Midwife/Client Contract

Midwife/Client Contract

Purpose of this Contract
The midwifery model of care puts a heavy emphasis on the expectant mother being able to make the choices that are right for her based on adequate knowledge of the risks and benefits of the given choice. This document is intended to provide you with the information you will need to decide if I am the midwife for you and whether my philosophy is a good match with yours.

Pregnancy is a natural process, like any other and the vast majority of the time the woman’s body will know what to do. The midwife offers guidance and helps the woman to trust her body, but usually does not intervene in the natural process. Midwifery care can help the woman to find the information and support that will help her to nourish and care for her body so that it will serve her well.

Some problems do occur in a small percentage of pregnancies and by keeping watch over a woman’s physical and emotional signs and knowing what is normal for her I can help her to keep herself and baby healthy. In the cases where I cannot help the woman to resolve problems or they are beyond my scope of practice I will refer the woman to an appropriate care provider.

About your Midwife

My full name is Sara Marie Forrest Jaimes. I practice as a Certified Nurse Midwife (CNM) and I am licensed through the Arizona Board of Nursing. Currently, Mexico has no official regulation of professional midwives. I hold a Bachelor’s in Nursing and a Master’s of Science in Nurse Midwifery. My credentials from the American Midwifery Certification Board (AMCB) exam qualify me as a Certified Nurse Midwife. I hold a current certification in Neonatal Resuscitation, Cardio Respiratory Resuscitation and Advanced Life Support. To earn my Master’s, I had to perform a minimum numbers of prenatal exams, labor/birth/postpartum managements as well as complication management in a hospital setting, newborn assessments, breastfeeding support visits, family planning visits, preconception visits, perimenopausal/postmenopausal visits, gynecological exams, primary care/common health problem visits, and a certain number of clinical hours for each of her qualifications. I then had to pass national qualifying exams for each qualification.

About Homebirth

Homebirth midwives provide comprehensive clinical care during pregnancy. The Midwifery Model of Care offers women education and empowerment in all aspects of their care. In labor, surrounded by supportive people of her own choosing in a comfortable and familiar environment, a woman may feel remarkably less inhibited in expressing her natural and individual responses to labor. In addition, when labor and birth occur in the home, there is less interruption of family routines. Laboring women can, according to their own values, choose how to involve their children in the birth experience. Children, making their adjustments to new roles in the family, are not challenged with a lengthy absence of their mothers. Staying home to birth eliminates the difficult decision about when to go to the hospital or birth center during labor. Breastfeeding and family bonding are uninterrupted. Expecting the process of labor and birth to unfold smoothly but educated in prevention and treatment of complications, midwives are ever vigilant but non-interfering. Statistically, fewer complications and unnecessary medical interventions occur in the home.

Generally homebirth is considered appropriate for women who are not at high risk of developing complications during pregnancy or birth. As parents, you have the right to choose your place of birth. If at any time a consultation or transfer of care is advisable, I will initiate a referral. You have the right to refuse any such referral. If, however, I believe your life or your baby’s life is in imminent danger, I reserve the right to initiate an emergency transfer, without argument.

My Philosophy

I am committed to serving families of all backgrounds and of all incomes and to making midwifery care available to more women.

I feel that each woman is capable of making the decisions that are best for her. In choosing homebirth you have both a higher level of responsibility and control in your care. Throughout your care I am committed to fully informing you of your status and options, discussing the pros and cons of each option, and making an individualized care plan with you.

I view the childbearing period as a healthy time that provides an opportunity to grow personally and as a family. I offer you preventative and individualized care, autonomy, control, privacy, and my focused attention. Repeated studies have shown that for women with low-risk pregnancies, homebirth is as safe as hospital birth. In addition, hospital births carry some risks seldom associated with homebirths.

About My Services

Our standard schedule for prenatal care: appointments every three-four weeks until 28 weeks, every two weeks until 36 weeks, and weekly until the birth of your baby. After attending your birth, we generally do appointments at one day, three days, six-seven days, ten-fourteen days, and six weeks postpartum. Additional appointments can be scheduled according to your needs. I am always available by phone or email/whatsapp/facebook.

Labor and Birth Care

I want to be present at your labor when you reach the active phase so that I can ensure the baby is in a good position and that both mother and baby are doing well. I will obtain vital signs initially and every few hours as labor progresses. The baby’s heart tones are monitored every half hour in active labor and more frequently as transition approaches. During the second stage fetal heart tones are assessed every fifteen minutes, or less depending on how the baby is coping.

I will provide the appropriate medical/safety equipment necessary to handle any complications or emergencies, including oxygen and resuscitation equipment.

Postpartum Care
After the birth when both mother and baby are stable and content, a newborn exam will be done. Both mother and baby’s vitals are monitored on a regular basis during the postpartum period, breastfeeding is established and the family settles into normal postpartum routines. I will stay for as long as is necessary after the birth to ensure you and the baby are stable, both have eaten and the mother has been up to care for herself. This may be as little as two hours or as long as is needed.

I will check in on you by telephone frequently and then visit you at home approximately 24-36 hours after the birth. At two days postpartum I do a home visit for breastfeeding support, and a wellness check. A two week visit includes a wellness and weight check for baby, and breast feeding support. At six weeks postpartum there will be a final visit that includes a basic ‘return to normal functions’ assessment for the mother.

Newborn Care
I provide immediate newborn examination. I recommend that you obtain an appropriate care provider for your newborn before labor and delivery who can see the baby within 24-48 hours of delivery.

Safety and Back-up
Home birth has been proven in a number of studies to be as safe for mothers and babies as hospital birth. There are a few exceedingly rare complications where it could possibly save mom or baby’s lives to have an operating room and surgeon immediately available. (Giving birth in a hospital doesn’t guarantee an immediate cesarean either). The majority of transfers are not emergencies and will be done via private vehicle, but there may be times that an ambulance is used.

Possible Complications

I do not have a designated physician to transfer your care to should a hospital birth become a requirement. If this should occur I will stay with you and provide support. Circumstances requiring transfer of care or transport are unusual and affect fewer than ten percent of the women cared for by midwives. This list below does not, of course, include all possible reasons a home birth may no longer be advisable, but it does give the most commonly encountered complications. A more comprehensive list is available upon request.

Transfer of care during pregnancy

  • Diagnosis of diabetes
  • Excessive or diminished amniotic fluid
  • Evidence of significant of fetal growth retardation
  • Premature labor, before 37 weeks gestation
  • Thyroid problems not satisfactorily controlled.
  • Multiple gestation
  • Non-vertex position
  • Placental problems
  • Lack of compliance

Transport during labor

  • Non-vertex presentation discovered in labor
  • Excessive bleeding during any stage of labor
  • Blood pressure problems indicating pre-eclampsia or shock
  • Heavy meconium staining
  • Umbilical cord prolapse
  • Evidence of fetal distress
  • Prolonged labor
  • Elevated temperature
  • Maternal fatigue or inability to cope with labor
  • Signs of infection during labor/birth
  • Severe lacerations

Transport of the newborn

  • Possibility of meconium aspiration
  • Baby unable to maintain normal color, temperature, vital signs or unable to breastfeed
  • Any obvious defects or birth injuries that may impair the infant’s immediate well being

No matter where you choose to birth there are rare, but potential risks. Throughout your prenatal care I will be screening for these potential complications using basic physical assessment, blood work, urinalysis and further testing as necessary or desired. As during your prenatal care, I work proactively during labor and birth to prevent some of these complications. I will monitor your baby’s heart beat with a doppler, a handheld machine that uses ultrasound to listen to the heart beat intermittently throughout your labor and birth. Equipment that I will have at your birth to handle potential complications at home or to supplement on route to the hospital include: oxygen for both mother and baby, neonatal resuscitation equipment, equipment for suctioning the baby in case of meconium, IV equipment for maternal dehydration or hemorrhage, medications for hemorrhage, and suture material for repair of lacerations within the scope of my practice. Even with great prenatal care and attention, responsible care during labor and birth, complications can still arise. By signing this consent form you affirm that you understand that these or other complications may require transport to a hospital and could lead to permanent injury or death for you or your child, the same as if you were to birth your child in a hospital.

Please initial the following to ensure you have read and understand this document:

•It is my responsibility to take excellent care of myself through good nutrition, balanced exercise and healthy lifestyle _____

•It is my responsibility to avoid cigarette smoke and other harmful substances during this pregnancy. _____

•It is my responsibility to educate myself about birth by reading and taking a good childbirth education class. _____

•I will prepare my home by making sure it is clean and that the appropriate birth supplies are at hand. If my home is not acceptable or more than 30 minutes from the hospital then I will find another home to give birth in. _____

•I will ensure I have a working telephone and the appropriate phone numbers. _____

•I will ensure I have a working vehicle with a full tank of gas and will know the shortest route to the hospital. _____

•I will plan to breastfeed my new baby. _____

•I will arrange backup with a physician and a pediatrician in the event a consultation or transport is necessary. _____

•I will pay the fees for services in full. _____

Please  feel  free  to  ask  us  questions  regarding  our  experience  with  complicated  births.    We  want  you  to  have  confidence  in  the  care  you  have  chosen.  Ultimately, this will create a comfortable environment in which to birth your baby. The  majority  of  studies  on  the  safety  of  homebirth  show  that  homebirth  is  safe  for  low  risk  pregnant  women,  provided  there  is  a  skilled  attendant  present.  Homebirth  studies  also  demonstrate  that  good outcomes are achieved with very low rates of intervention, such as labor induction, labor augmentation and  cesarean  section.  These  procedures  are  used  at  very  high  rates  in  low  risk  hospital  births.  I  personally  believe,  and  evidence  shows,  that  home  birth  is  safe,  but  I am  not  against  hospitals.    Hospitals  are  vital  for  women  and  babies  with  complications,  and  for  those  who  simply  feel  uncomfortable  at  home.   Ultimately the choice is yours.

My Fees

My fee includes: complete prenatal, birth, and postpartum care, as well as, nutritional counseling, risk assessment, some diagnostic testing, birth preparation, newborn care education, breastfeeding support, and family planning consultation. It does not include: fees for lab work, ultrasound, physician consultation, hospital care, doula, or the cost of the few supplies we ask you to purchase for the birth. If my fee is not possible for you to pay please inquire about our sliding scale information sheet, the Birth Fund, or consider a payment plan.

Rarely, one or both parties may decide to discontinue care. In this case, we will both sign a document acknowledging this and we will do our best to suggest alternative care providers. Please see our refund policy in our financial agreement for more information.

Refund Policy

There are a number of reasons why a client may not birth at home with us. In some cases the client discontinues care during pregnancy and at other times a medical reason necessitates a hospital birth. If you birth in the hospital, I will maintain my commitment to providing care for you during the birth and postpartum. When care is discontinued for any reason, you are responsible for paying for the care you received. Similarly, there is no refund if I am unable to attend your birth due to insufficient notice or unanticipated circumstances beyond our control.

Refunds will be issued according to the following policy:

• $2500.00 of your payments is a non-refundable deposit

• You will be responsible for paying for the appointments you have already had at the rate of $300.00 per appointment.

• There is no refund if we attend your labor, birth, or provide immediate postpartum care either at home or in a hospital.

If you have questions about why we use this refund policy, we would be happy to explain it in more detail.

Transfer of Care

There are times as listed above, during prenatal care, labor, birth or postpartum when a health issue arises which is outside of the scope of our practice. At these times I may ask a client to have testing or consultation with other practitioners and possibly even transfer care.I am qualified and experienced in handling many birth complications; however, some cannot be treated effectively at home. If one of these complications were to arise during your homebirth, you would be further away from the life- saving technology that is available in hospitals, although of course, even the most advanced hospital care cannot prevent every complication or save every life. In the case of a transport to the hospital I am committed to fully informing you of the reasons why and the possible options available to you. Transporting, particularly during labor, can be frustrating or disappointing for clients who had been planning a birth at home. If there is a transport, I maintain our commitment to providing care during the birth and postpartum, but I do not have privileges to practice in any hospital and cannot act as your primary health care providers in the hospital. Most transports are not emergency situations and you can go to the hospital of your choice. In the event of an emergency, I will transfer care to the closest hospital that can provide appropriate emergency services. Each client will make a non-emergency and an emergency transport plan for the prenatal, birth, and postpartum period. During pregnancy, each client is responsible for having a physician and pediatrician in case of transfer.

Transfer Plan

Hospital (non-emergency) ______________________________________________________

Hospital (emergency)__________________________________________________________

Physician Phone ______________________________________

Pediatrician Phone_____________________________________

After  the  birth  of  your  baby,  I  would  like  to  celebrate  this  event  with  others  in  our  community. I  do  this  by  posting  a  birth  announcement (with only the baby’s gender, no names) with  a  photograph  on  my  Facebook account and documenting the birth in my records. Please initial here to show agreement to this. ________

I, _____________________________________ have chosen to have a home birth and have some/all of my prenatal care provided by Sara Marie Forrest Jaimes, CNM. This choice was made after careful consideration of the alternatives. I have discussed our prenatal care and birth options with Sara, had all my questions regarding her experience and background answered to my satisfaction, and have had the opportunity to see a physician of my choosing to discuss options to the extent that I think necessary.

In requesting the services of a home birth Certified Nurse Midwife, I freely exercise my right to seek the type of maternity services I feel is best for my baby and myself.

All births regardless of setting (hospital, birth center, or home) carry a certain degree of risk. Even with low-risk pregnancies and births, complications may arise. Generally, when complications arise there is ample time to transport to the hospital. Occasionally, complications must be dealt with at home. In choosing to have a home birth, I knowingly and of my own free will accept any and all risks and responsibilities for this home birth and the health of myself and my baby. I realize that no matter how carefully my risk status is assessed, there can arise emergencies or other unforeseen events resulting in poor outcomes. Obstetric emergencies and complications include, but are not limited to, labor prior to 37 weeks or after 42 weeks gestation, abnormal vaginal bleeding, placenta previa or abruption, postpartum hemorrhage, retained or adherent placenta, pregnancy induced hypertension, prolonged rupture of membranes, fetal distress, prolapse of the umbilical cord, stillbirth, respiratory distress in the newborn, sepsis, and shoulder dystocia. I understand that this list is incomplete and agree to transfer mother and/or infant to physician management and care if deemed necessary by my midwife. I realize that there are fewer diagnostic and therapeutic measures available at home to use in the event of an emergency. I recognize the possibility that some emergencies are better managed in a hospital setting. Whenever possible, the decision to transfer care will be made jointly by me and the midwife, although I understand that a situation may arise where I must accept the judgment of the midwife to transfer care. I understand that Sara Marie Forrest Jaimes, CNM, does not carry medical liability insurance.

I hereby consent to the prenatal and home birth care provided by Sara Marie Forrest Jaimes, CNM. I hereby release Sara Marie Forrest Jaimes, CNM, and any consulting physician from all liability arising from acts or omissions on their part. I acknowledge that the management of my pregnancy and birth are based in part by the information provided by me and therefore agree to provide the most accurate information possible.

I understand that if I refuse a physician referral that my midwife deems necessary during pregnancy, then my midwife can discontinue care. I understand that if I refuse transport when it is advised, the midwife and/or her assistants reserve the right to call an ambulance to stabilize the mother and/or baby. I understand that our reception at a hospital in a transport situation may be less than pleasant.

I understand that I may terminate my midwife’s services at any time.

Name ___________________________________  Date __________________

Signature (Client) _____________________________________________________________

Signature (Midwife) ____________________________________________________________