For as long as women have been pregnant, curiosity has abounded about what the baby is doing in utero and how it develops and grows.  X-rays were used starting in the 1920's to look at the baby in the uterus.  As concerns about safety arose and evidence accumulated, X-rays finally stopped in the 70's in the US.  Ultrasound was used in pregnancy starting in the 1950's in Scottland.  As the technology improved in the 70's, viewing baby in utero shifted from X-rays to ultrasound.

Ultrasound can be very helpful during pregnancy. Ultrasound can tell where the placenta is located, if it is on scar tissue for someone wanting a VBAC, or how close the placenta is to the cervical opening in suspected cases of placenta previa.  It can tell if baby is breech or head down, or outside the uterus in the case of an eptopic pregnancy. It can also detect some fetal anomolies such as a 2 vessel cord instead of a 3 vessel umbilical cord, kidney issues, heart defects and many other anomolies that may be concerning or require additional medical attention.  And of course, it can show baby's gender, or what baby is doing at the time of the ultrasound.  It can be amazing to see your baby doing things like sucking their thumb or having hiccups.

Ultrasound studies completed before 1992 showed no adverse affects.  These studies were completed using lower intensity ultrasound.  Since 1992, ultrasound intensity has increased by seven times without any in-depth studies to track if there are any effects from this higher intensity.  We do know ultrasounds can heat up water and tissue.  The longer the ultrasound is applied, the higher the risk of overheating the tissues and amniotic fluid.  

I may ask my clients to get an ultrasound if there is information I feel we need to provide optimal care.  For instance I may ask a client who is planning a VBAC to get an ultrasound to verify where the placenta is located in relation to the cesearan incision site, or to confirm baby is head down if we are wondering about a breech presentation.  I do not require my clients to have an ultrasound as a routine part of my prenatal care.  If my client wants to get an ultrasound, or decides not to is their choice.  I support my client's decision regardless of what they choose.

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Pressure! Going past your due date can bring lots of pressure from family, friends and even complete strangers.  No one would place a bet on something when the odds of winning are only 5% but that doesn't seem to apply to due dates.  It amazes me just how much focus we put on a date that we know has a 95% chance of being wrong! (Click here to read my post on due dates.)

What should you do? Provided you and baby are doing well, I don't feel there is a need to "do" anything besides wait.

There are ways to check on how baby is doing in utero just to be sure waiting is a good option. I like using a biophysical profile to assess.  A biophysical profile is an ultrasound witih additional factors measured.  It measures five criteria: amniotic fluid levels, fetal movement, breathing movements, fetal heart rate, and fetal muscle tone.  Each criteria is worth a maximum of 2 points.  If the score is 8 or higher, that indicates baby is doing well and it is ok for the pregnancy to continue without any interventions for up to a week.  I like to listen longer during prenatals to hear how baby's heart rate changes during the stimulation of palpation and how long it takes to come back down to baby's normal or resting heart rate. This helps me assess how well baby is doing.  I ask clients to track baby's movements starting at 28 weeks gestation so it is easy to spot any changes that might need further evaluation.  I also rely on mother's intuition since they are the ones who know baby best.

There are risks to be aware of if pregnancy goes past 42 weeks.  The risk of stillbirth doubles from 1 out of 1,000 babies to 2 out of 1,000.  Your baby should continue to grow so it will be larger than if you gave birth earlier.  There is an increased risk of cesearean section if a hospital induction fails, meconium aspiration syndrome and baby being in the NICU.  

My clients and I will have a discussion about the risks of pregnancy going beyond 42 weeks.  We will also discuss the options of going to the hospital for an induction, waiting for labor to start on its own as well as gentle things that can be done at home to encourage labor to start like chiropractic or accupressure.  If I do not see anything that concerns me or tells me that baby needs to come soon, and my client's intuition isn't telling her baby needs to be born, then I will support the option of waiting if that is what the client decides to do.  





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Do you strip membranes?  Can you rupture my amniotic sac?  When should I start this tea, herbal rememdy, preparation to get my body ready for labor? What do I need to do to get labor started? 

What do all these questions have in common?  The idea or belief that the body needs some form of help or assistance to get labor started, that the body will not or can't start labor without help.

Please stop!!  Your body isn't broken!  Your body doesn't need help!  Your body knows what to do!  You can trust your body!

Due dates are based on Naegel's rule.  Franz Karl Naegel was an obstretrician born in Germany in 1778, who became the director of what we would consider a maternity hospital.  Naegel's rule assumes every woman has a 28 day cycle, and that ovulation is on the 14th day of the cycle and that pregnancy lasts 280 days from the first day of the last period. We can use modern tools such as ultrasound to try to estimate a more precise date,  but we are still using an estimated date.

The evidence shows that only 5% of women actually give birth on the due date.  Even if the date of conception is known there is still a wide variation in how long gestation is.  Up to 41% of pregnant women are induced for reasons including being close to or past the due date.  We have very little data on women who carry past 42 weeks gestation in part due to inductions. It appears that 1% of women will go past 42 weeks. I personally know mothers who had in-vitro fertilization and went over a week past the due date even though the date of conception and implantation was known.

Just as we grow at different rates after birth, babies grow at different rates inside the uterus.  Some babies are ready to be born before the estimated due date and some babies wait 2 or more weeks after the estimated due date.  This is to be expected and perfectly normal.  Having to wait for labor to start does not mean that your body won't go into labor, or that something is wrong.  It simply means that you need to continue to wait.  

Labor works best when it starts on its own without "outside" help.  When it starts on its own, your body is primed for labor and your baby is primed for birth.  Being primed means labor may be more effecient, and your baby will be ready for life outside the uterus.  When introducing something external such as rupturing the amniotic sac to get labor started, there can be interference with the hormonal cascade of labor which may lead to a longer labor, or baby not tolerating labor well.

If I have a client who goes well past her estimated due date (more than a week), we will discuss what all the options are including continuing to wait.  We will have a discussion about the risks and benefits of the options and I will trust her to make the choice that is best for her and her baby.  I do not consider going past the due date an emergency or requiring the need for interventions.  Babies come on thier own schedule and that is ok. Your body doesn't need help just because you are past your due date.  You can trust your body to go into labor without help when the time is right.

​I am often asked by those considering my midwifery services if I take insurance.  I do not and I would like to share why.

One factor in my decision to not accept insurance is that insurance does not accept me.  Insurance often covers the services of Certified Nurse Midwives but not Certified Professional Midwives, or they may cover a hospital birth but not a home birth.  It is extremely rare for a health insurance company to cover my services.


​Money from insurance companies does not come without strings attached.  I do not want to be told who I can serve and who I cannot.  I do not want to have to do certain labs or procedures to meet the requirements of an insurance company.  I operate from the principle of fully informed consent and I am concerned that insurance requirements would intefere with informed consent. I am also concerned that meeting insurance requirements may mean unecessary tests or procedures, or that the insurance company may disagree with what my client and I agree is necessary to provide the best care.

When my oldest son had his wisdom teeth removed, the insurance company decided that my son only needed one dose of anesthesia so I had to cover the second dose of anesthesia out of pocket.  I was appalled that the insurance company was using a "one size fits all" guideline for medical procedures instead of taking into account individual diferences such as metabolism which would affect how long the anesthesia remained effective, or that my son's teeth had to be broken up to be removed instead of just pulled out.  The insurance company decided they knew more than my son's medical provider.  I have dealt with health insurance restrictions in my own health care.  I had to take the "cheaper" medications and get proof (labs in my case) that they were not effective for me before I could take the more expensive medication my doctor wanted to prescribe that worked best for me.  My health insurance policy dictated my health care, instead of my provider's expertise.  

Not accepting health insurance gives me the freedom to provide the best possible care I can for my clients without delays or having my clients jump through hoops.  I can use my best judgement without navigating restrictions or requirements.  Not accepting health insurance ensures my clients know I am working solely for them, not an insurance company.  Not accepting health insurance gives me the freedom to use all my knowledge and skills to provide the best care I possibly can for every client I serve.