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. 

A Complete Guide About Shoulder Dystocia

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What is Shoulder Dystocia?

Shoulder Dystocia is a birth complication that happens during vaginal delivery. When this occurs, one or both of the baby’s shoulders get stuck inside the mother’s pelvis during labor. This causes a stall in the delivery process, which can be life threatening. In most cases, babies born with this complication are delivered safely. However, it can cause problems for both the baby and mother. 

Shoulder dystocia happens in 0.2 to 3 percent of pregnancies, and sadly, is unpredictable and unpreventable. When complications happen during labor, doctors turn to urgent cesarean delivery or surgery to avoid further issues. Although this may work in most cases, urgent cesarean delivery or surgery cannot correct this condition. 

Continue reading below for answers to all questions regarding this topic. 

Frequently Asked Questions:

What Does Shoulder Dystocia Look Like?

When Shoulder Dystocia occurs, the fetal head is delivered but the shoulders are not seen and are not being delivered with normal maneuvers. In other words, this delay in labor causes the baby to be trapped mid delivery. When this is happening, your midwife or provider tries to move your body and baby into better positions to continue natural delivery. 

The shoulder of the baby normally gets stuck behind the mothers pubic bone or sacrum. During this delay, the baby cannot breathe and the umbilical cord may be squeezed or wrapped around the baby’s neck. It is dire that everyone stays calm but acts quickly and efficiently to prevent further complications. The midwife will ask the mother to cease pushing so she can reposition her and the baby as needed.       

Why Does This Happen?

Shoulder Dystocia can occur during any vaginal birth, and without warning. Some of the most common causes for this are that the baby is too big, the baby is in the wrong position or the mother being in a restricting position. Oftentimes, your midwife or provider will change the mothers position to help free the shoulders from the pelvic area. 

It is nearly impossible to predict the risk factors of whether or not your baby will have this complication, but there are some things that can make it more likely. This includes:

  • Shoulder Dystocia occurred during previous pregnancies
  • Fetal Macrosomia (having a larger baby)
  • Having twins or multiple babies
  • Mother is overweight
  • Mother has diabetes
  • Labor induced 

Although these factors may increase the risk of a baby being born with Shoulder Dystocia, it is not clear why some pregnancies experience this complication while others do not. One statistic states that women with a history of having a delivery with Shoulder Dystocia are 10- 20 percent more likely to have a recurrence. 

What are the Complications?

Although most mothers and babies may not experience any further issues regarding this complication, it can bring about further issues. When delivering a baby with Shoulder Dystocia, a midwife or provider may have to break the baby’s collarbone to help with removal of the shoulders. This is a last resort, but may be necessary. This is only one risk that may come from this condition. 

Further risk for the baby may include:

  • Fractured collarbone (clavicle) or arm
  • Fetal brachial plexus injury
  • Lack of oxygen to the body
  • Brain injury due to lack of oxygen (this is rare)
  • Loss of baby (this is rare)

Further risk for the mother may include:

  • Maternal hemorrhage/ postpartum hemorrhage
  • Repairs for episiotomy or tearing during delivery 
  • Uterine rupture

Can You Prevent or Treat Shoulder Dystocia?

Like we touched on above, Shoulder Dystocia is extremely unpredictable and there is very little prevention. Being mindful of potential risk factors like diabetes and watching your weight during pregnancy are all things to help lower your chance of complications during labor. At Midwife360, we recommend our mothers to give birth lying on their side or on all fours to help natural movement of the delivery process. This will help prevent complications like Shoulder Dystocia. 

It is important to inform the expecting mother about the complications and risks of Shoulder Dystocia.  As well as reassure her that, as a midwife, we are trained thoroughly on how to deal with these complications in the safest and most efficient way for the safety of you and your unborn child.  

If You Have Further Questions

If you have any questions unanswered or need more information contact us at Midwife360. At Midwife360 we provide holistic gynecology and pregnancy services, including home and water birth to women throughout South Florida. Our mission and practice is designed to meet the individual needs of each woman and expecting family we care for. We believe women should be informed and educated about their healthcare options for routine care, family planning and birthing.

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! 

Creating Value in Childbirth

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Costs of Care Creating Value Challenge

In 2007, the Institute for Healthcare Improvement (IHI) proposed a framework for optimizing health system performance known as the “triple aim”. The three components are:

  • Improve the experience of care
  • Improve the health of populations
  • Reduce the per capita costs of healthcare

At Midwife360 we hit the bullseye on all three! Now, where is that friendly OB who wants to play with us?

It’s time to apply the IHI triple aim to childbirth!

It is well known that the American childbirth culture is very expensive with very poor performance AND little of what happens to birthing people in hospitals is evidence-based.

Childbirth for low-risk healthy women (who comprise the majority of people giving birth) benefits from less, rather than more technology. It is, after all, the only physiologic human function that has been relegated to hospital care. Achieving good outcomes usually goes hand in hand with a positive experience of care and this can be done in a very low-tech, inexpensive way by creating teams of home birth midwives and OBs.

Comfort is key

ACOG approves of home birth under certain conditions – choosing the appropriate client, with a CNM, in an integrated environment. As giving birth is much like making love, it is easier to imagine this happening in an environment where the birthing person feels the most comfortable – whether that be her home, a birthing center, or a hospital. So creating a culture that truly supports choice for birthing people without removing the option of access to a higher level of care can be accomplished by having a care team of a homebirth midwife and OB with hospital privileges.

Recreating home

Short of that, making hospital labor rooms more homelike – dimmers on the main lights, several options for water immersion (large shower, birthing tubs), small refrigerators in the room, and a second bed for family members or the doula to use – and updating care to reflect the evidence and patient preference are all absolutely necessary to achieve the IHI triple aim.