Maternity FAQ

Maternity FAQ

We try to anticipate questions you might have about our services and provide the answers here. If you need additional assistance, please email women@ncbirthcenter.org.

Prenatal Care

What happens if I need to be transferred?

It is possible that during your prenatal care with us, you will need a physician’s care for medical reasons. The most common causes are twins, fetal problems, or maternal complications. Many of these complications require high-risk rather than low-risk prenatal care and thus a transfer out of the birth center. We can transfer you to our consulting physicians, UNC Family Medicine, or to UNC OB/GYN, or another practice of your choice.

Though a vast majority of our patients will proceed through their pregnancy and birth without complications, we do keep our back-up physicians informed of your progress in pregnancy, in the event a transfer is necessary. Very rarely are transfers to the hospital made on an emergency basis. However, in the event of an emergency in labor, Orange County Emergency Services ambulance will be called. The midwife will go to the hospital with you. Most transfers in labor are not emergencies and are made by car. Children must remain with their designated caregiver. Infants may occasionally be admitted to the hospital, usually for observation of respiratory problems. These transports are usually via ambulance. In the event of an emergency involving an infant, we have made arrangements with the highly trained Neonatal Transport Team from UNC (if available) to come for the transfer of the infant to the hospital, with Orange County Emergency Services as back-up.

WBWC certified nurse-midwives all have privileges at UNC Hospital. This means that when a transfer occurs that is non-emergent and the scope of care needed is within the parameters of midwifery care, the midwife will continue to manage your care, deliver your baby at the hospital, and plan your discharge from the hospital. If the care you or your baby needs is beyond the midwifery scope of care, our back-up physicians will assume care, but the midwife will remain with you. All of your postpartum care will continue the same as if you delivered at WBWC.

What is Community Prenatal Care?

Community prenatal care (CPC) at Women’s Birth & Wellness Center is a unique program designed to meet the needs of the family delivering in a birth center. CPC is inspired by an evidence-based/researched model of delivering prenatal care to women in a group setting. After two individual prenatal visits in the clinic, you begin monthly group visits from 16-20 weeks in your pregnancy until your due date. You will know the dates of all six of the group sessions in advance. You will also have regular visits in the clinic between group sessions.

Birth & The Birth Center

I have certain health problems. How do I know if an out-of-hospital birth is safe for me?

Many women have health issues that are well controlled by lifestyle or medication and can still birth safely at the birth center. Examples are:

  • Thyroid disorders managed with medication
  • Mild asthma
  • Depression or anxiety managed with counseling or medication
  • Abnormal pap smears, or surgery on the cervix
  • Pregnancy with a prior history of infertility
  • Women 35-45 years old
  • History of miscarriage

Some conditions make out-of-hospital births potentially unsafe. The following is a partial list of common medical conditions that would “risk out” a woman from the birth center:

  • Hypertension or high blood pressure prior to pregnancy
  • Diabetes requiring insulin or medication
  • Prior surgery on the uterus
  • A new patient with a prior Cesarean birth planning on a vaginal birth with a subsequent pregnancy or VBAC. At this time, we can only offer VBACs to our established patients whose prior pregnancy under our care ended with a Cesarean birth.
  • Bleeding or blood-clotting disorders
  • With a first pregnancy, being very overweight with a Body Mass Index higher than 35 or being very slim with a BMI lower than 18 and a history of an eating disorder
  • With a second pregnancy or higher, being very overweight with a BMI higher than 40
  • History of a blood clot
  • Smoking more than one pack of cigarettes per day
  • IVF Pregnancy
  • A chronic infectious disease, such as HIV, Hepatits B or C, or Tuberculosis
  • Certain psychiatric disorders, such as psychosis, especially related to a previous pregnancy or postpartum experience
  • Certain autoimmune disorders, such as Lupus
  • Twins or other multiples

You will be asked about your health history on your intake screening phone call. Any question will be discussed with a midwife and decided on a case-by-case basis.

What pain management strategies are available when giving birth at WBWC?

Pain management strategies available include:

  • Extra large tub
  • Birth ball
  • Essential oils / aromatherapy
  • TENS unit
  • Nitrous Oxide

What happens if I need to be transferred?

It is possible that during your prenatal care with us, you will need a physician’s care for medical reasons. The most common causes are twins, fetal problems, or maternal complications. Many of these complications require high-risk rather than low-risk prenatal care and thus a transfer out of the birth center. We can transfer you to our consulting physicians, UNC Family Medicine, or to UNC OB/GYN, or another practice of your choice.

Though a vast majority of our patients will proceed through their pregnancy and birth without complications, we do keep our back-up physicians informed of your progress in pregnancy, in the event a transfer is necessary. Very rarely are transfers to the hospital made on an emergency basis. However, in the event of an emergency in labor, Orange County Emergency Services ambulance will be called. The midwife will go to the hospital with you. Most transfers in labor are not emergencies and are made by car. Children must remain with their designated caregiver. Infants may occasionally be admitted to the hospital, usually for observation of respiratory problems. These transports are usually via ambulance. In the event of an emergency involving an infant, we have made arrangements with the highly trained Neonatal Transport Team from UNC (if available) to come for the transfer of the infant to the hospital, with Orange County Emergency Services as back-up.

WBWC certified nurse-midwives all have privileges at UNC Hospital. This means that when a transfer occurs that is non-emergent and the scope of care needed is within the parameters of midwifery care, the midwife will continue to manage your care, deliver your baby at the hospital, and plan your discharge from the hospital. If the care you or your baby needs is beyond the midwifery scope of care, our back-up physicians will assume care, but the midwife will remain with you. All of your postpartum care will continue the same as if you delivered at WBWC.

Is a birth center safe?

The National Birth Center Study II, conducted by the American Association of Birth Centers (AABC) and published in the January/February 2013 issue of the Journal of Midwifery & Women’s Health, highlights the benefits for women who seek care at midwife-led birth centers. Findings also reinforce longstanding evidence that midwife-led birth centers provide safe and effective health care for women during pregnancy, labor, and birth.

The study, which included more than 15,500 women who received care in 79 midwife-led birth centers in 33 US states from 2007 through 2010, found that fewer than one in sixteen (6 percent) of participants required a cesarean birth compared to nearly one in four (24 percent ) similarly low-risk women cared for in a hospital setting. Expecting families who choose the birth center setting in the U.S. can expect high-quality, family-centered care. Less than 2% of women who choose the birth center setting will require an urgent transfer for either mother or newborn. The stillbirth and newborn death rates are comparable to rates seen in other low-risk populations. The information provided by the new National Birth Center Study II will help women and families make evidencebased, informed decisions about their babies’ births.

What cannot be done in the Birth Center?

If any of the following are needed, a transfer from the Birth Center to the hospital is required. The situation causing the transfer determines whether the nurse-midwife will deliver you at the hospital or whether Family Medicine or OB/GYN physicians will become involved for the delivery.

  • Anesthesia. Epidural anesthesia is not available at the Birth Center. Pain medications in labor are used sparingly because they can cause respiratory depression in the newborn. Coaching, support, and hydrotherapy are used routinely. Labor and birth are hard work. It is our goal to help women and their families make labor a positive experience for everyone.
  • Vacuum, Forceps or Cesarean Birth. These procedures are done by our consulting physicians in the hospital, when medically necessary.
  • Pitocin Induction or Augmentation. Because this requires the use of continuous electronic fetal monitoring (EFM) and immediate access to surgery should it be indicated, delivery is done at the hospital, often by the nurse-midwife.
  • Fetal Monitoring. If there is a need for continuous EFM, a transfer is required and care is often continued by the nurse-midwife

What complications can be handled at the birth center?

Nurse-midwives are prepared to handle the following complications:

  • Post-partum hemorrhage/excessive bleeding that can be controlled with the use of medication. If necessary an IV can be started to replace fluids. The mother can be transferred to the hospital by ambulance, if necessary.
  • Infant resuscitation. A nurse-midwife and RN, certified in Neonatal Resuscitation, will be present at every birth. The training includes resuscitation, suction, and intubation to establish an airway. The Birth Center is equipped with suction, oxygen, laryngoscopes, and ambu-bags. The infant can be transferred to the hospital by ambulance, if necessary.
  • Perineal tears. Nurse-midwives are trained to repair tears and episiotomies using a local anesthetic.

Can WBWC attend my home birth?

WBWC midwives do not participate in home births, nor can we provide prenatal care to women who are planning home births. If, at some time during prenatal care here, you decide to have a home birth, be sure to inform us so that we can transfer your care to the provider of your choice.

Who cannot give birth at WBWC?

Women with certain conditions may need the extra support of the hospital environment for birth, but may still receive prenatal and postpartum care at a birth center. This includes women with:

  • Previous Cesarean birth (only former WBWC clients)
  • Breech at term
  • Labor occurring before 37 weeks or after 42 weeks of pregnancy, if risk criteria are met

Other women may have conditions that require high risk prenatal care, as well as hospital birth, and “risk out” of birth center care.

This includes, but is not limited to, women with:

  • Chronic high blood pressure or a cardiac condition
  • Excessive tobacco use
  • Clinically significant malnutrition or obesity
  • Multiple gestation (twins)
  • Diabetes requiring oral medication or insulin
  • In-Vitro Fertilization (IVF) pregnancy
  • Very high or very low BMI

Each client’s medical history will be reviewed individually by the nurse-midwives.

Who can give birth at WBWC?

Any woman who expects a normal pregnancy and birth can use a Birth Center for prenatal, labor and delivery, and postpartum care.

This includes women with:

  • Rh negative blood
  • First pregnancy at age 35 or older
  • History of miscarriage
  • Medical conditions that do not affect pregnancy
  • History of controlled gestational diabetes in a previous pregnancy
  • Desire to transfer when receiving prenatal care elsewhere
  • Full term pregnancy, at least the 37th week of gestation

How is a birth center different from a hospital?

The Birth Center is a safe, comfortable, homelike setting where low-risk, healthy women are offered choices in the manner in which they give birth. The staff encourages family participation and women themselves choose who will share in their birth experience. We believe that education is an integral and essential part of a satisfying pregnancy and birth experience; it allows women to make informed choices throughout the process. Laboring women will be continually assessed and monitored by the nurse-midwife and the RN to assure both mother and baby are doing well.

Mothers are encouraged to eat, drink and move around in order to be as comfortable as possible during the labor and birth. Three of the four private birthing rooms contain a bathtub where mothers can spend time in the warm water to help them relax. Careful follow-up is provided after discharge from the center via telephone, home visits and office visits. These are only some of the special attributes of the midwifery/birth center model of care.

Postpartum & New Baby Care

What does postpartum care include?

  • Postpartum home visit by an RN
  • Integrated postpartum care of mom, baby, and breastfeeding from the WBWC team
  • 2-week and 6-week postpartum checkups at WBWC with CNM
  • Access to 24-hour midwifery care and phone consultation
  • Lactation counseling visits with WBWC’s International Board Certified Lactation Consultants (IBCLC)

Request an Appointment →