How busy is your practice? How many midwives are on staff?

Elena Rosa, LM, CPM is the owner and founder of Kindred Holistic Midwifery. She is a solo practitioner who values providing her clients with a personalized experience. She takes on no more than 3 clients a month to ensure each client gets their needs met.  In the event of an emergency, she does maintain relationships with other midwives in the area for back up support as needed.

When do we make our first appointment? How many times do we see the midwife?

Your initial obstetric appointment (IOB) usually takes place between 10-12 weeks. For late transfers, we will keep to the standard prenatal visit schedule and strongly advise your records be uploaded to your client portal by your initial visit to ensure a smooth transition for your care. We follow the ACOG recommended schedule of prenatal visits: every 4 weeks for the first and second trimester, every 2 weeks after 28 weeks, and then every week from 36 weeks until delivery. The due window is between 37 and 42 weeks. Three postpartum visits are also included in your care: 48-72hr, 2 weeks, and 6 weeks postpartum.

How available will you be for me?

Our visits last from 30-60 minutes in duration where we cover topics ranging from nutrition, fetal wellbeing, mental and emotional health, and childbirth prep to name a few. Aside from the time spent during prenatal visits, any and all concerns should be addressed through a phone call for emergencies (miscarriage, preterm labor, etc) or through the client portal for non-emergent issues (appointments, financial arrangements, lab results).  Texting is not a preferred method of communication. Healthy boundaries make a healthy midwife/ client relationship.

Do I need to have an OB/GYN in addition to having a midwife? What is the main difference between the two?

Unless there is a medical reason for collaborative care, a licensed midwife is trained and qualified to provide prenatal care, labor and delivery, and postpartum care for low-risk clients who desire an unmedicated, out of hospital experience. A risk assessment is performed at the IOB and again at 28 weeks to verify no changes have occurred during the pregnancy and the remainder of care can be monitored by a midwife safely and independently. An OB/GYN has hospital privileges, monitors high risk patients, can medically induce labor, provides medical pain management, and can perform cesarean deliveries.

Can I have a hospital birth with a midwife?

At KHM, we have a prenatal and postpartum care package specifically designed for clients who want to benefit from one on one midwifery care but would prefer to deliver in the hospital. For an additional fee, the midwife may accompany the client for labor support depending on availability. Otherwise a list of trusted doulas will be provided for labor support.

If I have had previous c-sections, what are my chances for having a trial of labor for vaginal delivery?

Homebirth is an option for someone who has had 2 cesarean deliveries or less. We require a consultation with a OB to review your history, discuss the risks and benefits of a TOLAC/ VBAC, and obtain a signed consent form accepting responsibility

Are your services covered by insurance? Do you take Medicaid?

At this time, KHM is not a Medicaid or private insurance provider. Cash, credit card, check, and FSA/HSAs are all accepted forms of payment for services rendered. Payment plans are available. An itemized receipt can be provided for reimbursement. If one or both partners have vocational skills or services, barter is also a possibility for a portion of the package fee at the discretion of the midwife.

How do you handle complications and transfers during labor?

Possible interventions and complications are an important conversation to be had during the childbirth education/ prenatal care process.  There are protocols for both emergent and non-emergent transfers with a required emergency care plan on file that will be reviewed and signed at the 28 week visit.

Where do I go for labwork or a sonogram? Is that included? What if I don’t want to get a sonogram?

Kindred Holistic Midwifery is responsible for obtaining all lab samples and submitting them to the lab.  A standard prenatal lab package is offered, including but not limited to urine samples, blood work, and cultures.  The complete lab package fee is $450 and due at the initial visit. If a client has insurance, the labs can be billed accordingly.  If any additional labs are necessary or requested that are not included in the standard prenatal lab package (ie thyroid panel, complete metabolic panel, genetic screening, etc), the patient assumes responsibility for payment. An ultrasound script will be provided at between 18-20 weeks for a fetal anatomy scan, a significant component of prenatal care that provides vital information regarding fetal wellbeing.  This diagnostic test is non-negotiable. Location recommendations will be provided for clients to obtain the sonogram, however the client is responsible for payment directly to the chosen facility.

Do you provide resources and follow up for clients with PPMD?

Yes, clinical providers are becoming more aware of postpartum mood disorders (PPMD). The Edinburgh Postnatal Depression Scale (EDPS) assessment tool is used at the initial visit and at 6 weeks postpartum to gauge the need for mental health services.  If necessary, an additional follow up with the midwife between 4-6 months postpartum will be scheduled to assess any improvements using the Personal Health Questionnaire (PHQ-9). It is very important to our practice to provide excellent postpartum resources and support even after the prenatal journey has transitioned.