Questions & Answers

coupleInformation sessions are offered with Dr. Lane weekly in either our Lafayette or Carmel offices. A short discussion about the practice will be offered and then times for questions will be provided. These sessions are excellent opportunities not only to gain information about the practice and homebirth, but to help determine if our practice would best serve your individual childbearing needs. Preconception couples, or even those simply interested in learning about our practice or midwifery itself, are encouraged to attend.

Visit myMidwife.org for further information about nurse-midwifery.

How many midwives are in the practice?

Believe Midwifery Services, LLC is owned and operated by nurse-midwife, Dr. Penny Lane. She is licensed to provide full-scope women’s healthcare, including birth in the home, within the state of Indiana. Dr. Lane provides all the initial consults and follow-up visits with maternity clients and provides all care to our women’s health clients. She also attends all the births as the primary midwife.

Our midwifery team also includes a number of midwifery assistants who each share responsibility for covering all twenty-four hours shifts throughout the month, with two attending each birth in addition to the nurse-midwife, and each assist with the clinical care and education provided within the clinic. Currently we have a Certified Professional Midwife on staff who has earned her master’s degree in midwifery from Bastyr’s University in Seattle, Washington. She assists Dr. Lane within the clinic, particularly with the maternity discussion groups and supports clients in our functional programs.

Several of our assistants are Registered Nurses, doulas, student nurses, and others have EMT training. All have completed the midwifery assistant training course provided by Dr. Penny Lane, CNM.

As a Christian practice, will you care for those who have very different beliefs than your own, or who have life style choices that are not specifically ‘Christian’?

Absolutely! We live boldly and abundantly, and respect the fact that each of our clients do as well. It is a great joy to be given the opportunity to know people genuinely and utterly fascinating to realize the great diversity that exists in our own communities. Because of our desire to understand each individual and their unique needs, meeting clients where they are at, we believe we provide the most respectful and compassionate services to every client that chooses our practice for healthcare.

“I have no religion, I mostly agree with Buddhism, while living in Bloomington I spent a lot of time in the parks of a temple close to my house. I cannot stand hypercritical and/or pushy “insert organized religion here.” Before I contacted you I was concerned so I spoke to a friend of mine that had a previous homebirth with you. She assured me that you were not pushy with your beliefs & that you are a very genuine person. I honestly can’t remember it every really coming up during my appointments either. I feel that you and your staff are truly good and genuine people, that speaks more to me than any religious affiliation.” Logansport, Indiana Mother

“Knowing that you know the Lord sealed the deal for us, not because we wanted to talk all the time about our faith, but because I loved the idea that you cover your decisions in prayerful consideration. That means the world to us.” Brownsburg, Indiana Mom

“I read your whole website. I’m not religious but agree with the basic philosophies. You are very good at knowing your patients, so I think you use your philosophies where appropriate.” Lafayette, Indiana Mother

“I felt more hesitant contacting you after reading your philosophy of practice statement. Ive had too many experiences with people who identify as Christians in a very self righteous way. I knew from my first appointment it would be a nonissue though. I love that your work is a calling and so meaningful to you. I know this is tied to your faith and I believe you’re a better midwife for it.” Indianapolis, Indiana Woman

“I love your philosophy! Knowing your beliefs helped me make the decision to home birth. I feel less fear with this birth and I think it has to do with your faith and obviously your medical background.” Indianapolis, Indiana Mother

“I am pagan and was hesitant at first contacting you, especially in our circumstance that hubby was out of the country for deployment, but after meeting with you we knew it wouldn’t be an issue. i agree that the apprehension came from previous encounters with self righteous Christians, but you (and your staff) are not that way…caring, honest people…that’s all that matters no matter your beliefs.” Logansport, Indiana Mother

Approximately what percentage of the women in your practice have unmedicated births?

Women who labor at home avoid spending energy on adapting to a new environment, leaving more energy to devote to the work of labor. They can engage in a wide variety of activities of daily living until labor requires their undivided attention.

Pain medications are not provided in our practice, as this would increase the risk of homebirth management. However, our clients are offered a plethora of comfort measures that overwhelmingly satisfy, including: labor support, hydrotherapy, herbs, nutrition, encouragement, sterile water papules, massage, TENS machines, aromatherapy, music and prayer. Dr. Lane has had only two mothers transfer to the hospital for pain management and unfortunately, neither had attended our highly recommended childbirth preparation course. However, both were complete and ready to push upon arrival!

It is a misconception that the hospital’s conveniences offer increased safety in childbirth. “A strong association of epidural with fetal occiput posterior position at delivery represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery consistently observed with epidural” (Liberman E. Obstet Gynecol 2005; 105(5 Pt 1);974-82). Cesarean sections increase the risk of maternal death by 3 times.

What percentage of your clients have undergone the following: early artificial rupture of membranes, continuous fetal monitoring, episiotomy, cesarean sections, and other interventions?

Interventions such as these, when necessary, often indicate the need for immediate medical care which is best provided within the hospital. The intrinsic safety in homebirth is that the natural process is supported and interventions are at an absolute minimum. However, interventions utilized wisely have the potential to optimize outcomes, and our practice has the clinical expertise and experience to integrate these selectively into our client’s care as appropriate.

Visit our statistics page for up-to-date data regarding our numbers for specific interventions and our outcomes.

What is your policy about my partner, family, or friends participating in my prenatal appointments? Who can I invite to my birth?

Friends and family are always invited to prenatal appointments per your discretion. This may prove perfect opportunity for your less than supportive family members to ask any questions they may have of the midwife. These have always proven fruitful as most opposition comes from ignorance to the level of care possible in out-of-hospital scenarios.

Clients are also welcome to invite whomever they feel would support and comfort them during their birthing experience. However, feeling obligated to invite friends and family to your birth who are fearful quite frequently lengthens the labor experience, as mom is unable to relax and allow the birth process to occur. It is also vital that those invited respect the midwife and her assistants, allowing them to maintain a safe birthing environment and attend the antenatal home risk assessment near the 36th week of pregnancy.

Well-behaved children are always welcome within your prenatal visits, and certainly at your birth. However, children present during the birth process do require an adult to be present in the home, besides your partner, in the event we need to transfer quickly.

Where do prenatal visits occur? At what time are appointments available?

The first maternity visit is scheduled for an hour with one of our nurse-midwives when which your health history will be reviewed, informed consents will be discussed and a physical exam will be provided, including any necessary labs. All subsequent prenatal visits are scheduled for thirty minutes and continue with the nurse-midwives in either the Lafayette or Carmel office.

Appointments are available on Tuesdays and Thursdays in Lafayette, and Mondays, Wednesdays and Fridays in Carmel. Well-behaved children are always welcome at your visits.

What about childbirth education classes?

Believe Midwifery Services, LLC offers a four class educational series for anyone and everyone interested in attending. Couples choosing to have their first homebirth are asked to attend all workshops to better understand the midwifery model of care, and how to achieve and optimal experience for your birth and beyond. Clients interested in joining our classes but are not planning to birth with our midwives, are asked to pay a small fee of $65 per class. If choosing to attend classes prior to becoming pregnant, but then later become pregnant and become a maternity client within our practice, we will happily credit the $65 fee to your account.

The practice also hosts a confidential facebook group for our clientele. Clients are encouraged to participate in discussion with like-minded families, sharing your experiences and seeking advice; however, the group is not a source of supplemental healthcare by the midwifery team.

The nursing staff and nurse-midwives will review many of the major teaching points within the thirty minute prenatal sessions and most families who have experienced natural childbirth before, find these sessions more than fulfill their learning needs.

If I develop a complication during pregnancy, will you still take care of me? If not, who will be my caregiver?

The state of Indiana recognizes Certified Nurse Midwives as independent practitioners that work within a system of collaboration (scroll down to page 84 of the Indiana Nurse Practice Act).

Clients who seek care with Believe Midwifery Services, LLC rarely require physician collaboration, although many are referred for consultation with other clinicians for a variety of reasons, most commonly, a chiropractor.

Dr. Penny Lane, CNM and Miss Kristina Michael, CNM have a strong relationship with the maternity team at Methodist Hospital and the Indiana University Medical Center. The Maternal Fetal Medicine team are our preferred source of consultation for high risk pregnancies and transfers from home to hospital are typically escorted to the Nurse-Midwives at Methodist Hospital. They have proven to be tremendous advocates for the choices of our homebirth clientele.

MFM physicians are obstetricians who have completed an additional fellowship and provide high risk consultations for obstetricians and Nurse Midwives throughout the state.

It is our belief that ALL pregnant mothers benefit from midwifery care, yet not all women are appropriate candidates for primary care with a midwife or homebirth. If this proves to be the case, your midwife will work with you to find a physician that best matches your medical needs and one that supports your decisions.

What if my baby or I have a complication during the birth process? How can you manage this at home?

We would like to first ask you to consider what safety you can expect as a birthing mother within the hospital? It is a misconception to believe that a physician is immediately available in each and every hospital’s maternity ward. Only in the rare tertiary center might this be the case. Rather, hospitals require on-call staff be available within thirty minutes of an emergency call. Following their arrival, the emergency team would then require time to assemble themselves and manage the emergency situation.

Nurses are the primary care provider in hospital births and unfortunately are frequently under-staffed and managing several laboring women who commonly have high risk interventions such as pitocin augmentation and epidural anesthesia. These sorts of interventions not only invite significantly more risk to each birth scenario, but often mask warning signs that are easily observed in a homebirth while mother and baby still have enough reserve to escape any long-term damaging effects. Once your hospital nurse does observe signs of impending danger, she would notify your on-call obstetrician, the anesthesiologist, the pediatrician and the operating room staff who are either in their offices, which are rarely located on site, or in the privacy of their own homes.

In a homebirth scenario, your nurse-midwife is present at your side continually, with two of her medical assistants. You are their only priority. In a transfer scenario, our birth team would provide all necessary medical preparation necessary while transporting to the most appropriate maternity center based on either mom or neonatal needs. Rarely are homebirth transfers emergent, so we work hard to build relationships with maternity units that will respect your decisions and offer you the most safe and satisfying experience following transfer. On occasion, we have had to transfer more urgently to a local facility that provided less than friendly care and on rare occasion were hostile to our clients, which negatively impacted care. This is exceedingly rare and limited to specific hospitals which we are well aware. As part of the decision making process, we discuss with our clients the level of care offered at any potential transferring hospital, as well as their friendliness to homebirth families which can be just as important in determining the speediness and overall quality of care provided.

Homebirth is not a guarantee of safety. Birth itself is only as safe as life gets. However, an environment that supports the normal course of labor and birth lends itself to the most optimal outcomes. Many taxi drivers and have claimed the glory of a successful birth because they simply caught a baby in an otherwise non-interventive birth. On the rare occasion that a birth emergency or challenge presents itself, homebirth families are at the mercy of the training and expertise of their midwife. Believe Midwifery Services, LLC has worked diligently to provide the utmost of professional care for these specific events.

Do I need to find a ‘back-up’ physician?

As mentioned previously, certified nurse-midwives in the state of Indiana are licensed as independent practitioners; therefore clients do not require physician care unless a medical consultation proves necessary. In the event of an emergency, you would transfer to the nearest hospital and be cared for by the on-call physician. If you have already established a relationship with a physician, it would be exceptionally rare for this physician to come in for your labor and/or emergency. No matter your birth environment, mothers are routinely cared for by the on-call physician.

From a homebirth transfer, this care cannot be denied. You have the right to be treated in a hospital if you arrive in active labor. You will be cared for from the time of contractions through the delivery of the baby and the placenta. This is established by federal law. Your midwife would accompany you and provide the staff an immediate copy of your prenatal and intrapartum paperwork. Her presence would be as labor support.

What equipment do you carry to births? What supplies do we need to obtain for our homebirth?

All medical equipment is provided by Believe Midwifery Services, LLC. We do ask that our clients have available towels, sheets, baby diapers, meals, and Motrin if desired for postpartum cramping. A deeply discounted kit is available from the Red Raspberry Boutique, offering the remaining home supplies utilized within homebirths. Most clients choose to add one of the Postpartum Personal Care Kit.

Visit our equipment page for more information regarding the Midwife’s Bags.

What is your policy regarding follow-up care after delivery?

The birth team will remain with the family until everyone is stable. This is at least a few hours. A follow-up visit during the first and second week is offered, as part of the package fee, as well as mom’s six week visit. We are available to you throughout however, if additional support is necessary or desired.

Who will examine our baby immediately following the birth?

Certified nurse-midwives are trained to care for newborns through six weeks of age in the primary provider role. Dr. Penny Lane CNM, IBCLC has earned an undergraduate degree in maternal and child health: lactation consulting, broadening her expertise in the care of newborns, infants and children.

Maintaining care of the newborn with either Dr. Lane or Miss Michael means they can offer you continued support through the initial few weeks of particular vulnerability. The newborn metabolic screen, hearing screen and oxygen saturation screening – all required screenings in the state of Indiana, can be provided by our staff, in your home. Lactation consultations with Dr. Lane or Miss Michael are also available by appointment.

How do we obtain a birth certificate and social security card?

Our office submits birth certificate information electronically to the state, for each birth attended by the midwife. If parents have opted for a social security card, this will arrive in the mail within just a few weeks. The birth certificate is available at the local health department for a small fee.

If you are unmarried and would like to have a paternity affidavit completed, we can offer this service as well. Dr. Lane is a notary and can assist you in completing the necessary paperwork prior to submitting your baby’s birth certificate.

Is homebirth unclean? Who cleans up the mess?

Your house is home to your own germs with which your body is well accustomed. Your baby will be colonized with these germs and because you are well familiar, antibodies will be immediately present in your breastmilk that your baby may need.

Hospital born babies are exposed to a plethora of bacteria, many of which are highly dangerous. One in ten hospital admissions are complicated by a hospital acquired infection. Your newborn’s normal flora, if born in the hospital, will initially be that of the nurse or hospital, and will take up to two weeks to transition to that of your own. Hospitals are not sterile environments, not even within the operating room.

Your birth assistant and midwife will stay with you following your birth, not only until you and baby are stable, but until your birthing environment is clean and shows no signs that a birth has just occurred. Laundry is often completed and folded prior to our departure. We have found the magic antidote for removing both blood and meconium from even your most precious linen and carpets.

Is homebirth legal in Indiana? Will my insurance cover your services?

Homebirth is legal with a licensed nurse-midwife (CNM). At this time, the state of Indiana only licenses certified nurse-midwives, although on July 1st, 2013 a bill to certify the practice of direct entry midwifery was signed into law. The board of representatives to extend certification to direct entry midwives was established in the spring of 2014 and has not yet extended certification. Therefore, midwives other than nurse-midwives practicing in Indiana are still practicing outside the law.

Midwives who are not licensed as a nurse-midwife in the state of Indiana commit a class C felony for the practice of medicine, and a class D felony for the practice of nurse-midwifery. Paying someone to commit a felony is conspiracy to commit a crime. It should also be well understood that while most births go exceptionally well, a midwife risking prosecution may abandon care in the event of an emergency to avoid discovery and potential prosecution.

While Believe Midwifery Services, LLC has ceased accepting third-party reimbursement, we do provide each of our clients a receipt for services rendered which can then be submitted for insurance reimbursement.

Nearly all insurance plans cover our services, with exception of HMOs. We are in-network for some insurance plans, and out-of-network for others. A large number of our clientele have received an in-network exception by simple phone call request because there were no other contracted CNMs in their service area.

Does your practice support Vaginal Birth After Cesarean (VBAC) mothers?

Dr. Lane has experienced a few cesarean births personally, and has had two successful VBACs/HBACs. She is passionate in this regard. VBAC mothers are counseled and screened to determine their appropriate candidacy for homebirth; however, VBAC in itself does not pose a higher risk in most cases, than any other unforeseeable birthing event such as a cord prolapse, fetal distress or postpartum hemorrhage. Midwives do not intervene in your labor and birth process unless indicated, drastically reducing adverse outcomes.

It is our belief that most all VBAC mothers are safer in the homebirth environment than the hospital simply because the high risk interventions that increase the risk of uterine rupture aren’t offered in the homebirth environment.

Any hospital that says they cannot support a VBAC mother because they aren’t prepared to handle the consequences of a uterine rupture are not safe places for any birthing mother to give birth.

Visit our service page discussing Vaginal Birth After Cesarean for further information.

Do the nurse-midwives carry malpractice insurance?

Malpractice insurance has not improved birth outcomes or public health. In fact, it has encouraged an increased number of lawsuits, which increases maternal morbidity and mortality rates by promoting the practice of “defensive medicine” on healthy women experiencing normal pregnancies.

The contention that insurance companies will pay fortunes of money for “unforseen outcomes,” is simply not the case. Each and every birth has unpredictable “unforeseen outcomes” (usually happy ones!). Insurance companies will not pay for bad outcomes, but only for documented damage caused by a practitioner.

The issue, simplified, is about increasing the ceiling of payment for damages caused by malpractice; it is not about public health or recourse for unforeseen outcomes.

Do you have a spa or birth pool available for families to use?

Believe Midwifery Services, LLC has five spa-n-a-box birth tubs available for rental. These tubs are heated and jetted, and are brought to your home and set up at or around your thirty-seventh week of pregnancy. Rental for the spas are reserved with payment of $500. Contracts for spa rentals is provided at your first maternity visit.

We also have a La Bassine tub for rental, which is brought to your thirty-six week home visit. Clients are provided supplies to air-up the spa, fill it and monitor its temperature. We ask that clients await set up until labor in effort to minimize opportunity for damage. The nursing staff will empty, clean and take home the La Bassine following your birth.

Why are your fees so much higher than other homebirth midwives in the area?

Our nurse-midwives are licensed practitioners in the state of Indiana, offering full scope midwifery care with credentialed and highly-trained assistants. Nurse-midwives spend ten plus years gaining their education and approximately $150,000 in educational expenses. In every way our practice and boutique works within the law, obtaining every certification, waiver, license, and credential with the mission to exceed all expectations. Our practitioners are experienced leaders in the profession, have been awarded for their professional practice and have achieved maternity statistics among the best in the state.

As the saying goes, “you get what you pay for” and with Believe Midwifery Services, LLC, your money ensures a full team of clinical experts who are passionate about natural childbirth and professional integrity. We remain by your side throughout your journey, educating and advocating for your right to decide what is best for your family. Our practitioners also carry high grade equipment, matching or exceeding those available within level one facilities. These come at an expense, but are not only life-saving, they quite frequently prevent the need for transfer.

Many homebirth attendants in Indiana are working outside the law, and in doing so, spare themselves a plethora of state mandated expenses; however, they also risk prosecution while you risk being abandoned by your midwife during an emergency. Our collaborative relationships are secure and so we are able to provide a seamless transition if necessary, and respectful consultation as the need arises. Again, these resources increase the standard of care we are able to extend, increasing the value of care you receive, but also increase the expense incurred.

Who is not a good candidate for homebirth?

Our practitioners have experience in high risk obstetrics, with Dr. Lane having initiated her career in the obstetrical intensive care unit that was once located at the Indiana University Medical Hospital. Because of our experience, professional relationships and extended resources, we are able to meet the needs of higher risk clients in a safe manner more so than the standard homebirth practice. More importantly, each individual client is provided their own risk assessment, taking into account a number of important points in your care for determining appropriate management. Clear reasons for referring a pregnant client to a medical provider would include:

  • Smokers
  • Alcohol or drug abuse
  • Placenta previa
  • Insulin-dependent diabetes
  • Transverse fetal lie
  • Uncontrolled hypertension

While medical reasons are important considerations for whether one is an appropriate homebirth candidate, our practice values the midwifery relationship equally, including assessing your preparedness for homebirth. This requires that each pregnant client commit to attending prenatal visits, childbirth education classes, gathering and preparing their home, and respecting the financial agreement. While is often the reputation of midwives to continue care in the absence of payment, because our profession is one of great passion and eagerness to serve, we have learned that this may be the boundary with which our Heavenly Father might choose to risk a couple out of homebirth that may benefit from care in a medical facility. Ignoring that boundary may cause us to risk your safety, and quite frankly, our ability to commit to providing high quality care depends on adequate payment for services rendered. Finally, a relationship is one that honors and respects both the childbearing couple and the midwifery team. If this relationship fails for any reason, the nurse-midwife will share her concerns and if resolution is not agreed upon, our practice will recommend other providers who might better serve your needs.

There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low-risk or normal pregnancy and birth. So if you are among the more than 75 percent of all women with a normal pregnancy, the safest birth attendant for you is not a doctor but a midwife. – Marsden Wagner, MD, past director of the WHO Women’s and Children’s Health Section

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Food For Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has."

Sir William Osler

 

Food for Thought

"Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy."

Aviva Romm

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"Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs."

Snyderman and Weil

Food for Thought #1

"They say that time changes things. But you actually have to change them yourselves."

Andy Warhol

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"To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking."

Johann Wolfgang von Goether

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"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole."

Rixa Freeze PhD

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"Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective."

Dr. Penny Lane, nurse-midwife

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"When the debate is lost, slander becomes the tool of the loser."

Socrates

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"To accomplish great things, we must not only act but also dream; not only plan, but also believe."

Anatole France

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"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'"

Grimes (1986)

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"American physicians are rewarded for doing things to patients, not for keeping them well."

Grimes, 1986

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"The false idol of technology. 'Having a widget screwed into one's scalp has become an American birthright.'"

Grimes, 1986

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"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days."

Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it."

Goer & Romaro, 2012, p 35

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"If you play God, you will be blamed for natural disasters."

Marsden Wagner (2006)

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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't."

Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

"Believe there is always, always, always a way. When you have exhausted all possibilities, remember this: you haven't."

Thomas Edison

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident."

Arthur Schopenhauer

Food for Thought #2

"Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast."

Psalm 22:9