TriCare, just like the overwhelming majority of health insurance, does not cover my services. However there's a change coming in 2025 that gives service members and their family another option to fund a homebirth.

Starting this year, military members can have a Flexible Health Care Spending Account or FSA. This account can be used to pay for services not covered by Tricare, including midwifery fees for a home birth.

The benefit of a FSA is that it uses pre-tax dollars which effectively gives a discount of whatever your tax rate is for anything you use those funds to pay for.  

Of course there are other ways to fund a home birth including: 

• Start saving for a home birth in a regular savings account. This option is available for everyone and can be a great way to get a head start on funding a homebirth, or to supplement FSA funds if needed. You can start funding the birth before baby is more than a twinkle in your eye.
• Use a gift certificate. Some midwives may offer gift certificates so family and friends can support you in getting the birth you want. If the midwife doesn't offer gift certificates, she may be willing to if asked.
• Add funding for the home birth to your wish list for a baby shower.  
• Declutter and have a yard sale or sell things online.
• Bartering for all or a portion of the midwifery fee may be an option if the midwife is open to barter. 

Having more options to fund a home birth when insurance doesn't is helpful, especially when an option lets you use all your money instead of what is left after taxes.

​I serve many clients who have pets and I have attended births where pets are present and I have some observations and thoughts about pets, labor and birth.

Full disclosure here: Cats have been part of my life from day one. I've been told that when I was brought home from the hospital after birth, our cat decided to sleep with me in my crib that day. So I may be a little biased about pets and infants.

I think dogs and cats know when Mom is pregnant. Cats and dogs have very sensitive noses, and can detect changes in odors and pheromones. While there aren't studies on pheromone changes during pregnancy, we do have research that hormonal changes can change body odor. I strongly believe our pets pick up on these changes. I have been at labors where I could tell that Mom was getting closer to birth because her pets wanted to be closer to her the nearer she got to birth. Even if pets aren't in the room with Mom for labor and birth, they will hear a baby crying, and will know there has been a change and that they are hearing someone new.

I encourage families to introduce pets to their newborn in the first hours after birth. Just as you would introduce your pet to a guest who comes into your home, you should introduce your pet to the new family member. I do recommend a supervised introduction so parents can help pets to stay calm when they meet baby. I also recommend continued  supervision when your pet and baby are together in the future. 

After baby is born, expect a few changes in your pet. If you have dogs, they may become very protective and guarding of your baby and may not be as welcoming to visitors as they used to be. With a little time, they will figure out that visitors are okay when a parent is around. Cats may want to sniff baby and that might be all they are interested in doing. Some cats might want to sleep where baby sleeps in the hopes of getting more attention.

Pets are family members too. Letting pets be part of your baby's journey will make life all the richer for both your little one and your pet.

The umbilical cord is what connects the placenta and baby. It has one function, to carry nutrients, antibodies etc to the baby and and to carry waste from baby to Mom. 

The umbilical cord has one artery and two veins.  The artery carries oxygen and nutrients to baby while the two veins carry waste products away from baby.  The umbilical cord vessels are cushioned by Wharton's Jelly.  This is the same substance found in eyeballs.  Because of this substance, the cord is very resilient, being able to function even if baby is sitting on it, or has it wrapped around a hand or leg.  

One thing I find fascinating is that the blood vessels that carry blood and waste products to and from the umbilical cord stop functioning after baby has transitioned to normal newborn circulation around 24-36 hours after birth. In the days and weeks after birth, the umbilical arteries becomes the medial umbilical ligaments and the umbilical vein becomes a ligament between the liver and the abdominal wall.

Sometimes at birth, the cord is wrapped around a shoulder or baby's neck.  While it sounds scary to have the cord wrapped around the neck, it is important to remember that baby isn't breathing until after birth and the umbilical cord continues to carry oxygen to the baby.  If the cord is wrapped, I simply unwrap it.  I have seen cords that have a knot. It's not common.  It can cause a problem if it gets pulled extremely tight, but most of the time that does not happen.

Fun facts about the umbilical cord:

• the length of the cord is close to how long baby is in many cases.
• 30% of babies have the cord wrapped somewhere on their body at birth.
• Most umbilical cords are twisted, similar to the way old school phone cords twist.
• Umbilical cords do not have nerves.
• The umbilical cord has no impact on whether your baby will have an "innie or outie" belly button.
• At birth, the umbilical cord is a blue/purple color and plump with blood which transfers to baby after birth, as a result the cord becomes thin and white.

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Recently, a client decided during labor to transfer to hospital care for birth.  Shortly after we got there, the OB asked me why I "let" my client continue to labor. That got me thinking about what I see as the biggest difference between midwifery care and obstretric care.

There was nothing happening with the labor I was at that would indicate an immediate trip to the hospital was needed.  As I've written before, hospital transfers can happen for benign reasons like a client wanting pain medication, or because the client is tired and wants the tools hospitals offer to get contractions stronger to get finished. The client is in charge and if they want to go to the hospital, it's my job to facilitate and support them in that.

In the past the American College of Obstetrics and Gynecology has had wording to include "allow a trial of labor after cesarean"  as well as "allowed to push" in their provider guidelines. I was asked why I "let" someone continue to labor at home. The connotations those words have is the difference between midwifery and obstetrical care. 

To allow or let means someone is in charge, or has control over what another person is doing. My clients are adults who have taken the time to educate themselves on the risks and benefits of home birth, and they have also educated themselves on the risks and benefits of hospital births and interventions that are offered at hospitals.  

My clients are the ones making decisions regarding their care. My role is to facilitate and offer education so they understand what is happening and understand fully the risks and benefits of the options so they can decide what is best for the individual situation and for them. I don't "let" or "allow" my clients to do anything!!  My clients are fully capable of making decisions without my permission and I wouldn't want it any other way.

​Recently during a birth, my client commented on how hands off I was. I took that as a huge compliment.  

I've attended many hospital births. At every birth I attended except one, all the doctors were very hands on, stretching vaginal tissues as baby's head came down, reaching hands in to grasp baby by the shoulders to bring baby out, or worse yet, placing both hands on either side of the baby's head and applying traction to pull baby out. These were births where there were no indications the baby needed any help to get out.  

Being hands on, intervening in the physiological process of birth, can have negative impacts. Pulling on a baby's head can cause nerve damage to the shoulders, and/or face. Placing hands in to stretch tissues may actually stress and weaken the tissues compared to letting them stretch gradually around baby's head.  Placing hands in to pull baby out by the shoulders can lead to tearing when there normally wouldn't have been tearing or it may make a tear worse.  

There are times I need to use my hands to help baby navigate its way out. A shoulder could get hung up on the pubic bone, or baby's torso could be larger than the head leading to the need to help baby out. Often in those situations, simple position changes to open the pelvis in different ways are all that is needed to help baby out. It is rare that I actually have to use my hands to help baby. In fact, I have only needed to use my hands to help baby out twice in the births I've attended in my own practice so far.

I firmly believe birth works best when it is not interfered with. I am mindful of this at every birth I attend. I don't want to disrupt physiological birth unless baby lets me know they need help, and then using an intervention that involves my hands is a last resort when other options have not worked. Balancing my knowledge, and intuition with trust in birth helps me keep my hands off unless there truly is a need to use them to help baby.