a monthly premium usually $300-500 per month and are always shocked at the sticker price when we do the breakdown of what their financial responsibility is even with insurance. If they have a deductible, they must pay up to the entire amount before the insurance will cover anything. In addition, if there is co-insurance then once the deductible is met, they will have to pay their percentage of what’s left according to the contracted rate. Then there are things not covered by insurance (birth tub rental, second licensed person at the birth, supplies, home visits) and this fee is added. They are typically paying us an average of $4000 in addition to their monthly premiums. 

Through the years this system has consistently been the limiting factor for Midwife360. I went through 7 different billing scenarios (including doing my own electronic filing for about 14 months until I couldn’t keep up with the appeals process) before settling on the current company that we use. Innovation Billing (thanks guys!) And they are great – really help me feel that they care about our success. However, all of this paper chasing has taken the joy out of the work. The constant need to keep up with figuring out who needs to have an authorization and following up on them. And the length of time that payment can take if there is a denial or any problems with the claim makes it impossible to know what the actual revenue is for any specific period of time. It’s a ‘keep churning out the work, fingers crossed and hope for the best’ situation. 

MIDWIFE360 IS A CONCIERGE PRACTICE

Another consideration – we are a concierge practice. We offer hour long prenatal visits with at least one home visit during the prenatal period. The client has prenatal care with the provider that will attend the birth. We come to the home for the active labor and birth and stay 2-4 hours after, providing immediate postpartum care to the mom and immediate newborn care to the baby. We come to the home twice in the first week of the baby’s life. We draw labs in the office. We can perform some simple ultrasound procedures. Clients who have had standard OB care in our community are familiar with the 5-10 min prenatal visits after waiting an hour in the waiting room, sometimes having to go to the lab for blood draws, getting a provider at the birth they’ve never met, and another stranger to care for the baby. And on top of all that, insurance companies are paying the OB providers more for that level of service than they pay us for the concierge level services we offer.

NO LONGER ACCEPTING INSURANCE

In light of all of the aforementioned issues, Midwife360 is going to discontinue working with insurance companies as of November 1, 2021. We will continue all of our current contracts through October 31, 2021.

We encourage prospective clients to come in for an hour long consultation. We charge $50 for the hour, and apply that to the fees once the client has decided to come in for care with us.

We will do our best to make our services affordable for everyone who decides that they want this level of care for one of the most important days of their lives! 

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Birth Plan: Why You Need a Midwife and Doula

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The Birth Plan

If you are an expectant mother, then you understand the importance of having a birth plan. Each couple will have a different plan for their pregnancy and birth; this plan is associated with their wishes and values. Do you have a birth plan? Does your birth plan include a Midwife and Doula? First, it is necessary to understand how a Midwife and Doula can help you before, during and after your pregnancy.

Midwives and Doulas

Ever since the beginning of humanity, women have been giving birth, and they have had individuals who were there to support them in their birthing process. Midwives and Doulas are the individuals who help mothers to create and fulfill their desired birthing plan. Even though these specialists have job descriptions that pertain to pregnancy and delivery, their responsibilities are actually quite different.

The Work of a Doula

Doulas are individuals who are particularly concerned with the mother’s comfort and care before, during and after the birthing process. Doulas are able to give the mother the comfort that she needs. This comfort can include massages, soft music, aromatherapy, encouraging words or other techniques that will help the mother to have the best birthing experience possible. A Doula is not a medical professional and cannot perform any medical procedure. She cannot help a woman give birth, she is only there for the comfort of the mother who is in labor.

What is a Midwife?

A midwife is a medical professional who works directly with a mother who is giving birth. The job of this specialist may vary according to the state where she practices. Generally, midwives have received training from an accredited establishment that has licensed them as a midwife.  Midwives are able to help the mother in the delivery process. A Midwife also has the skills and knowledge to know when a delivery may require the skills of an obstetrician.

Your Birth, Your Choice

You have a choice when it comes to your birth plan and who attends (doctor, midwife, doula etc). There are traditional methods, holistic methods and natural methods that you can choose from for your labor and delivery. There is nothing that can be more special or personal than giving birth, and a midwife and doula will help make the experience more comfortable and personalized.
We’d love to help. Contact us today.
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Midwife360 Partners with Care Credit

Care Credit for Maternity Services Palm Beach

Introducing Care Credit at Midwife360!

Having a natural birth at home is becoming more and more appealing as the COVID numbers grow and healthy pregnant people begin to question the automatic choice to give birth in the hospital.

However, home birth is not always covered 100% by insurance (think deductible and co-insurance) and even with Medicaid, there are some out of pocket expenses that Medicaid does not cover. With Midwife360, the lowest out of pocket amount is currently $1200 and many folks with private insurance may have to pay around $5000 when the numbers are crunched for their particular benefit plan. Our self pay rate is $6700. While even that is a small price to pay for one of the most beautiful and memorable days of your life, not everyone has that kind of cash available or even that much credit.

Enter Care Credit. Care Credit is easy to apply for and most people are approved and the staff at Midwife360 will help. It allows for a 4th option (other than cash, debit, or traditional credit card) to pay for your care without breaking the bank. Depending on the program chosen, there is an option for 6 or 12 months credit with no interest, or a low interest 24 month credit card.

Midwife360 pays a small percentage and we get paid for our services while the client gets to pay over more time for no extra cost (when choosing the no interest option).

We are happy to be able to help our clients be able to pay for their care without causing undue financial stress. Contact us today to find out more!

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Midwife360 and the Scoop on IUDs

Many of my clients ask about birth control options that do not have hormones. There are a few, mostly they are the barrier methods like condoms (male and female), diaphragms, and cervical caps, or surgery. But the copper IUD is the only one that is long term and reversible and does not have any hormones. Since the copper IUD is not the only long term, reversible contraceptive, I wanted to break it down here for you.

What is an IUD?

IUD stands for IntraUterine Device. There are 2 types of IUDs, those with hormones and those without. Both of them are T-shaped plastic rods that are about 1.3 inches long with a string attached to the leg. The ones with hormones contain progesterone impregnated plastic, while those without have some copper wrapped around the arms and/or leg. 

Progesterone IUDs

The hormonal IUDs are called Mirena, Liletta, Kyleena, and Skyla. They are approved to last from 3 to 5 years and the Mirena and Liletta can be effective up to 7 years. The Skyla (3 year device) is a bit smaller than the others and is marketed towards young women who havenʼt had babies yet. The hormones effectively thin the lining of the uterus causing the wearer to have a super light or no period. Women usually still feel that they are cycling, as they can still get bloating or other pre-menstrual symptoms, but without the bleeding. Sometimes the IUD can cause an increase in period bleeding, but this is usually short-lived and will slow down or stop completely within a few months. This can make it more difficult to get pregnant once the IUD is removed as it can be 6 months or longer before the period returns to normal. 

Copper IUDs

The copper IUD that is approved for use in the US is called Paragard. There is another brand that is used in other parts of the world called Nova-T that is the exact same thing as the Paragard – a plastic T-shaped device with 380mm2 surface area of exposed copper. The Paragard is approved for 10 years and effective for at least 12. The Nova-T package insert says itʼs approved for 5 years. 

Pros and cons

The benefit of using an IUD is that it is placed once and then you donʼt have to think about it. You donʼt have to remember to take a daily pill, switch out your patch every week, do a monthly vaginal ring swap, or get a shot every 3 months. They are very effective, partly for this very reason – everyone is a perfect user. They are considered 99% effective in preventing pregnancy.

However, if you do get pregnant, especially with a hormonal IUD, you have a greater chance of having an ectopic pregnancy (when the fertilized egg doesnʼt make it past the tube into the uterus). As mentioned above, the hormonal IUDs can lighten or stop the period which is beneficial for those with super heavy cycles or super painful cramping – such as with endometriosis (a condition where the uterine lining or endometrium grows in places outside the uterus – when she has her period these places also bleed causing extreme cramping).

Another con with the hormonal IUDs is the tendency for those with them to be unable to lose weight or gain unwanted pounds over time.

An advantage of the copper IUDs is that one gets very effective birth control without using hormones. This means that it doesnʼt affect your cycle or your ability to get pregnant once it is removed. The only other birth control that doesnʼt use hormones are the barrier devices (make and female condoms, diaphragms and cervical caps). However if one has a copper allergy, it can cause multiple systemic symptoms and even affect the efficiency of the immune system. 

Placement

When you go to have your IUD placed, you should be on your period. This helps reduce the risk of infection as you have a flow that will carry any unwanted accidentally introduced bacteria out of the uterus. It also means that your cervix is softer and more open. You will be counseled regarding the risks of perforation and infection – which are the more common risks of placement. Your provider may also mention that expulsion of the device is also possible. Perforation would be pushing the inserter through the wall of the uterus and placing the IUD outside of the uterus. 

The provider should use sterile technique and clean inside your vaginal vault with betadine or hibicleanse prior to inserting the IUD. Some providers will numb the cervix with lidocaine, which makes the insertion much less uncomfortable. The uterus should be at least 6 cm deep, which is noted during the insertion as the inserter has cm markings on it. Once the IUD is properly placed the provider will make sure to cauterize any active bleeding with silver nitrate sticks.

Then you should be given a prescription to get an ultrasound to check placement and cautioned to refrain from intercourse for one week. Having an ultrasound assures that the IUD was placed properly in case there are questions about that in the future. It also reassures everyone that there was no perforation at the time of insertion. You can feel the strings which should be about 2-3 cm long hanging out of your cervix. These strings will be used to remove the IUD when you are ready to have it taken out. 

Removal

Getting the IUD removed is typically much easier than placing it. Sometimes the strings are no longer visible in which case an instrument is used to capture them and draw them out where they can be grasped with an instrument and the IUD removed with one swift tug. It does not hurt and I donʼt think Iʼve ever removed one where the client didnʼt say “Thatʼs it? Youʼre done?” It is important to wait a couple of cycles before trying to conceive as the risk of miscarriage is higher in the first 2 cycles of stopping any type of birth control. 

Support your local Nurse Midwife!

You can see an OB/GYN or CNM to get counseled regarding which birth control option is right for you, or if an IUD is a good option for its effectiveness in treating heavy menstrual bleeding and painful periods even if you donʼt need birth control. As always – do your research, know your body, ask questions, expect respect – make sure you are satisfied with the results! 

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Call to Action

My name is Fadwah Halaby and I am a certified nurse midwife serving families in Palm Beach and Broward counties. I offer well-woman care with a holistic touch as well as pregnancy and birth services with birth in the clients home. This is a choice that any woman can make and a viable option for all low risk, healthy clients and even with some that have a more complex physiologic pregnancy – such as previous cesarean, twins, or breech.

Pregnant people have human rights too!

The bottom line is that we all agree that everyone should have certain rights by virtue of being human – we call them human rights. And these rights are repeatedly denied to many pregnant women because her care provider has decided:

  • that he or she is not comfortable with a given situation
  • has decided on a particular course of action
  • is determined to force the client to comply

This has gone so far in some cases as getting a judge to order a forced cesarean surgery by deeming the client incompetent to make decisions for her own body and that of her baby. It is ludicrous to imagine that a person who has conceived and grown a baby in their womb for 40 weeks does not have the best interests of that baby in mind when making decisions regarding the birth of the baby. No one has more of a vested interest in that baby than that pregnant person. And no one has more of a vested interest in the woman’s body than the woman herself. We have a right to choose to birth at home, in a birth center, in the hospital or anywhere else a person would choose to birth. This is a basic human right and is upheld in the laws and rules of our state.

What is not supported by our laws and rules is the right of that pregnant person to have the trained and licensed provider of their choice attend to them in any of these settings.

Nurse Midwives are trained to practice independently

As a certified nurse midwife (CNM), I am trained and licensed to attend to women in any of these settings. I have maintained hospital privileges without any negative incidents for more than 8 years and over 1600 births. Yet now that I am attending to women in their homes, I am not allowed to continue to care for them should they require a transfer to the hospital either before or during labor. ACOG (American Congress of Obstetricians and Gynecologists, the OB/GYN national organization) recognizes women’s right to choose their place of birth and makes a recommendation that if a woman wants to birth at home she should be a healthy, low-risk candidate, choose a CNM to attend her, and birth in an integrated environment. [ACOG Committee Opinion on Home Birth] And this, my friends, is the missing piece of the puzzle. The lack of integration makes out of hospital birth less safe for everyone.

Transferring from home to hospital is fraught with anxiety for both clients and home birth care providers

How many times have you heard stories of “train wrecks” – home birth transfers to the hospital when things have gone far past the point of being OK? Midwives dropping clients off at the door or not participating in the transfer at all are tales that are told by hospital personnel about home birth transfers. It is true that the out of hospital provider is bound by duty to shift location to the hospital once they feel that it is no longer safe to be at home and if it is for an emergent reason, then the 911 system should be employed to make the transfer. If it is for a non-emergent reason (as 90% of home to hospital transfers are), then the transfer can happen by private vehicle. In both cases, the hospital should be alerted and records sent ahead to facilitate care for the client and to give the receiving provider as much advance information as possible. The provider should accompany the client and be prepared to give a concise report of the relevant details and reasons for the transfer. This is considered a hand-off and according to JCHAO [Joint Commission for Hospital Accreditation] is where most critical incidents happen.

One solution

Giving APRNs (Advanced Practice RNs or Nurse Practitioners) the ability to practice to the extent of their training (why are we being restricted from that in the first place?!) would make this situation much safer. By allowing the clients chosen provider to be a member of the team once the transfer to the hospital becomes necessary. I have not been able to maintain hospital privileges, not due to any malpractice or incidents. This is purely due to not having an obstetrician who doesn’t have a financial stake in me or my practice being willing to “take responsibility” for my actions. Really, why should anyone else take responsibility for my actions?

I am trained to work to the extent of my scope of practice like any other healthcare provider. To make decisions, prescribe medications and tests and to interpret those results and determine when consultation, co-management, or referral is necessary. LIKE ANY OTHER HEALTHCARE PROVIDER. There is no worry that OBs will start trying to treat people for heart failure – they would refer to a cardiologist. If they try to work outside their scope of practice, then they are appropriately reprimanded or relieved of their license to practice. We understand that we would be held to the same standards. However, to require me to find a doctor willing to take responsibility for my work and to require that they sign my application for hospital privileges places an undue burden on me and is effectively restraint of trade. This has to stop now.

Please support Senate Bill 972 and HB 871 to increase the number of health care providers and contribute to reducing the costs of health care. Reach out to your Senator and Legislator with a postcard, email, and/or phone call today! Click here or below to find your elected official now.

 

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The Health Insurance Rant

Palm Beach Water Birth at Home Midwife

Health Insurance A Lose:Lose Situation for Consumers and Providers

How did we come to this juncture where we are supporting the lumbering giant that is the insurance industry particularly as it relates to healthcare? I am an NPR person; I listen to NPR when I’m driving in my car and I heard a piece yesterday that really got me upset! They were talking about the rising cost of healthcare insurance. All of the big companies were planning on raising their rates next year and  Humana was going to be raising their rates higher than everyone else – like by 40%! It is predicted that for someone earning around 27K, their premium would be about $150/m. I remember when I earned less than 30K per year and paying out $150/m for health insurance would have been extremely difficult. So that’s one thing. The other, more important thing that really concerns me – and this, my friends, is the elephant in the room – is how the heck did we get to this place where we support this industry that has absolutely nothing to do with our health?

Difficult Contracting

I have been running my own small healthcare practice for 2 ½ years now. I have been struggling for recognition and compensation from these insurance companies from day 1. Achieving in-network status was the first thing. Cigna updated my new tax ID with my NPI (National Provider Identifier – a national registry that lets them know that the person is legit and bestows a unique identifying number) and we were good to go right away. I thought that all the other companies would do that. However, I found out that even though I’d been providing care for their members for nearly a decade. All of the other companies required me to apply for a contract, and most of the big guys denied me initially. Aetna came around after my national body (ACNM – American College of Nurse-Midwives) wrote a letter for me. Humana is just starting to consider a contract – after multiple Humana members applied for a gap exception for coverage for my care. Blue CrossBlue Sheild won’t even talk to me, doesn’t contract with non-MDs and is extremely difficult to deal with – even for their members. The rest of the companies fell somewhere in-between and eventually granted the in-network status.

Difficult Reimbursement

The next insult is the rates that I am bound to accept now that I have achieved the holy grail of in-network status. My clients pay their premiums and want to use their insurance plan. However, they are subject to their deductibles and co-insurance amounts which require a certain amount of investigation to discover and interpret. The industry standard requires those of us providing maternity care to refrain from billing any services until after the baby is born. This puts all maternity providers in a precarious position because everyone knows that most people are not as keen to pay for a service once the job has been completed. So the trick is to estimate what the insurance company is going to say that the client owes (the deductible and co-insurance up to the amount that is in the insurance contract for the service) and make payment arrangements for this to be paid off prior to their due date. This is irrespective of my charge for the service. If we overestimate, then we have to refund money to the client. If we underestimate, then we have to try to collect for the services that have already been performed.

The Game of Claims and Coding

Submitting forms and getting paid is the other side of this game. The act of submitting a claim is like a ritual or a game – literally. They will deny payment if the coding isn’t correct, but they won’t tell you what’s wrong with it. Most providers pay someone to do this for them and they have to subscribe to a billing platform that electronically submits the claim through one of several national clearinghouses that pass it along to the insurance company. If a paper claim is submitted, it has to be on a particular form that is printed in red ink – if the ink isn’t red, then they won’t accept the claim. All while the status of the claim is communicated to the provider through many forms that are generated, printed, and mailed. So much paper! So many people involved who are making an hourly wage!

Keep the Money Between Consumers and Providers

The bottom line is that all of this detracts from the relationship between me and my clients. The longer I participate intimately with this system, the more I am confused as to the purpose of the insurance industry in health care. Instead of paying out large sums of money for insurance premiums to people whose only job is to move paper around (accept or deny claims and issue checks or take-back letters) we could be using that money to pay for health care. Obviously, the industry is making money – record gains even – and that is off the backs of their members and their providers. I think those folks ought to find another career and we should move away from this cumbersome system.

#getridofhealthinsurance #protectsmallhealthcarebusiness #ontgetbetweenmeandmymidwife