Midwifery Services
Except where there is an issue concerning the safety of the mother or baby, I believe the parents should have the personalized experience they desire and I encourage specific requests regarding their birth plan.  Women must maintain full responsibility for their own health care and for the outcomes of the birth.  I will assist with information on nutrition, exercise, pregnancy and childbirth education, water birth, etc., but the woman must assume the responsibility of maintaining her own health.

Free Consultation:
This gives us a chance to meet and discuss whether a planned homebirth is appropriate. I’ll get some background information, explain the scope of my practice and answer any questions or concerns about your pregnancy and birth.  My consultations and all the prenatal visits are an hour long, which gives you plenty of time to get to know me and me, you!

Prenatal Care:
I require all women to be screened for risk factors.  This includes pregnancy blood work and a thorough interview and exam at the first visit.  I also require that you complete and return the birthing contact, the fee agreement, the personal and medical information forms I send home with you at the consultation visit.


Prenatal Visits: 
Regular visits are monthly until 32 weeks, 
bi-weekly until 36 weeks and then weekly until birth.

Included in Prenatal Visits:
Blood pressure
Urine testing
Weight monitoring
Uterine growth
Fetal size and position
Fetal heart rate
Pregnancy and child birth education
Ultrasounds are available, for a fee, and will be used as needed.  Extensive ultrasounds can be ordered, if needed.


Labor and Delivery: Once active labor is established, I will come to your home and stay with you until after the birth.  Usually I stay 2-3 hours after the birth, only leaving when I feel the mother and baby are stable and well.  My role as your midwife is to help you create a safe and calm birthing environment.  Including:
  
Labor guidance
Monitoring labor progress
Monitoring fetal heart rate and fetal position
Perineum support
Assisting in the birth of the baby
Delivery and Examination of the placenta
Examination of the newborn (after an hour or so of family/baby bonding time....baby never leaves your side)
Monitoring of the mother's uterus, bleeding and general condition

As a result of my training and experience, I can recognize complications in the mother and the baby.  Most complications can be resolved at home. In the rare event of a true emergency, I am trained to keep mother/baby stable until we can reach medical help.  I carry oxygen and I am trained in neonatal resuscitation.

Postnatal Care:
Instructions on the care of the mother and baby
Telephone support
Home visits as needed
Metabolic screening tests (PKU) for the baby
Birth Certificate and Social Security Card
General assessment of mother and baby
Birth control counseling 

Telephone Support:
I am available to answer questions or your concerns during normal office hours...and, of course, at anytime, day or night, for any emergencies.  

CONSULTATION QUESTIONS FOR PROSPECTIVE MIDWIVES

The following questions can't all be covered in one interview, but you should know the following about your midwife prior to giving birth.  A good indication of the well-regarded midwife may be her affiliation with state and national organizations, and a printed offering of an “Informed Choice Agreement”, a statement of her background and statistics.  This reduces confusion or misunderstanding later.  Try to circle the most pressing concerns or questions you have now, for the initial interview. 

I.     TRAINING AND EXPERIENCE

    - What training have you had?  Schools, degrees, certificates, CPR?
    - How much of it was hospital experience, home experience?
    - How long have you been attending births as primary midwife?
    - How many births do you attend per month?
    - How many clients required C-sections, episiotomies, suturing?
    -What is the advantage of a homebirth?  Birth Center birth?
    - Any disadvantages of each?

II.     COMPLICATIONS AND EMERGENCIES

    - What complications and emergencies have you seen and how were they
       handled? (i.e. postmaturity, prolonged labor, fetal distress, breech, 
       bleeding)
    - What circumstances/conditions would rule out your attendance?
    - What complications/emergencies have you or can you handle?
    - Under what circumstances do you transfer to a hospital?
    - What percentage of clients have cesareans in your practice?

III.    MEDICAL BACKUP

    - Who is your consult physician in case of hospital transfer?
    - What hospitals are used?
    - Can you accompany the couple through the hospital birth?
    - Do you have a family doctor/pediatrician or recommend one?

IV.    EQUIPMENT AND PROCEDURES

    A.  Prenatal:
       - Do you do prenatal care?  What is your schedule for visits?
       - What is included in prenatal care?  (Should include lab work, urine 
          checks, blood pressure, fetal heart tones, & vaginal exams & PAP)
       - What nutrition counseling do you provide?
       - What are your feelings about birth preparation classes?
       - Do you visit the home at any time before the birth?   

    B.  During Labor and Birth:
       - When do you want to be called once labor has begun?
       - When do you come to the home once labor has begun?
       - What equipment do you bring and what must we provide?
       - What emergency equipment do you provide?
       - How do you view the father’s role?
       - What is your role during labor? birth?
       - How do you feel about sibling participation in birth?
       - What non-drug measures do you suggest for pain relief?
       - How often do you listen to the baby’s hear in labor?
       - What is fetal distress in your opinion?
       - What do you consider prolonged labor/birth pushing?
       - Do you have preferences for labor/ birth positions?  
       - How do you feel about waterbirth?  Have you attended any?
       - What measures do you take to prevent tearing?
       - How often do the fathers actually help “catch the baby”?

   C.   After Delivery
       - Do you check for tears? (vaginal, urethral, rectal)
       - Do you have local anesthetic & suturing equipment for this repair to 
          be done without going to the hospital?
       - How do you prevent/treat excessive postpartum bleeding?
       - How do you handle the baby immediately after birth?
       - How long do you stay after the birth?  What do you check at this time?
       - What is your schedule for follow-up care?
       - Do you do the newborn screening tests? (required by the state)
       - What is your philosophy regarding circumcision?
       - How is the filing of the birth certificate handled?
       - Do you routinely give me a copy of all my records after the birth?

V.     FINANCIAL ARRANGEMENTS

       - How much do you charge for your services?
       - What services are not included in this fee?
       - Do insurance plans cover your fee?  Do you accept direct payment?
       - When do you want the full fee paid?

VI.    ATTITUDE AND COMMUNICATION

       - Determine willingness to: 
          Be open to communicate now and in labor/birth;
          Explain things that you don’t understand;
          Help you see the consequences of your choices;
          Let you make your own decisions.


(702) 595-5210

Phone: (702) 595-5210
Email: homebirth@cox.net
   
Margie Dacko, CM
The Midwife House
286 Merrick Way Henderson, NV 89014     
The Midwife House 
Margie Dacko, Midwife

Changing the World One Birth At A Time!