Prenatal Care

 
Prenatal Care

Prenatal care in the comfort of your home

 

With Threshold Community Midwives, the heart of your prenatal care is about building a trusting and honest relationship. We offer you hour-long prenatal appointments to discuss your pregnancy, monitor you and your baby’s health and well-being, as well as spend time getting to know you and your family. By the time you have your baby, we hope to have built a strong relationship of trust and comfort, so we can best support you in your birth and transition into parenthood.

Prenatal care begins at the start of your pregnancy (or whenever you come into care with us). We offer comprehensive prenatal care including all screening and testing options related to pregnancy (prenatal labs, genetic screening, STI testing, gestational diabetes screening, Group B Strep testing, referrals for ultrasounds, etc) and do our labs in our office or at your home. Each prenatal visit includes pregnancy assessments and monitoring of the health and well-being of you and your baby, education and counseling, and consultations with other medical providers as needed. We make sure that all of your questions and concerns are addressed, and we give you evidence-based information on all testing, options, and exams during your pregnancy so that you can make the best choice for you and your baby. We are committed to informed consent and embodied consent; we know that you are the expert in your body, family and needs and in honoring that we share decision making and responsibility with you.

Prenatal Visits Include:

  • Initial consultation either in-person or by phone to see if we are a good fit and answer your questions

  • 1.5 hour initial prenatal visit to get your medical history, discuss your pregnancy thus far, do initial lab work, pregnancy assessments + listen to fetal heart tones

  • Hour long routine prenatal visits

    • Every 4 weeks until 28 weeks gestation

    • Every other week from 28-36 weeks gestation

    • A home visit at 36 weeks with your complete birth team (both midwives and anyone else planning to be at your birth)

    • Weekly visits from 36 weeks until birth

    • Additional appointments as needed

  • Flexible appointment times so that you can have an appointment during the day or in the evening, depending on what works best for your schedule

  • Visits that alternate between midwives, so you build quality relationships with both of us

  • Ongoing phone calls or emails throughout your pregnancy to help you answer questions / concerns in between prenatal appointments; for non-urgent matters we respond within 48 hours

  • On-Call 24/7 for urgent support throughout pregnancy. Your midwives will discuss what urgent needs might be and when to call the midwife after business hours

Labor & Birth

 
Labor and Birth

Photo by Brooklyn Logan of Mindful Mama Birth

 

Your midwives are on-call for your labor and birth beginning at 37 weeks gestation through the birth of your child.

Both Tessa and Emmy will attend your birth, one acting as a primary midwife and the other as the assistant midwife. Your primary midwife will be in contact with you throughout early labor, offering phone support and advice for coping. We will plan to arrive at your home when you are in active labor, providing gentle and loving support. During your labor we monitor your vital signs, intermittently monitor the baby’s heart rate, track your labor progress and coping to assess your overall well-being. We encourage freedom of movement and offer positions to facilitate progress, offer comfort measures, herbs to facilitate labor and provide emotional support.

While monitoring the health and well-being of you and your baby is one of our top priorities, we also strive to hold you in a safe and affirmed space. Physiological birth happens best when you can relax, feel cared for and safe, and when you can tap into the trust and wisdom of your own body and its ability to birth. We encourage oxytocin-rich, supportive environments during and after birth to facilitate the best outcomes for new families.

After the birth of your baby, we support immediate and uninterrupted skin to skin contact with your baby. We encourage delayed cord clamping by keeping the cord intact until the birth of the placenta (or longer if desired). After your babe arrives, your birth team will stay for 2-4 hours to monitor you and baby, ensuring that everyone is stable and well. We will perform a newborn exam on baby and leave you with thorough postpartum instructions for how to care for yourself and baby, as well as what might be cause for concern. Your primary midwife continues to be on call for you 24/7 after we leave, should any concerns arise.

If anything during your labor is abnormal or requires more care than we are able to provide you at home, we will transfer you to the nearest or preferred hospital; safety of babies and parents is our top priority. If a transfer occurs in labor, your primary midwife will accompany you to the hospital (as Covid-19 protocols allow) and continue to support you through your birth.

Please see the section on Home Birth FAQs regarding the safety of home birth, our emergency skills and capacities, and information about emergent and non-emergent transfers to the hospital during or after labor.

Postpartum Care

 
Postpartum care

Photo by Brooklyn Logan of Mindful Mama Birth

 

We love the sweetness of postpartum home visits and think this is one of the best parts of home birth care. During your postpartum visits, we monitor the overall health of you and your baby, offer support and education for lactation / infant feeding, support your healing and caring for your baby. We continue to be available to you 24/7 by phone throughout your postpartum to answer question and address concerns regarding you or your baby.

Postpartum visits include:

  • Home visits on day 1, day 3, and day 7

  • Care for you in our office at 2 weeks and 6 weeks and additional visits as needed

  • Ongoing drop-in postpartum group gatherings, as a part of the Threshold Community Midwives network

  • Monitoring you and your baby’s vital signs and baby’s weight and family bonding

  • Support and education around breast/chest feeding, including troubleshooting issues, monitoring frequency and feeding patterns, baby’s output and referral to lactation consultants as needed

  • Support your physical and emotional well-being during this time of transition

  • Offer Critical Congenital Heart Defect (CCHD) screening, Hearing Screening, and Newborn Metabolic Screening

  • Opportunities to process and debrief your birth experience

  • Opportunities to give your midwives feedback and evaluation of care

  • If you transferred to a hospital during your labor, we will pick up postpartum care once you and your baby are discharged

Payment + Fees

Our total fee for your entire course of home birth care (including prenatal, labor and birth, and postpartum care) is $6000. This includes the $600 assistant fee.

We accept Medicaid (Green Mountain Care and Dr. Dynosaur). Medicaid clients are charged an out-of-pocket fee of $1800 - $3000. For those with private insurance we work with a medical biller to prepare a claim to your insurance company for reimbursement after the end of your care. We are out-of-network providers with private insurance companies.

This does not cover lab fees (covered through your insurance company).

We offer sliding scale options and payment plans.

Please visit the Payment + Fees page for more information.