Collaboration:
One of the biggest differences in between the standard America obstetric care model and the midwifery model of care is the way in which we work with clients to make decisions together. In our long prenatal visits (90 minutes for the first one and 45 min for each subsequent one, the entirety of which is spent with the midwife) we take the time to help you understand what’s happening in your body during a pregnancy so that you can make informed decisions regarding your care. We give you an array of choices, provide pros and cons of various courses of action, as well as any statistics regarding probable outcomes, and come to a jointly-made decision. Our providers may make recommendations, but we do not “force” or “push” any particular testing, medication, or course of action on our clients, save for those that are absolutely essential to safety in the birth center.


Education:
We take the concepts of ‘informed consent’ and ‘informed refusal’ very seriously here at the Nest. To us, a client cannot make an informed choice unless they have all the facts, so we spend the time that it takes to help families understand the choices in front of them. We encourage all of our families and/or moms having a first baby to take childbirth education classes, and we also have a lending library in our office full of books that we find to be evidence-based and informative. Knowledge is power, especially in health care. While we do also expect and encourage our clients to pursue knowledge about pregnancy and birth outside of prenatal visits, the sheer amount of time that we spend with our clients in prenatal care ensures that they are well-informed enough to take an active role in the decision-making around their own pregnancy, birth and postpartum care.


Evidence-Based:
This is a buzzword you might be hearing more and more of these days. What this means is that before recommending a test, treatment, or course of action, we look at the available evidence to see if it is effective, and if its benefits outweigh its costs – in side effects, dollars, and risk of harm.

In the world of childbirth, the high rates of C-section deliveries that we see here in the US indicates that a sizeable portion of these procedures are medically unnecessary, and are causing harm – even contributing to our rising national maternal mortality rate. Other common practices in obstetrics that are not supported by evidence are late-term ultrasounds for predicting fetal weight (often inaccurate in the larger direction by 1-2 lbs), or inductions for “big babies.” On the other end of the spectrum, some common practices among midwives are not at all evidence-based, such as the use of Evening Primrose Oil to ripen the cervix, which has proven to not only be ineffective at cervical ripening, but to be associated with a higher risk of complications such as postpartum hemorrhage. In our practice – both in the birth center and in the hospital – we endeavor to use only tests, treatments and medical interventions that are proven to be effective. Most importantly, since clinical guidelines have been changing so frequently on topics that impact women such as breast cancer screening, pap smears, and pelvic exams, we take the time to come up with an approach that suits each client’s tolerance for risk and/or false-positives, family history, and their desire for testing, rather than reflexively following old or new guidelines.


Integrity:
To us, integrity means both honesty and transparency. It means avoiding some of the common conflicts of interest one might find in a health care office, such as referring patients for “needed” labs or imaging services using a lab or imaging equipment owned by that same clinician or office, or selling the supplements that the clinician recommends as a treatment for a specific condition or for overall wellness. Sometimes these services or products really are necessary or beneficial, but how can the average person really know? We do not provide laboratory testing in-house or do ‘pass-through billing’ for labs that we order, and thus have no financial incentive to order any tests – meaning we only order what we believe you need, and what the standards of care call for. We offer ultrasounds in the office, but only perform them when there is a medical indication (such as being uncertain on dates or for spotting in early pregnancy) or upon specific client request – they are not a routine part of any prenatal visit.


Respect:
Providing health care that is sensitive and responsive to the needs of our clients must always stem from mutual respect.

We respect your time by endeavoring to always start your visits on time. It is rare that visits in our office start more than 10 minutes late, with most starting on time or less than 5 minutes late.

We respect your finances by only ordering testing and treatment that we believe that you need. Unlike most offices, we offer multiple options of laboratories so that we can help you get the best price for some of the more expensive, elective testing such as cfDNA testing and genetically-inherited disease carrier screening. We work with both Quest and LabCorp so that we can make sure that we are sending tests to your preferred lab. We endeavor to always refer you to in-network specialists and in-network imaging centers.

We have admitting privileges at both Providence Alaska Medical Center and Alaska Regional Hospital, so that we can take our clients to their preferred hospital in the event of complications. We prepare a worksheet for all of our self-pay and privately insured clients so that they know what everything costs and what we expect their out-of-pocket costs after benefits to be.

We respect your right to make informed choices about your care. We take the time to inform you what testing options exist for your pregnancy, and help you choose the ones that are right for you and your family. We are very transparent about what tests or treatments can be declined, and what the risks may be of not doing those things – but the choice is yours and we respect your right to make it. This applies to choices in prenatal care, such as whether to screen for gestational diabetes or Group B Strep, or whether to get a TDAP or a flu vaccine. It also applies to choices in labor, such as how to handle prolonged early labor, what to do if your water breaks with no labor, or whether to consent to hospital interventions such as the use of Pitocin or an epidural. At every step we are there, giving you the information that you need to make whatever are the best choices for you and your baby.


Community:
We have always felt a strong obligation and desire to both create community and to give back to the community. We create community by hosting events for our families where they can reconnect with us and meet other families with kids, such as our annual Halloween party, free fitness parties at the Alaska Club, free postpartum physical therapy events, and the occasional anniversary party. We give back to the community in a variety of ways. We sponsor family-friendly events such as NSAA’s Solstice Tree tour in Kincaid, the ‘Breastaurant’ (nursing/pumping trailer) at the Women’s Gold Nugget Triathlon and at the Downtown Solstice Festival, just to name a few.

We participate in local medical conferences and lecture at others. Barbara Norton has been at times adjunct faculty and a guest lecturer at UAA for many years. Our office helps train CNM, FNP and RN students as a clinical site. We are active supporters (in many different ways) of the American Association of Birth Centers (AABC), which helps new and established birth centers around the country to spread this wonderful model of care. We have also been longtime supporters of the Commission for the Accreditation of Birth Centers (CABC), ever since becoming the first birth center in Anchorage to be nationally accredited in 2002.