Serving San Diego, San Marcos, Vista, Escondido, Poway, Carlsbad, Oceanside, Encinitas

Questions​ & Answers 

The Midwife
Why choose a Midwife?

Midwives offer an in-depth amount of education and time spent at prenatal visits, choices in how care is rendered, flexibility in the way you choose to give birth including water birth, continuity of care throughout your whole pregnancy, birth and postpartum. Also see our
Fathers page for more information. 

Here is what the American Pregnancy Association has to say about midwives.  

How were you trained?

I began my midwifery education attending births with a midwife of 25 years in central Kansas. After 14 months I returned to my home state of California, enrolled in a state approved school and began my academic studies while gaining invaluable clinical experience assisting a local midwife of 26 years in a busy practice serving 4-6 clients a month.  In 2014 I sat for my medical board exams and became licensed, while also receiving my Certified Professional Midwife (CPM) status.  Hands on clinical experience is invaluable in this profession and has molded me as a midwife.  
  

What is the difference between a doula, midwife and monitrice?

Doula -- a non-medical support person educated in birth and postpartum recovery who accompanies a woman throughout her labor regardless of where she has chosen to give birth.

Doula Monitrice –- a medically trained and licensed professional who supports the women as doula and can also make medical evaluations, such as vitals on mom, listening to the baby’s heart rate, and doing vaginal exams.  The extra services are an additional charge but can be very good for those moms who desire to deliver in the hospital but would like to labor at home safely as long as possible. I highly recommend this option for VBAC mothers who want a hospital birth.
  
CNM or LM Midwife –- an autonomous healthcare provider trained in the comprehensive care of pregnancy, birth and postpartum.  Midwives trained as Certified Nurse Midwives often provide care through the medical system, while Licensed Midwives provide out-of-hospital birth options. Note, some CNM's do provide out-of-hospital care.


Midwives 
How late in my pregnancy can I transfer care to a midwife?​​

Frequently women find out about midwifery care and out-of-hospital birth late into their pregnancy and begin seeking options. If this is you, I recommend that you request your prior medical records and have them in hand when you start interviewing midwives. The sooner you get into care the better, but better late than never! 


How do I know if a midwife is right for me?

If you are experiencing a low-risk pregnancy, want to be educated on your chooses, and desire a natural birth outside of a hospital setting then a midwife might be right for you. Interviewing midwives in the community is one of the best ways to get a feel for whether a specific midwife is right for you. It is SO important that you are giving birth where you feel safe and with someone attending you whom you feel comfortable with. You can check out my Birth Center or Home birth options on the Services page.

siblings at birth with newborn
 Prenatal Care
What can I expect to happen at my prenatal visits?

During the first prenatal, we go through an orientation, do the necessary paper work, complete medical history, do a physical exam and offer a breast exam. Then we move onto what you can expect at the rest of your prenatal visits, we talk about how you are feeling, upcoming test, how to prepare for your birth, answer questions and go through educational forms.   We also check on you and your baby by doing your blood pressure, measuring your baby’s growth, listen to the baby’s heart rate, feeling the baby’s position and review baby’s activity level.    


How do I get my labs done?    

Myself and my assistants are trained phlebotomists and we do the lab draws for you right in your home. No need to make a special trip to a lab!


What labs and test are done?

For a comprehensive list and description of laboratory test that will be offered please see  pre and post-natal labs.     All labs that are offered through traditional obstetrical care will be offered through our services. This includes a basic prenatal panel, UA, and STI screening.  Other testing offered would include genetic screening, and noninvasive pregnancy testing (the NIPT).   Testing can be basic to complex depending on the desire of the women.  We educate the mother about each test so she can give informed refusals or consent.
       

daughter helps midwife at birth
Pre/Postnatal Labs 

For what reasons would I be risked out of care?


I  spend hours with my clients throughout their pregnancy, this time is spent educating and getting to know one another, but this time is also used to spot any early issues that may be arising.  I believe in preventive care, and taking the first steps of action when with the earliest detection of an issue. For this reason, high risk pregnancies rarely develop. 

Pre-eclampsia is one of the main issues we are looking for especially toward the end for pregnancy, but other issues such as fetal abnormalities, preterm labor, post dates, non-controlled blood sugars, non-head down (vertex) position of the baby at the time of labor or caring multiples. These are reasons you may be referred to an Obstetrician. If you are being followed by an obstetrician that does not exclude you from receiving midwifery care, many women who are having twins or have other high-risk complications like to utilize both strengths of care for the best outcome.         
  
You can refer to my Practice Act Disclosure for conditions that are considered out of the scope of practice for a Licensed Midwife as stated by the Medical board of California.  Midwives are considered the experts in normal healthy pregnancy.  We are trained in the science of what is normal, and spend hundreds of hours with seasoned midwives being shown what normal is.   The same as studying counterfeit money, the best way to know when something is not right is to know what right is.  Attending women through hundreds of pregnancies and births, and spending thousands of hours watching women labor and give birth I have a strong understanding of what normal is. 


Medical Board of CA 
Practice Act Disclosure
Fees
How do I pay for your services?

I except cash, check or payment through PayPal.  A payment schedule is arranged at your first visit to be paid in full by 36 weeks gestation. A $1000 non-refundable down payment is expected at your first visit.  For more infomation on fees please contact our office.
 
  

Do you take insurance?

We are not covered as an in-network provider for any insurance companies.
All clients are provided with a super bill of care to submit to their insurance provider.  If you are looking for an insurance that will cover alternative health care options look into a health care sharing program*.   
*You must be enrolled before conception to be eligible for coverage for pregnancy.   



Labor & Birth 
Who comes to my birth?

Your birth team will include a Licensed Midwife and a trained assistant and most often an assistant who is being trained to assist. All medical personnel who come to your birth have been trained in basic life support and neonatal resuscitation and are or have been enrolled in a midwifery academic program and are in good standing with their school or have graduated.   

​​What equipment do you bring to a birth?

Supplies are tastefully set up for easy access but out of immediate sight.  I bring a water proof hand held Doppler for checking the baby’s heart rate during labor, birth instruments including special scissors for siblings who desire to cut the cord, suturing supplies, herbs, essential oils and homeopathics…   

Emergency equipment I carry includes oxytocic anti-hemorrhage medications--which I will use only in the case of excessive bleeding, IV supplies and fluid--used for maternal dehydration or hemorrhage, oxygen and resuscitation equipment for both mother and baby along with other disposable supplies for various situations.
  

​​What about a water birth? 

If you want a water birth or the use of a birth tub for labor, tub rentals are available on a first requested basis and come with a sump pump for emptying the tub after birth.  A tub liner is required and purchased with your birth kit. Water is one of the many wonderful tools a laboring mother can use to help her relax, helping her to be more weightless.   With no complications, mom can stay in the birth tub as long as she desires after the birth.​​  
​​

What can I expect when it is time for labor?

After preparing for months it is finally time.  During the months prior we will have prepared you for what to expect during your labor and gone over multiple times when and how to reach your midwife. Your midwife will be available to you 24/7 from 37 weeks to 42 weeks to assist you in your labor and delivery time.

Midwives are often called in and stay once the mother is in active labor,  doing house calls and phone consulting as need until that time.  

When the mother is in active labor and the birth team has arrived 
mom and baby’s vitals are assesses and all of the equipment is quietly and discreetly set up, ensuring that everything is ready to help things run as smoothly and neatly as possible.  We watch the mother and offer help, guidance and encouragement as needed.    

As the birth time approaches, monitoring the baby’s vitals increases and we talk about how to push and everything we need is brought within arm’s reach.  The mom or dad is encouraged to catch the baby if they would like, and siblings are gathered to be present if desired.  
What if there is an emergency during labor?

Birth time emergencies and transfers of care can be categorized into a few different levels:


1st most common reason to transfer to the hospital is during a long labor when the mother is experiencing fatigue, exhaustion and/or an irregular labor pattern and is desiring pain relief or needing augmentation of labor that we are unable to do at home. If the mom and baby’s vital signs are stable and both are doing well this is a non-emergency reason to transport.


2nd reason to transport is a non-urgent emergency. This encompasses most of the reasons for transporting to the hospital. A few examples would be, non-reassuring vitals for mom or baby that need monitoring beyond what is available at home, a baby not in the right positions for a homebirth (i.e. breech) at the start of labor, a retained placenta without bleeding, a needed repair beyond the midwife’s capabilities, thick meconium present with rupture of water bag.


3rd This is what would be considered a true emergency and would require transport to the hospital via EMS. This would be non-stable vitals of mom or baby which could be caused by uncontrolled bleeding; severe abnormal pain; ominous or lack of fetal heart tones. This category of emergency is very rare, but a possibility that we must be prepared for. That is why we monitor mom and baby closely throughout labor watching for signs of concern before they become emergencies.


For all clients prior to going into labor,  a plan is created in your chart to follow in case of an emergency. Where is your closest hospital? What is your preferred hospital in a non-emergency transport? Your birth team will remain with you in whatever capacity we are able, through the birth of your baby.   

sibling waiting for baby to be born at home
big sister palpating mommy's pregnant belly
laboring mom with midwifery birth assistant
newborn skin to skin with dad and big sister
newborn at san diego homebirth
postpartum care after water birth
Postpartum and Newborn Care 

Who does the newborn exam, what does the newborn exam include? Can you administer newborn medications? Vitamin k, Erythromycin, PKU?


Midwives are trained in well baby care. After the birth, a complete physical and neurological exam will be performed on your baby. We carry equipment to screen for Critical Congenital Heart Defect (CCHD) which will be checked at your first postpartum visit in your home.  All newborn medications and testing will be offered to you the same as if you delivered in a medical facility; you have the right to accept or refuse them. We offer the newborn screening which includes the PKU test in your home when we return for your first visit after the birth.     

How long do you stay after the birth?

We stay until mom and baby are stable and ready for us to go. On average we will be with you about three hours after the birth, however, we will stay as long as needed to ensure mom and baby are safe and comfortable.


What about the mess… and the placenta?

Midwives are often asked about the mess. What mess?  Each family is given a list of supplies they should have on hand which includes trash bags and very simple cleaning supplies such as peroxide, isopropyl alcohol and paper towels. When the birth is over the mess is cleaned up and the laundry started so all you have is a bag of trash to take out and a load of towels to fold. 


The placenta is for you to keep, is it is bagged in a couple of ziplocks, wrapped in a paper towel and placed in your refrigerator. It can be frozen and thrown out on trash day, or you can:  plant a fruit tree over it, make prints with it or have it encapsulated. Check out these artful ideas from Parents.com     
  

What if I tear?

Most lacerations can be repaired at home with a local anesthetic for numbing and dissolvable sutures.

Placenta Art
What support do you offer after the birth?

Midwives offer a tremendous amount of support during what some have termed the fourth trimester. I offer breast feeding support, ensure that you have the care you need to feel fully confident in feeding your baby beyond the first few days.  
After the birth we return to your home a couple of times, usually 24 hour and 72 hours to make sure that mom and baby are well and that breast feeding is off to a good start. I also see you at 2, 4 and 6 weeks as desired.  The Newborn Screening can be done in your home at the 24 hour visit and a referal is given for the Hearing Screening test. 


newborn and big sister at midwifery birth at home
sibling and new baby after homebirth
newborn feet at newborn exam
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Kaydee Welchons Midwifery Services