One midwife, one or two assistants: RNs, Trained Birth Assistants, Nursing or Midwifery or Nursing Students. Although it is rare, if there are two women in labor at the same time we have other midwives willing to help. Babies are rarely born at the same time or even the same day in such a small practice. During the rare times when that happens I can often finish the delivery at the first birth, turn postpartum and newborn care over to the RNs and head to the next birth with a different crew of assistants.

Margie Kline, LM, CPM began her work with women and babies in 1995, serving as a doula, birth & breastfeeding rights advocate, and midwife in New Mexico until relocating to Arizona in 2005. She began her formal midwifery education at Aviva Midwifery Institute in 2009, interning for several months in a high volume birth center in El Paso, Texas, and a busy missionary birthing home in Tay Tay, Rizal, Philippines. She gained additional clinical experience working with a homebirth midwifery practice and a birth center in Phoenix. In 2013 she received her national certification from the North American Registry of Midwives and her Arizona state licensure. She is a member of the Arizona Association of Midwives. Over the course of her career she has observed, assisted, or served as primary midwife at over 700 births.

Yes, doulas are a welcome addition to any birth. Hiring a doula at a home birth is highly recommended. While not a requirement this extra care can lower your risk of needing medical intervention especially for first time moms or long labors. Women find they receive a lot of extra attention and loving-kindness from both doulas and midwives during a very important transition of becoming a mother.

We encourage fathers or the family member(s) of your choice to attend prenatal visits, and birth classes with you. During the birth fathers are welcome to help receive the baby, and cut the umbilical cord if both parents are comfortable with this. Mothers may have the person or persons of their choice attend their birth. Children are always welcome. You are in control and there is no limit.

We have seen our clients use a number of nutritive herbs and occasionally some medicinal herbs for various reasons in pregnancy, with excellent results. We have herb books available to loan you and we are glad to talk to you about what we know regarding herbs, including which herbs to avoid during pregnancy and breastfeeding. Many clients use and love essential oils in pregnancy, labor & delivery and postpartum. While internal use is discouraged in pregnancy, some topical use and aromatherapy can be very helpful to some mothers.

We offer pregnancy testing. We routinely draw labs for what is known as an OB panel which tests your complete blood count (CBC), checks your blood type and Rh factor, immunity to Rubella, Red cell Antibody screen, RPR screen, Hepititis B screen. We also take a urine sample and send that to the lab for a urinalysis and urine culture. We are happy to offer you a PAP smear either during or after pregnancy and also offer full STI screening as requested as well as Hep C screen and HIV screen. We offer cell free DNA testing for anomalies of the fetus in early pregnancy, and can send referrals for further genetic testing as requested. In mid pregnancy we repeat the CBC and do a Glucose tolerance screen. At 36 weeks we do a swab to check for overgrowth of Group b strep. We also offer extra Antibody testing for mothers who are Rh negative and cord blood testing /Rhogam injections as needed. Many of these may be refused, but we find them helpful to monitor your health and baby’s health. The state of Arizona has certain requirements that could preclude you from using an AZ licensed midwife if you do not wish to do prenatal testing but they are minimal. No matter who your health care provider is or what setting you are in, you have the right to refuse treatment or testing.

We have a list of recommended books that I would love every mother to read, but they are not required. Many are available in our lending library. We encourage every mother to take the childbirth class of her choice during her pregnancy to prepare for labor. We are happy to recommend Kristen Pearson of Flagstaff Doulas who teaches Natural Childbirth Classes

Although we do not offer ultrasounds in our office, we do refer to several radiologists and/or MFM specialists that provide ultrasounds here and in the Phoenix area. We can order early pregnancy ultrasounds, anatomy ultrasounds, followup ultrasounds, nonstress tests, and biophysical profiles. It is very important to establish that you are low risk for you to have the mid-pregnancy ultrasound at around 19 to 23 weeks. This test will rule out any life threatening major anomalies in the fetus or problems with the placental placement or maternal anatomy. For clients with a high deductible, or no insurance where finances are an issue we have an excellent cash pay only option for ultrasounds at Ultrasound Institute in Phoenix.

Studies show that Obstetricians spend on average 7 minutes per prenatal visit and an initial visit can be about 20 to 45 minutes although not all of that time is spent with the doctor. You will find midwifery care much different. The pace of the visits is relaxed and inviting. There will always be time to have all your questions and concerns addressed. The first visit is a free consultation and we spend about one hour answering any questions and discussing our practice and protocols. Then we do an initial work-up, and we spend about two, to two and a half hours going over your medical history, talking about how to have an optimum pregnancy, and doing a complete physical examination including all desired lab work. After that, we spend about 45 minutes to an hour at every prenatal visit. Visits are monthly until the 7th month, then every two weeks until the beginning of the 9th month, and then weekly after that. This extra time allows us to know one another on a more intimate level as we all prepare for the day of your birth. We find this helps build a deeper level of trust and understanding which allows us to deliver the ultimate prenatal care to each of our clients.

Lots of ways! We encourage your questions and comments at every visit. We give you the reasons for all prenatal testing and let you make the decisions about which ones you want. We encourage fathers to come to visits, listen to baby’s heartbeat and be as involved in your care as you and he feel comfortable. We encourage you to evaluate your own eating habits and make healthy choices. We discuss all recommended supplements, health foods, and healthy home remedies for particular conditions. We listen and ask your opinions about the choices that are available for your care. Older children are encouraged to be the midwife’s helpers at the visits and can help feel mom’s belly for fetal position, measure her tummy for growth and development, hold the Doppler in place as we listen to baby’s heartbeat. We show pictures of baby’s development at each stage of the prenatal journey.

Yes, and yes! Women often want to eat small amounts of nutritious food and keep drinking juices or other nutritious liquids during labor. There is no reason not to eat, and we actually encourage women to keep up their energy by drinking fluids and eating. Women can labor in whatever position they want, but we might encourage different positions in order to help the baby move down and get the labor progressing, or we might encourage rest at other times. We are there to help facilitate normal, natural labor and birth.

In all these years, there have only been a handful of women who chose to go into the hospital for pain medication when they were experiencing normal labors. Sometimes, during an especially long, complicated labor, women get tired and if they are transported to the hospital they opt to have something for pain. We always honor their request if that is what they wish, as an epidural or other methods can be helpful in seeing labor through to the birth. At home, we use warm baths, showers, massage, walking, changing positions and many other comfort measures to help women give birth naturally. We offer a labor pool for those wishing to use warm water immersion. A doula can also offer so many gentle methods of support and pain relief.

We will provide a list of common household items to prepare for a home birth, as well as a few things to buy. We will also provide a birth kit of disposable medical supplies that will be used during the birth. In addition we ask that you Pre-register at the nearest hospital and prepare a bag for the hospital in case of transport.

During labor, we come to support the woman once we know that active labor has begun. It might be hours or more than a day! We stay for at least 3 hours after the birth, and come back approximately 24 hours later to make sure everything is fine with both mother and baby. We see the mother and baby again at their home 3 days postpartum (after the birth), and then in our office at one week, two weeks (Optional), four weeks (Optional) and six weeks postpartum. Other visits are available if needed to monitor weight gain in the baby, lactation support, or other difficulties that may arise.

Yes, if they desire to attend. We recommend that they have someone present to care just for them and attend to their needs. They can talk to the midwives ahead of time if they wish and have any questions answered. We encourage you to seek out information, birth films, or books to help prepare them ahead of time.

In some cases Vaginal Birth after Cesarean is allowed in our scope of practice by the Arizona Department of Health Services. You may be considered as a candidate if you have had only 1 previous cesarean and if the surgeon’s notes are available stating that your previous incision was low transverse in both layers and was repaired using a double suture. In addition if you had a particular condition that caused you to need surgery that is still present you may not be able to birth vaginally. You will need to be carefully screened if we are to proceed. You will be required to seek medical consult and in some cases you may need dual care with a physician. Vaginal Breech Births are within scope of practice as outlined by the Arizona Department of Health Services are. Vaginal Breech is possible if baby is not presenting feet first and is in optimal position. We practice “Hands off the breech” with excellent outcomes. Before birth we encourage the use of spinning babies to help encourage baby into a head down position and if baby doesn’t turn we want your pelvic floor to be well balanced and relaxed. Breech is another form of normal birth. Twins are not allowed within my scope, however I do know of an out of hospital birth option with a team of midwives nearby if you would like a referral.

Our episiotomy rate at home is less than 1%. For the women who transport to the hospital in labor, 95% of them do not receive episiotomies either. Episiotomies are rarely needed and are no longer standard practice for the doctors.

If there is an emergency requiring a cesarean section, we call the hospital and doctor on the way and let them know we are coming, so that they can organize their staff and prepare to take care of the mother immediately. We may call an ambulance for transport, and we accompany the mother to the hospital when allowed. We do everything possible to assure a safe and smooth transition from home to hospital under the circumstances.

There are many things that would make a pregnancy high risk, more than we can answer here. However, most of these conditions are rare, and many can be prevented with healthy lifestyle choices, especially taking good care of yourself! Some of the complications you might have heard of are: high blood pressure, diabetes, heart disease, pre-term labor, preeclampsia or twins. We stress healthy lifestyle and good diet in pregnancy to achieve an optimum pregnancy, and educate women and families about ways to prevent complications. We also perform all the necessary screening for these complications during the course of your prenatal care.

We will refer you to the OB of your choice for any complications that may arise during pregnancy or birth. Locally both North Country OB and Flagstaff OB have proven to be excellent choices when a consult, referral, or transfer of care is needed. We have also referred special cases to MFM specialists in Phoenix. We have a good working relationship with the hospital staff at Flagstaff Medical Center, and have found in general that our clients are pleased with FMC’s care whenever it is needed as they have an excellent labor and delivery staff and NICU. They are generally kind and respectful to women who transport to hospital from a home birth setting.

At one to two weeks overdue. As licensed midwives, our regulations by the AZ Dept. of Health Services require that we transfer care at 42 weeks. We will begin discussing options for your care at one week beyond your due date. There are times when induction is recommended for the safety of the baby. We work with women before that time to encourage labor, with natural methods such as walking, making love, and other natural alternatives.

Our cesarean rate is very low at just over 5%. The national average for cesarean section is 29 %. The World Health Organization recommends the rate of cesarean sections remain below 15%. For the women we transport to the hospital for complications, 70% of them still give birth vaginally.

We carry oxygen, newborn resuscitation and suctioning equipment, and we are certified in Neonatal Life Support. We carry medications to stop bleeding. We carry equipment to monitor the mother and baby during the intrapartum period. We offer suturing for tears of the perineum. We offer IV therapy for certain conditions if needed. We offer erythromycin eye ointment, or vitamin K (Injection or Drops).

Our overall transport rate during labor or after the birth averages about 13% over the past 20 years. That means that out of 100 women starting labor at home, 87 of them give birth successfully at home without requiring any additional medical care for themselves or the newborn. We transport to Flagstaff Medical Center in case of complications or emergencies when in the Flagstaff area. If you are delivering outside of the Flagstaff area we will transport you to the nearest hospital. The most common reasons for transport are prolonged labors (where the mother is exhausted and dehydrated) or signs that the baby is not tolerating labor well. It is extremely rare for us to transport in an emergency situation, where time is of the essence. Most transports are calmly accomplished by going in the car with the midwife to the hospital. Very rarely, we will need to call an ambulance for assistance and transport. We recommend that your home is no more than 20 minutes from the hospital, however we will consider attending births that are farther than that.

There is a check box on the Live Birth Certificate Worksheet that you will check if you want a social security card issued for your baby. It will automatically be mailed to you.

Yes. We MUST file a birth certificate within 7 days after the birth. Margie will provide a copy of the Live Birth Certificate Worksheet for you to fill out. A few days after that you must go to the ADHS Vital Statistics website and pay for a copy if you would like one.

Yes, we offer the same newborn initial exam, 1st and 2nd Newborn Metabolic screenings (Heel stick tests), Congenital heart defects screening, and hearing screen that your baby would receive from other practices or at the hospital.