A midwife is a trained and skilled health care provider of care for women of all ages. We specialize in women's health, pregnancy, labor, birth and postpartum periods for low risk, healthy women. There are different types of midwives who work in different settings (hospital, home, birth center) but we all share the goal of serving women, babies and families in our community by providing personalized, individualized care. Many women choose midwifery care because visits are longer and more in depth in order to get to know each woman individually and learn what her needs/desires are and how to serve her best. Midwives protect and promote normal vaginal birth that is respectful and collaborative, each woman is in charge of her body and care and options are discussed and explained, informed consent provided. Home birth midwives create deep personal relationships, are available 24hrs a day and seek to support the whole woman in all her dimensions and subtleties. We see health as a spectrum, pregnancy/labor/birth as normal processes rather than medical conditions and recognize what an intimate and vulnerable experience it is to be a woman, to be pregnant, birth and experience the postpartum period as well as what an incredible opportunity for empowerment. Additionally, we provide exceptional postpartum and breastfeeding support well beyond the typical 6 week visit by most medical doctors. We are experts in normal and know when things deviate from normal, how to correct issues and when a higher level of care is needed.

The short answer is yes, in most cases. Planned home birth is a safe option for healthy, low-risk women who have a provider skilled in labor & birth, such as a midwife or medical doctor, attending to them. There is extensive research that supports planned home birth with a skilled provider to be as safe as (and in some metrics, safer than) hospital birth with a midwife or medical doctor. I encourage every woman considering out of hospital (home or birth center) birth to do her research. The vast majority of studies demonstrate consistently good outcomes for out of hospital birth when certain conditions are met. Home birth for high risk women or women birthing without a skilled provider has shown to have more risks to the health and well-being of both mother and baby. That being said, many women can and will birth at home without a provider and be just fine, thankfully most births (over 90%) are not complicated and do not require any special support or intervention.

Distinguishing what is high and low risk can be a grey area, but there are some conditions that are absolute contraindications for out of hospital birth and are best served by care provided by a medical doctor: 1) Poorly controlled Pre-existing or gestational (pregnancy related) diabetes that requires medication like Metformin or Insulin-this condition if not well controlled poses a high risk to the mother, baby and the pregnancy in general and should be managed by a provider and diabetes specialist. One of the biggest concerns for blood sugar that is not well controlled is that the baby will grow very large, particularly in the width of the shoulders which increases the risk of shoulder dystocia (when baby's shoulders become "stuck" after the head is born). Shoulder dystocia is most often resolved with a varying degree of maneuvers, however, if not resolved, can lead to permanent brain injury and can be life-threatening to baby, it also increases the possibility of severe perineal trauma to mother as well as psychological trauma, it is a frightening situation that no mother or provider (midwife or medical doctor) ever wants to be faced with. Of note-well managed/well controlled diabetes lowers these risks. 2) Hypertension (high blood pressure) whether pre-existing or gestational -moderate high blood pressure is anything over 140/90, severe range is anything equal to above 160/110 at two or more occasions. Most often women will need blood pressure medication to keep blood pressure within a safe range. High blood pressure, especially if sustained at severe range, poses a risk of stroke/cardiac event/seizures and damage to organs for mother, growth restriction/damage to organs related to decrease in blood flow for fetus and increased chance of placental abruption (placenta separating from uterus prior to delivery of baby) which poses a serious risk of permanent injury or death to both baby and mother. Sometimes high blood pressure can improve or remain stable even without medication, other times it requires medication or develops into pre-eclampsia. 3) Pre-eclampsia is a complicated condition that comes with many issues, often including high blood pressure (but not always). It is believed to be caused by an abnormal development of the placenta for reasons that are unknown and still being explored. Telling the difference between hypertension and pre-eclampsia is usually the presence of protein in the urine (proteinuria) which is easily tested for with a urine dipstick or urine collection for lab analysis. Pre-eclampsia can range from mild to severe, which is determined by blood and urine analysis, blood pressure monitoring and symptoms like persistent headache, changes in vision, pain in upper right abdomen, edema (swelling) that often starts in the lower extremities (feet, ankles, legs) and spreads to entire body. If untreated, pre-eclampsia has a high probability of causing the above mentioned issues for mother and baby. It is a dangerous condition that requires close monitoring for safety of mother and baby. 4) Seizure disorders generally cause a temporary loss of consciousness for mother and lack of oxygenation, this can lead to sustaining falls that can harm both mother and fetus as well as oxygen deprivation for fetus that can cause brain damage. History of a seizure does not mean someone has a seizure disorder as seizure can be caused by other issues that are not neurological (brain related), such as high fever, dehydration, medications. A seizure disorder is diagnosed by a neurologist who has performed an EEG, most often people require medications to control seizure disorders, many of these medications can be potentially harmful to a developing fetus and discussing options is an important conversation between each mama and her neurologist/OB. 5) Cardiac (heart) disease: Pregnancy can be very stressful on the body, especially for a heart that is already under stress, many cardiac conditions require medication that needs careful monitoring by a medical doctor to keep mother and baby safe and growing. Some heart conditions are benign but do require a cardiology consultation before determining eligibility and safety for home birth 6) Twins: Anytime there are two babies, there are higher risks for the pregnancy and for babies, but there are many different types of twins, some high risk (monozygotic/monochorionic, babies with twin to twin transfusion syndrome) and some are lower risk (dizygotic/dichorionic). For some cases, a nurse-midwife can manage care or participate in co-care (care with midwife and perinatologist) with great collaboration and successful vaginal birth at home or hospital if desired by mother and certain conditions met. Many women can birth their twins just fine at home, but there are many more unforeseen possible complications that may arise and additional ultrasounds, fetal surveillance and/or labs may be requested to determine eligibility and safety for home birth. I encourage mothers of twins to discuss their options, risks, benefits, etc with both midwives and medical doctors and to empower themselves with information so that they can make their own choices. I will consider homebirth for Di/Di twins and mothers that are healthy throughout pregnancy. 7)Fetal issues: Malformations: some babies have malformations of the heart, lungs, kidneys, brain, and/or other organs that are severe enough to mean they will likely need additional medical support or surgery after birth that cannot be provided out of hospital. Prematurity: babies born before 37 weeks are preterm and, depending on how many weeks they are at the time of birth, may need additional support after birth, it may be something simple like additional oxygen for a day or two or may need full life support to keep them alive and developing as healthy as possible. Although many babies born during the 36th week of gestation will be just fine and require no additional help, some may need additional help to transition to extra-uterine life (outside of mother's uterus) and need help breathing and getting enough oxygen, they often have more issues with jaundice (yellowing of skin) which may need phototherapy to clear, they may struggle with breastfeeding as they are smaller and get tired more easily than babies born later. If a mama is a within the 36th week of pregnancy when labor begins, we can discuss options and consider birth at home knowing that there is a much higher chance we may need to transfer baby to a children's hospital after delivery if they appear to be struggling to breathe. 8) Rh sensitization: This is for mothers who's blood type is Rh negative (ie: A-, B-, AB-, O-) and have previously had a baby with Rh positive blood (A+, B+, AB+, O+) and became "sensitized" to the positive Rh of the baby's blood. This can happen when there is some exchange of baby & mother's blood that most often happens during birth. This doesn't cause a problem for the mother or for the first pregnancy, but in subsequent pregnancies, there is a higher risk of stillbirth, fetal anemia and growth issues. This complication can be prevented if the mother received a medication called Rhogam during pregnancy and after birth. Some women choose to decline Rhogam because it is a blood product or for other reasons, which is 100% their right to choose to decline. Many women with Rh negative blood type and Rh positive fetus will NOT become sensitized, but once sensitized, there is no way to reverse it and if she desires more than one child, a thorough discussion with evidence based information should be had between mother and provider so that she can make the decision she feels is best for her and her future pregnancies. This condition can be tested for with a simple blood test and if part of the standard prenatal lab panel. 9) Vaginal Birth after Cesarean (VBAC)-this is considered by ACOG to be a high risk delivery, however, there is ample research that shows that vaginal birth is a safe options and many times safer options that repeat cesarean. There is an increased risk of uterine rupture with a VBAC, however, depending on the type of incision (low transverse vs vertical or "T" incision) will change the level of risk as will the time since the cesarean and estimated due date of current baby and number of previous cesareans. I currently offer home VBAC (or HBAC) to people with a history of 1 or 2 cesareans who have had low transverse uterine incisions. I do not offer HBAC to people with a history of a vertical or "T" incision due to the increased risk of uterine rupture, however I do support VBAC with vertical incision by providing resources of excellent and supportive providers in-hospital. This is not an exhaustive list of high risk conditions, just the most common ones, may other risks are not absolute, but relative based on each individual circumstance. Each case is individual and I am always happy to have a consultation with any woman looking to inform herself of her options and what risks exist and why she may be high risk. A note about "risk"...risk is a potential for harm, there is never a guarantee that any "high risk" pregnancy will lead to harm nor that any "low risk" pregnancy will be free from harm. Each individual has the right of self-determination, regardless of whether a provider agrees or not with their decision. The primary responsibility of a midwife or medical doctor is to empower people with up-to-date and well researched information so that they can make the best decisions for themselves, their bodies, babies and families. Every person must take a look at their "risk" and decide what risks/potentials are acceptable to them, some are more comfortable with risk than others and willing to accept consequences ("good" or "bad") for their choices. At the end of the day, my hope is that every person will feel they made decisions from an informed place and have grace for themselves in knowing they made the best decision they could with the information they had at the time. It is never easy to have to tell a woman that she is high risk and therefore, ineligible for out of hospital birth, especially when midwifery care is beneficial for ALL pregnant and postpartum people, regardless of their medical conditions. A good way to have both the support of a midwife and have high risk pregnancies cared for properly is to consider having a primary OB medical doctor and a secondary provider be a midwife who can work together to give the best, most well-rounded care. This may not always be a possibility for all high risk women, but any woman desiring the benefits of midwifery care to provide for the psychological/emotional/spiritual side of pregnancy and ESPECIALLY postpartum care, please reach out as I (and other midwives) would love to be able to provide whatever support I can. REALTIVE RISK: These are situations that there are some increased risks that can often be fairly easily managed and do NOT make a woman high risk or ineligible for home birth. 1) High starting weight...this is very relative! There are known risks for mamas starting pregnancy with high BMI (body mass index) or who experience greater than 50lbs weight gain in pregnancy, however, these risks can be discussed and certain measures taken to decrease those risk. I believe that healthy pregnancy is a two way street, every mama has their own responsibility to care for themselves and their baby to the best of their ability, sometimes that means a lot of hard work and lifestyle changes to keep risks low and increase opportunity for a healthy pregnancy, labor and birth. High starting weight or high weight gain does NOT risk a person out of care, but does mean more conversations and collaborations about care and her desires/goals for herself & baby in terms of out of hospital care. I believe in providing care to mothers that is free of shaming, blaming or coersion. 2)Previous cesarean birth: There are many reasons women have cesarean births, many times necessary, many times not. The success rate of a VBAC (vaginal birth after cesarean) is generally high (greater than 80%) depending on several factors (reason for cesarean, low transverse incision, type of incision closure, history of previous vaginal births) and the main concern with VBACs is the very low, but possible, risk for uterine rupture (opening of scar on uterus) which is a very serious, life-threatening emergency for mother and baby. This may mean that I may ask for additional ultrasound evaluation, more frequent monitoring of baby during labor and low threshold for hospital transfer if I suspect uterine rupture. Many women will have successful VBAC home births without complications. 3) Breech presentation (buttocks down instead of head): Breech presentation is a variation of normal, most babies will turn head down by around 30 weeks of pregnancy, some will wait a little longer to turn, others will not turn at all. The old school of thought was that a breech meant a mother needed a cesarean as breech vaginal birth does carry more risks for baby. Now breech vaginal birth is becoming more popular as the old beliefs and practices are being looked at with a more careful eye and more research done that shows that vaginal breech birth can be done safely. The initial goal with a breech presentation would be to turn baby by positioning, exercises, chiropractic, acupuncture and ECV (external cephalic version aka turning baby from the outside of the abdomen) to get baby head down. If baby persists in breech presentation, then more discussions with evidenced based information about risks and options will be had and each mother will make the decision for herself of what she would like to do. Cesarean is NOT the only option and there are medical doctors that will support vaginal breech deliveries in hospital. 4) Mother's age: There is evidence to support that women over 40 years old have more risks of stillbirth and other complications such as pre-eclampsia and placental issues, especially if it is their first pregnancy at or over 40 years of age. That being said, many women around the world have uncomplicated pregnancies and births over 40 years old, and the majority of women over 40 will have a healthy pregnancy and birth, but we have to talk about those "potentials" and what additional options exist to monitor the pregnancy if desired, including checking more frequently on well-being and growth of baby, well-being of mother and functioning of the placenta. 5) Gestational (pregnancy-related) Diabetes (GDM) can be well controlled with diet, exercise and recommended supplements. Most mamas with GDM (I was one of them!) will be able to keep blood glucose levels within a healthy range with making some changes to diet and adding more physical activity as well as some low-cost and easy to find supplements. Anytime a mother has diabetes, there are some increased risks to baby, however, when blood sugar is within normal ranges, I do not consider this to be a high risk condition, however it does mean that the mother will need to do some home monitoring of blood sugar and make adjustments as needed to maintain healthy blood sugar levels and that options to do additional monitoring of well-being of baby later in pregnancy will be offered as research does show increased risks to pregnancy with GDM.

I'm highly qualified and experienced in women's health care and an excellent provider for any woman looking for personalized care where trust is built through a collaborative relationship to grow in health and wholeness. I use my clinical and personal experience to work alongside each woman in her process of wellness and personal journey on a physical, emotional and spiritual level. We can go deep into healing together.

A CNM (that's me!) has dual degrees in nursing and midwifery from a university that is accredited by the American College of Nurse Midwives (ACNM) and has successfully passed the national midwifery board exam given by the American Midwifery Certification Board (AMCB) and are licensed by individual states to practice as primary care providers for women and babies up to 28 days of life. CNMs can practice in all 50 states and can provide care in hospital, home or birth center settings. CNMs can prescribe medications and provide a full spectrum of care to women and girls from the time they begin menstruation through menopause and beyond. A CPM most often has completed their education through an apprenticeship model and does complete a course of study through a school of midwifery that is accredited through MEAC (Midwifery Educational Accreditation Counsel). Most CPMs are not nurses. CPMs can provide care in out of hospital settings such as home or birth centers. CPMs have successfully passed the certification exam by the North American Registry of Midwives. Laws regarding CPMs vary from state to state and they are (unfortunately) not legal to practice in all 50 states. CPMs cannot prescribe medications and their scope of practice often has limitations based on the laws of their state. Often CNMs and CPMs work together (and it's wonderful!). Some CNMs are also CPMs. There are other types of licensed/certified midwives (LMs, CMs). There are other types of midwives that have taken alternate routes to learning the art and science of midwifery, however the duration and quality of their studies varies, some may have extensive experience and some may not. It is important to ask your midwife about their course of study and what qualifies them to provide care.

An OB/Gyn medical doctor has completed medical school and is licensed through the American Medical Association. They are doctors who specialize in high risk care and are surgeons with skills to perform surgical procedures relating to obstetrics and gynecology. They can perform cesarean sections and operative vaginal deliveries (vacuum and forceps assisted birth) and can repair severe lacerations (3rd & 4th degree) as well as manage high risk and low risk pregnancies and deliveries. Midwives and medical doctors come from difference philosophies regarding care. Midwives see the woman in a holistic view, considering all the aspects to her health and well-being including the physical, spiritual, psychological, nutritional, social, economic influences on her life. Visits with a midwife will generally be longer and more in depth than with a medical doctor. Medical doctors are very well trained in looking for and finding issues that deviate from "normal", they are more focused on the physical well-being of the mother and fetus and often do not have the time or training to focus on the other aspects of well-being (but some do!). Many midwives and medical doctors work very harmoniously together and recognize each profession's skills are contributions to women's health.

A midwife is a trained health care provider, a doula is not medically/clinically trained and is more like a coach, providing physical and emotional support to a woman and her family during labor and birth, some provide pregnancy and postpartum/lactation support (depending on each doula). Doulas cannot give medical advice or guidance, but many are very knowledgeable, their role is to be a support person for the mother's goals, desires and wishes throughout the birthing process.

Traditionally, a doula is any woman who ideally has had a baby before, and will be there to support another woman in the process of labor & birth. To be a doula, there is no special training required as they are support people, however, many are highly trained and some carry certification. In many cases, a doula can be someone's mother, sister, aunt, friend. Many doulas are incredibly experienced in support measures and their skills are invaluable to mothers (and midwives). Many doulas and midwives work together to provide complete support for women. Many doulas provide prenatal support as well as postpartum and breastfeeding support. I HIGHLY recommend a doula for every birthing woman who wants one, particularly first time mothers*. Doulas do charge their own fees for services and often work independently, although some are associated with a particular midwife or birth center. *Many first time mothers have labors that can be longer and more challenging that the mother might expect given the limited experience most people have with labor/birth. Although they may have supportive partners who feel they will be "all the support" their partner needs, very few have every witnessed a birth nor have the stamina or skills to know how to support their loved one during the challenge of labor and birth (and postpartum). When considering whether or not a doula is a good investment, I and countless other midwives will respond with a resounding YES! There are some doulas that provide very low cost or free services if cost is a limiting factor. Let's talk more about it at your visits!

Yes, midwives can provide newborn care for healthy newborns in the first month of life, but it is important to establish care with a pediatric provider in the case that baby needs additional support in the first few weeks of life. Midwives are specialists are normal, healthy, low risk newborns and just like any other provider there may be some deviations of normal that are outside of my scope of practice or knowledge, I prefer to have a provider who specializes in pediatric care have eyes on baby as well to identify anything I may have missed. I do not offer any vaccines for babies, this is something that needs to be discussed with a pediatric provider if you desire your child to be vaccinated. I recommend all babies be see by a pediatric provider within the first week of life, preferably after the 72hr home visit. It is every parents' right to decline to have their baby see a pediatric provider, the health of their baby is their responsibility but I will require all clients to sign an acknowledgement that they have been counseled as to the recommendation and importance of their baby seeing a pediatric provider within the first week of life.

Pregnancy-related midwifery services: Full prenatal, birth, and 6-8 weeks of postpartum care including initial newborn exams, lactation support, 24hr access to me by phone, birth assistant fee (additional midwife) to be present at birth. $5,000 when the majority of prenatal visits and half of postpartum visits occur at my office in Central Phoenix OR $5,500 if you would like all visits too take place at your home (this option is available to people living within approximately 35 minute drive from my office or home, locations beyond this distance are not eligible for full in-home prenatal visits) Discount: Save $100 by paying in up front in full Payment plan: $500 deposit due first visit, then minimum $200/month payments due starting at second visit, or may choose to divide fee into 4 or 6 payments $500 non-refundable deposit due at time of sign up for services, account due in full by 36wks unless other payment plan is agreed upon. *pricing does not include lab fees or ultrasounds, lab draw is included but client will receive separate bill from laboratory for samples sent during care. Ultrasounds must be paid for directly to ultrasound technician or they will bill insurance as appropriate. **payments made by credit card will have additional 3.5% fee added to cover cost charged by credit card company Insurance billing I work with True Healthcare Billing to provide a verification of benefits to see if reimbursement by insurance for prenatal care/home birth is available, however, insurance claims cannot be completed until the birth of the baby. This means that payment for midwifery services will be paid out of pocket first and we will seek reimbursement postpartum. Unfortunately, not many insurance companies will reimburse for home birth.

For general gynecology & primary care: $125 initial visit (90min) $75 follow up visit (60min) Pricing does not include lab fees or ultrasounds, lab draw is included but client will receive separate bill from laboratory for samples sent during care. Ultrasounds must be paid for directly to ultrasound technician or they will bill insurance as appropriate. Payment due at time of visit.

Phone consultations for CPM clients $50/call $125 office visit $500 birth assist

I offer a free 30-minute phone consultation for prospective clients. Call or email me and we can have a conversation or schedule an appointment to address what your needs/concerns are and to explore how I can serve you in wherever you are in your journey on the path of achieving or maintaining health and wellness throughout your life.

Your $1,000 deposit is non-refundable—this is because I take only 2-3 births/month and every person who enters in to my care has their place secured and I will not take additional clients once I have a maximum of 3 due in a month. If care is canceled or transfer of care due to development of high-risk status prior to 36wks, I will itemize each visit completed at rate of $150/visit and refund remainder minus deposit (example: client paid $5000 at start of care then transferred of care at 30wks after 6 visits, 6 x$150/visit=$900 plus 1000 deposit. $5000-1900=$3100 refunded. No refunds after 36wks, even if hospital transfer for birth. My services are contracted to ensure highest quality care and the safest delivery possible, sometimes the safest delivery for mother and/or baby is in the hospital. Birth is inherently unpredictable and we can never really know how any birth will unfold and where it will happen or why a baby chooses to be born in any particular setting (home, hospital, car!) or any particular way (vaginal birth vs cesarean birth). I cannot guarantee anyone a home birth, but I can guarantee I will provide excellent, evidence based care that preserves the safety and well-being of mother and baby. No refunds on gynegology/primary care visits or IV therapy once completed.

For gyn/primary care visits, 24hr notice for cancellation/reschedule, less than 24hrs notice for cancellation client pays 50% of visit fee ($125 x .50 = $62.50)