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! 

Natural Approaches To Depression During Pregnancy

The media makes pregnancy out to be one of the happiest times in a woman’s life. Pregnant women are always portrayed as being overjoyed and looking forward to their new life with their baby. The reality is that many women develop depression during pregnancy, and it often continues after the birth of their child. There are many different factors that could lead to depression in a pregnant woman, including the fact that many prescription antidepressants aren’t safe for women to take while pregnant. When a woman has to give up her antidepressants in order to carry a healthy child to term, her mental health can suffer greatly.

Fortunately, there are many signs that can identify depression in a pregnant woman. For example, rapid mood swings or noticeable changes in her sleep patterns could be a symptom of depression. A lack of enthusiasm about the pregnancy or baby and thoughts of death and suicide are also markers for depression in a pregnant woman. If a pregnant woman speaks of having feelings of worthlessness, or if there is a noticeable change in her eating habits, these are also indicators of depression during pregnancy. If someone you know is displaying symptoms, you should encourage them to seek help within her community, or from a licensed therapist to ensure that her mental health is addressed early in her pregnancy.

Natural Remedies for Depression

 

Unfortunately, commonly prescribed antidepressants and MAOIs on the market can be harmful or fatal to the fetus. However, there are many natural remedies for depression that will have no negative impact on the mother or the unborn baby. The following list is a sampling of some of the popular natural remedies for depression.

Keep A Diary

You may find that documenting and journaling your thoughts and emotions can help you to get to the cause of the problem. You may be sad after visits from a certain family member, or after seeing particular clients at work. Keeping a diary of your activities and feelings helps to clear your mind and might even reveal what is causing your depression. 

Get Some Exercise

You don’t have to do high-impact aerobics in order to feel better. Yoga is an excellent choice for a pregnancy workout and is also a great postpartum program for weight loss and toning. It also has high impact rates on depression. Another healthy option is brisk walking or light jogging. Always be sure to consult with your doctor before starting a new workout routine while pregnant. 

Get Some Rest

Pregnancy alone causes women to feel exhausted, If you don’t get adequate rest, you’ll quickly feel like you’re suffering from chronic fatigue. Be sure to get plenty of rest, at least 7 to 9 hours of sleep per night if possible. This will greatly improve the way your pregnant body feels, and also will improve your mood. 

Women’s Peer Support Groups

Pregnancy groups on Facebook are a great example of peer support groups that could help you feel better. Many of those ladies are experiencing a lot of the same emotions that you’re also feeling. It helps to know that you aren’t alone. Wherever you can find groups of supportive women in similar situations, you may find help with your feelings of depression. 

Turn to Your Faith

Regardless of your beliefs or denomination, many people find that prayer and/or church services can help to lift them out of depression. If it is something that you regularly practice, then allow your spirituality to elevate your mood. 

Avoid Inflammatory Foods

Foods such as carbohydrates, refined sugars, and caffeine can actually make your depression worse. Stick with a healthy diet that consists of fresh fruits and vegetables. Include probiotics and prenatal vitamins in your daily regimen for some extra pep in your step. 

Sunlight/Lightbox

Sunlight, or a high-intensity light in a lightbox (to simulate sunshine), could be what you need to feel refreshed and add happiness to your mood. Sunlight allows your skin to produce Vitamin D, which plays an essential role in your mental health. 

 

If you’re feeling hopeless, please know that this is not abnormal for pregnant and post-partum women. Reach out to your spouse or family members to help you get the treatment you need. You want to be healthy and happy for your growing family. 

Professional help is available to you 24/7, call  1-800-273-8255

Benefits of Massage During Labor

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Massage is one of the oldest healing traditions. It has therapeutic properties induced by manipulating your soft-tissue or muscles to enhance your general well-being and health. More so, it influences how a woman goes through labor as well as the progression of labor.

There are numerous benefits of the nurturing and sensitive touch of a massage to a pregnant woman during labor, especially if the masseur is in tune with the mother’s body and quickly picks up on cues.

Labor pain is often caused by the contraction of uterine muscles and pressure at the cervix. The pain can be felt as an intense cramping in the lower abdomen, back, groin, or as an achy feeling. Other women experience pain in the thighs, or their sides as well.

Massage helps relieve this pain, anxiety, and muscular discomfort. It is beneficial with low back aches and common leg cramps. Touch techniques to a pregnant woman’s lower back relieve back labor and general lower back pain.

Massage Reduces Medical Interventions

There are risks with medicinal approaches that something unwanted may happen, such as an upset stomach, liver damage, tolerance, palpitations, or nausea. These vary from one patient to another.

With the right massaging techniques, medical interventions, such as forceps, cesarean birth, and synthetic oxytocin hormone are reduced. A masseur can also increase a woman’s pain perception and threshold during labor, thus, reducing the need for pain medications.

Massage Reduces Anxiety

Anxiety is considered normal, however it may be considered a medical disorder when it reoccurs from time to time during pregnancy. Anxiety and depression prevalence in pregnancy doubled between 2015 and 2018 in the US alone. It leads to excessive fear, feeling of apprehension, nervousness, and worry.

Massage during labor is proven to decrease the chances of postpartum depression. It also provides emotional support, reassurance, and decreases fear and anxiety. Typically, after a woman in labor is massaged, they feel relaxed and have enhanced confidence in themselves, and the birth process.

Massage Reduces Labor Pain

In a research study dubbed Pregnancy and Labor massage in 2010, it was found that women who were massaged during labor experienced much less pain. Their labor lasted an average of three hours shorter and with minimal need for medication.

During the study, partners for pregnant women were instructed on how to work the legs and back. It was noted that these were the areas that experience the most pain. They were required to do it every first fifteen minutes of every hour of labor.

Massage Enhances Psychological Functioning

Vagal activity is a process that results in various effects, such as reduction of heart rate, vasoconstriction or dilation of vessels, immune system regulation, glandular activity in the lungs, heart, and digestive tract. Massages help improve oxytocin levels. Oxytocin is the hormone responsible for reduced anxiety, blood pressure, and it can have a sedative effect.

According to Tiffany Field, moderate massages elicit a significant increase in vagal activity. It increases cerebral flow in various brain regions concerned with stress and depression regulation. Psychological stressors reduce vagal activity during pregnancy, but increased vagal activity decreases blood pressure, cortisol, and heart rate.

Massage Speeds Labor

Massaging helps reduce the need for the augmentation of contractions with synthetic oxytocin. When using an effective stimulating-abdominal massaging techniques, the strength and frequency of contractions may also increase.

Final Word

Most massaging techniques are safe during pregnancy and labor, though there may be exceptions. If you have any queries about massage during labor, it is best to talk to your healthcare provider. Above all, the benefits of massaging during labor precedes ignorance of the same by far. It is a great way to reduce labor pain and ease the journey of a pregnant woman.

What to Expect During Your Second Trimester

What_To_Expect_Second_Trimester

The second trimester marks the second phase of the pregnancy journey. This trimester ranges from the 13th to the 28th week. Essentially, this trimester lasts between the fourth, fifth, and sixth months of pregnancy.

For most women, the second trimester is the easiest and most comfortable. The fatigue and morning sickness gradually begins to fade. Additionally, your energy levels are higher than in the first trimester.

Lots of body changes happen during this trimester. Your pregnancy belly begins to show as the trimester progresses. You also start to feel baby movements towards the end of this trimester. An ultrasound between the 18th and 22nd week will help determine the baby’s progress in the tummy. Here are the significant changes to expect during the second trimester.

1. Weight Gain

Typically, your weight increases as the pregnancy journey advances. The primary reason for weight gain is the increment in the size of your baby.

Towards the 20th week, the body weight grows by eight to ten pounds for most women. Essentially, your body weight increases by a pound every week. In some cases, the weekly weight gain might be half a pound. The average weight increment throughout this trimester ranges from 12 to 14 pounds.

2. Backaches

Back pains become more prevalent during this trimester. Weight gain during this phase builds up pressure, mainly on your lower back.

It will help if you use a couch or chair with a stable back support feature. Most women prefer sleeping on the side to ease the back pains. Additionally, shoes with low heels are more comfortable during this phase.

If the backache becomes unbearable, consider going for a professional pregnancy massage. Alternatively, you could request your partner, friend, or caregiver to gently rub your back.

3. Abdominal Cramps

You might experience mild cramps in the lower abdomen from time to time during the second trimester. Usually, the uterus expands to accommodate the growing baby. Abdominal cramps arise due to pressure on the pelvic muscles as the uterus expands. Other causes of mild abdominal cramps include gas accumulation and constipation.

Taking a warm shower will come in handy to soothe the pain. You could place a bottle filled with warm water around your lower abdomen. Soft belly rubs also help to minimize the pain. In case you’re experiencing sharp pain, seek immediate medical attention.

4. Leg Cramps

Leg cramps are quite common in the second trimester, particularly during sleep. Often these pains occur due to the baby’s pressure on the blood vessels. Additionally, the baby may also be causing pressure buildup in the nerves connecting to the legs.

Other leading causes of leg pains include calcium and magnesium deficiency. Make sure to stick to a healthy diet rich in calcium and magnesium minerals.

5. Mild Swelling

You may experience mild swelling in your ankles, face, hands, and feet halfway through this trimester. The main reason for swelling is increased fluid retention for your growing baby. In some cases, swelling occurs due to reduced blood circulation in the body. Indulging in physical exercises is vital to control the swelling. Additionally, avoid sitting or standing for a long duration. While sleeping, make sure to change sides occasionally.

6. Dizziness

Pregnancy requires your body to pump lots of blood. Subsequently, you may experience low blood pressure. Dizziness arises due to low blood pressure or hormonal variations in the body. If you’re experiencing frequent bouts of dizziness, consider embracing a healthy diet. Moreover, take more fluids to alleviate dizziness symptoms.

Other notable changes include skin sensitivity, bleeding gums, and nasal congestion. Amid all the changes that come with pregnancy, remember to create beautiful memories during this trimester.

Have questions about your pregnancy? Contact our midwives.

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.

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!

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!