Questions & Answers
Is it safe to give birth outside the hospital?
Yes. Many studies have been done that prove the safety of out-of-hospital birth. For a low-risk woman with a low-risk pregnancy, outcomes are just as good, if not better for planned out-of-hospital births with a Certified Professional Midwife than for hospital births, and are associated with fewer interventions and a much lower likelihood of cesarean birth. Below are some links to some more information about the safety of out-of-hospital birth:
What is the fee, and do you work with insurance?
Our fee is what we bill insurance. However, we require less than that from you before your birth. If you are uninsured, or if your insurance does not cover our care, we will work with you to help you find a way to make your dream of an out-of-hospital birth a reality.
We do work with insurance. Each insurance company is different, and each plan within a particular insurance company is different as well. We are out of network with all insurance companies, and the Federal plans do not cover our care. The best way to know what your insurance reimbursement might be is to do a verification of benefits with our insurance billing company. For $20, our professional billing company, Larsen, will contact your insurance company and verify your benefit coverage for the billing codes we use, and they will give you an estimate of benefits based upon their conversations with the insurance company.
Begin the Verification of Benefits process here.
-Our Provider PIN is 18277
You will receive an email from Larsen with detail about what your plan covers.
If you have insurance to help with some of the costs involved with having your baby with NOVA Natural Birth Center, it will be necessary to do this initial step.
For all clients we require a flat fee deposit that is due at 36 weeks or a month before your due date. If you have insurance, you may use credit card, cash, EFT or check to make your deposit payment. We will set up a payment plan with you. Some of our clients have HSA (Health Savings Accounts), and choose to use those funds to pay for their birth. That way, any out of pocket expense would be covered by your HSA funds. Insurance is billed after the birth. Depending on the amount of claims filed to insurance and their payments, you may receive a partial refund of the deposit based upon your insurance's guidelines for reimbursement.
We also offer a twelve month 0% interest loan option to pay this deposit. Click on the MedLoan graphic to learn more about this option.
We know that the financial aspect is an important part of your decision in choosing a care provider. It is hard to pay for these services yourself when insurance may cover 100% for a different provider or a hospital birth. We believe having a baby is a special event that is an investment in your lives and worth the cost. It is all about what you value and a choice you make. We offer a unique opportunity and have several flexible payment options available that make the financial aspect of your birth work for those who truly desire it.
What’s included in your fee?
For Birth Center births, our fee includes all of your prenatal care, the birth, the facility fee, postpartum care for you, and well baby care for your baby through the 6-week postpartum period. It does not include any services from other providers or companies, such as labs or ultrasounds you may need or want.
For home births, you will also need to purchase a birth kit, which is a box of disposable supplies you will need for your birth. It is about
$70. Clients choosing to give birth in water at home may need to purchase or rent a birthing pool. The cost of the birthing pool is not included in our fee.
Can I have my prenatal visits at home?
For people planning home births, the 36 week home visit is included in our fee. All other prenatal visits are done at NOVA Natural Birth Center. Whether you give birth at home or at the birth center, our fee also includes a 2 day postpartum home visit if you live in our service area.
I've been seeing another provider. How do I start the process of transferring to NOVA Natural Birth Center? What are your policies for accepting clients transferring later in their pregnancy?
care is usually an easy process. We will need copy of your prenatal
records to date. You can request them yourself, or we can send a records
request to your previous provider. Ideally, we like to see women starting in the first trimester. We know that sometimes, as you learn more about birth, your priorities and beliefs about how you intend your birth to be may change, and your provider may not be the right fit for you anymore. Also, some people come to us later in their pregnancy due to a move. We've had people come here from other countries as far away as Saudi Arabia and Turkey to have a natural birth at the birth center. As long as you have been receiving regular prenatal care, you have records documenting your prenatal care, and your pregnancy has been low risk, you are very likely a candidate for transferring into our care.
How do I get a birth certificate?
As required by Virginia law, we file a birth certificate for every baby born at the birth center or at homebirths attended by our midwives. You will need to request a certified copy of the birth certificate from the Virginia Office of Vital Records by completing a Request for Vital Record according to the instructions provided on the Vital Records website.
I need to travel out of the country shortly after my baby is born, so I will need to get a U.S. Passport for my baby. In order to do that, I need a copy of my baby's birth certificate. How long does it take to get the birth certificate?
We cannot guarantee a definite processing time for the birth certificate. Generally, we complete the birth certificate at the birth, and file it with the Health Department the following business day. It takes about a week for the Health Department to process the birth certificate before they send it to the Department of Vital Records in Richmond for processing there. According to the Vital Records website, it can take anywhere from 2 to 4 weeks for the birth certificate to be issued, and we do not have a way to expedite that process.
How do I get a Social Security Card for my baby?
As part of the birth certificate process, we are able to request a Social Security Card for your baby. It merely requires a signature from you on the birth certificate to request it. The Social Security Card should come in the mail to you automatically if you indicate that you want one.
Do you offer VBAC (Vaginal Birth After Cesarean)?
Yes, we do offer VBAC under most circumstances. Certain VBACs are higher risk, and are not something we feel comfortable offering outside the hospital. We would have to assess your particular situation, and see if VBAC is something we can offer you.
How long do you stay after the birth?
For home births, most families are ready to for the midwives go home about 2-4 hours after the birth. We stay until mother and baby are stable, the birth area is cleaned up, and you have been given instructions for postpartum care.
For births at NOVA Natural Birth Center, most families are ready to go home about 4-6 hours after the birth. Once mother and baby are stable, there is no reason to stay at the birth center, unless you need a little nap before you get on your way. We do not currently offer extended stays.
Do you have an OB backup? If so, with whom?
Our credential does not require OB backup. We are autonomous care providers. If it becomes necessary to seek consultation with an OB or to transfer care, we are able to do that. Prenatally, if the need arises for consultation, we have several doctors we can refer you to. We do not have a formal collaborative relationship with them, however they have been favorable towards consultation for previous clients. If, in labor, it becomes necessary to transfer to the hospital for care, you would be assigned to the doctor on call. All of the hospitals have OBs on site 24 hours per day, and are able to care for our clients who transfer.
If the doctor takes over, what is your role?
If we go to the hospital with you, we stay with you until you decide you want us to go. We are not able to manage your care at the hospital as we would at home or at the birth center, but we do act in a support role while there. Typically, we accompany you to the hospital, provide records to the hospital personnel, discuss with the hospital staff what has been happening and why we're there. Then, once we have transferred care, we remain with you to support you. Sometimes, especially if you have decided to have an epidural and are just going to sleep, it may not really make sense for us to remain with you. Sometimes, there are limitations at the hospital on the number of support persons you can have with you, and we make a decision together about whether you would like us to stay with you based upon that.
What is the plan if we need to transfer to a hospital? Do you have a relationship with a hospital?
We are required, by law, to develop an emergency transport plan for every client we serve. In that plan, we determine the nearest hospital, as well as your hospital of choice (for non-emergent situations). In an emergency, we would call 911 and transport via ambulance. The midwife would accompany you or your baby in the ambulance, and would continue to provide care until care was transferred to the doctor on call at the hospital. The vast majority of our transfers are non-emergent. In a non-emergent transfer, we would normally travel by car to the hospital. Once we arrive, we would manage the transfer of care as described above.
Every labor and birth is different, and it is difficult to detail every possible condition that would require transfer. Again, most transfers are non-emergent. We consider the situation, discuss it with the couple, inform them of the risks and benefits of the various options available, and we make the decision together about transporting.
Since we are autonomous care providers, we do not have a formal relationship with any particular hospital. We have certain hospitals we prefer to use during transfers, if possible, but the choice of hospital is ultimately up to you or EMS. We can transfer to any hospital.
Do you perform episiotomies? What are your criteria for doing so? In case of a tear are you trained in suturing the perineum?
We do not routinely perform episiotomies. As part of our training, we are required to know how to perform an episiotomy, however we prefer to allow the perineum to stretch, and feel that a tear is generally better than an episiotomy. Most women do not tear, and if a woman does tear, the tear is usually minor, heals well on its own, and does not require suturing.
We try to prevent tearing by providing perineal support, warm compresses, oils, and verbal guidance. Waterbirth can also be helpful in preventing tears. In case of a tear, we are trained in suturing. We can suture most tears. However, if the tear involves the rectal sphincter, we feel that it is best to have it repaired at the hospital, by a doctor who has more experience suturing tears of that kind.
Are you certified in neonatal resuscitation? What equipment do you have to resuscitate?
All CPMs are required to be certified in neonatal resuscitation. In addition, our assistants/students are also certified in NRP as well. We set up a resuscitation area at every birth. That area includes a heated surface, a suction device, bulb syringe, and an Ambu Bag. Virginia law prohibits us from using oxygen legally at births. Current NRP guidelines and the best evidence both show that initiating resuscitation with room air is as effective as initiating resuscitation with oxygen, and does not carry the risks associated with oxygen usage.
Can you provide references of mothers?
Yes, we have several mothers we could refer you to. References can be provided upon request. Feel free to ask questions on our Facebook page, as well. Many current and former clients are there and can answer your questions about the quality of the care they have received from us.
Who will be my birth assistant?
We work with an experienced assistant, a student or apprentice certified in neonatal resuscitation and CPR. We are happy to let you choose if you know someone and have preferences. It can be very helpful in some situations to have a doula present, especially for a first baby.
What is your service area for home births?
We attend home births in Virginia from as far west as Strasburg, as far south as Stafford (route 610), and as far north and east as the state line. Below is a service area map. If you live near the border of our service area, we may, depending upon your exact location, still be able to help you or refer you to a midwife who lives closer to you.