Midwifery Care

Susan Mickley, CPM, and Linsey Kornya, CPM

Susan Mickley, CPM, and Linsey Kornya, CPM

Midwifery Model of Care

At confluence Midwifery Center, we are proud of the type of care independent midwives provide, and like this definition from the Midwives Alliance of North America

"The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

  • monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • minimizing technological interventions and
  • identifying and referring women who require obstetrical attention.

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section. 

How care will look with us is outlined below. 

Consultation

We offer a complimentary consultation that can be scheduled at your convenience.  We set aside an hour, giving us lots of time to discuss your questions and concerns.  We encourage prospective clients to bring a list of questions and concerns and always feel free to bring your partner and other children.  This is also an opportunity to tour our facility and get to know us a little better, helping you get a sense if we are a good fit for you and your birth. 

Hiring Us

Clients may choose at the consultation to set up their first appointment, but many people take some time to decide on a provider.  When you decide you would like to hire us, send us an email, call or text to set up your first appointment.  We will add you to our Electronic Medical Record (EMR) where you can log in and fill out your medical history and information.  We will review this before your appointment.  One nice thing about our EMR is that you have access to your complete chart throughout care.  Your labs, chart notes and labor record will always be a simple click away.

Initial Visit

At our first visit, we review your medical history with you, do a regular prenatal and draw any initial lab-work you need or want. This visit is usually a bit longer than our usual prenatals, lasting an hour and half or so. We review initial paperwork including the contract/disclosure. Throughout your care you will have access to the lending library, including several DVDs and may start borrowing these materials at the initial visit.  We discuss your medical and social history as it relates to your care.  Your informed choice is a critical aspect of care with us, and we are passionate about supporting choice and sharing evidence.  As independent midwives, we employ our own evidence based guidelines, but are not bound by the rules and regulations of legislators or physicians. 

Between Appointments

Between appointments we encourage you to contact your midwife directly via text, phone call or email if you have any questions or concerns.  We do not have a receptionist or exchange system, enjoying a direct, more personal relationship with our clients.

Prenatal Visits

Prenatal visits are frequent and always with one of the two midwives in the practice.  We like to meet once a month until 28 weeks and then every other week until 36 weeks.  Most visits are at our office in Tower Grove South, but if clients are close to where we live or close to where we are seeing other clients, multiple homevisits are usually possible.  At 36 or 37 weeks we always do a home visit so we can meet your pets, see where you have things set up and make sure we an easily find your house.  After that, we see you every week until you have your baby.  For each visit, we schedule a whole hour so there is ample time to ask questions and discuss any issues you may be having.  Basic clinical care includes measuring your blood pressure, listening to the baby's heartbeat, dipstick urinalysis, and palpating for the position of your baby.  As the need arises, we discuss any tests and procedures that we recommend or you request. We provide you with resources to help you make decisions on most common pregnancy tests and interventions.  We always check in about nutrition, exercise, how you are feeling and any discomforts you are having.

During visits you will notice that we chart mainly on an iPad or a computer.  We use Electronic Medical Records (EMRs) and utilize the client portal system that our service makes available.  This means that you will have the opportunity to review your chart as we go along and can see any updates and suggest changes.  We can send you handouts and files through the system as well.  We are also finding that, for the times when we do need to transfer care to a physician or hospital, that the EMR smooths the transition.

Birth

Our goal at your birth is to help you safely achieve the birth you envision for you and your family. Care during your birth includes the emotional and clinical support of two midwives - the two midwives you have gotten to know over the course of your care.  Though we use our knowledge of the birth process to monitor the health and well- being of mama and baby, our presence at births is usually hands off, intervening only as necessary or requested. We strive to create a calm, peaceful, environment for labor and birth, keeping lights and voices low and avoiding unnecessary and intrusive medical routines. We focus on prevention of issues through low-tech monitoring, hydration, nutrition, and rest.  While prevention is our primary strategy, we are prepared to respond appropriately when any complications arise.  Susan and Linsey are experienced and skilled managing a variety of emergency situations.  Most of the time, of course, birth is a safe and normal physiological event which we support as gently as possible.  The time immediately following the birth is special and support a quiet, gentle transition to life for babies.  In the hours after birth, we encourage rest, breastfeeding and bonding.  Many people think that cuddling up in your own bed with your new baby after birth is one of the best things about homebirth and we could not agree more!

Postpartum Care

Postpartum care is just as important as all those prenatal visits!  Your midwives always follow up with you at home in the postpartum period - we do not send nurses or strangers to check in on you.  We return after the birth within 24-36 hours, often checking in over phone or text before then.  We also come back to your home at least two more times during the first week post-partum, usually at days 3 and 7.  Office visits are offered at 2-3 weeks and 6 weeks postpartum. We work to ensure that mama and baby stay physically and emotionally strong and healthy throughout the post-partum period. We monitor baby’s weight gain, breastfeeding, jaundice, and the mother’s physical healing.  We leave plenty of time to talk and process the birth and the transition into parenting/parenting another newborn.  We support breastfeeding in a variety of ways including quick referrals to kind lactation professionals if there are any issues.  We are proud of the fact that our clients are breastfeeding exclusively over 95% of the time at 6 weeks post partum!

Weighing the baby after the birth

Weighing the baby after the birth