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.

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.

CPC is woman-focused, enhances a woman’s ability to make decisions regarding her own care, and encourages the social support that is so critical to successful out-of-hospital birth. You also receive the benefits of one-to-one care and meeting all the WBWC providers during your regular clinic visits.

For the family planning a birth center birth, the group sessions offer the opportunity to meet with like-minded women and partners who have made the same choice. Having a forum for discussing questions and concerns about pregnancy, birth, breastfeeding, and parenting provides you with a supportive community which will enhance your pregnancy and birth experience and build your confidence in your ability to birth, feed, and parent your baby. In community, you have the opportunity to challenge the traditional philosophy of birth that treats pregnancy and birth as disease states, embraces technology, and builds fear. You will help to empower each other with confidence in your body’s knowledge and wisdom, trust in your ability to cope with pain, and belief that you know more about your body and your baby than “experts” do.

A group of six to ten women with similar due dates meet for six monthly sessions for 90 minutes in an informal setting with two WBWC co-facilitators: a midwife, who rotates, and a nurse, who will be the same for all sessions. Partners may participate as well. You check and record your own weight, blood pressure, and weeks of pregnancy and keep a copy of the information in your “chart”. Growth of the uterus and fetal heart tones are checked by the midwife in a private area of the group space. You will only be apart from the group for three minutes for the tummy checks! The group sessions follow a syllabus but the majority of the time is spent in conversation with others, learning about and sharing pregnancy, birth, and parenting concerns. And we serve snacks.

CPC is part of your prenatal care so there are no extra charges. If you have health insurance, group care is covered. If you are self-pay, it is included in the fees you are paying for your care.

No, to avoid distraction for all those in group, as well as space and time constraints, we are unable to include siblings in group care. Children of any age find 90 minutes in a group boring! Since you will know the date and time for all of your CPC visits ahead of time, you can make child care arrangements more easily. WBWC staff is unable to provide childcare during group. You are always welcome to bring children to your individual appointments.

If you have a problem that needs additional evaluation by the midwife, there will be time before or after group to address these concerns. Please call the day before the group session to reserve additional time, if possible. You may also schedule problem visits between group sessions. If specific health conditions emerge during the pregnancy, those conditions may be managed in group or may require extra individual visits in the clinic.

Yes, you will still get all of the same testing offered if you participate in CPC that you would get with traditional care. Any labs, prescriptions or ultrasounds can be ordered for you as needed by your CPC midwife. Your labs will be drawn during your individual clinic visits.

Yes, prepared childbirth classes are required for all first time pregnant women and highly recommended for first time fathers-to-be. If for some reason you are unable to take childbirth education classes, you must make an alternative plan to prepare for your birth and review the plan with a midwife. This is a group.

Special confidentiality rules are maintained throughout the program. All participants, including support people, are required to sign a confidentiality agreement at the first group visit. We stress that a person’s specific concerns should not be discussed outside the group setting. Any information shared with the group is up to each person. No one is ever pressured to disclose private concerns.

Discussions get pretty lively when women (and partners) get together to talk about pregnancy & birth! The commitment we make to group participants is that we will start and end ON TIME – so instead of sitting in the waiting room when the office is busy or your midwife is running behind, you will start your visit as soon as you arrive and be learning and interacting the entire time. We have found that once women get to know each other, the time goes by very quickly.

“We participated in group prenatal care when we were pregnant with our daughter, and I loved the experience. It was great to have people to talk to throughout pregnancy that were at the same stage as I was and experiencing some of the same things. Especially for first time parents, I can’t recommend group prenatal care at WBWC enough!”

– Sarah, group prenatal care mom

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.

Pain management strategies available include:

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

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.

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.

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

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.

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.

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.

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

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 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)