The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Midwife's Financial Agreement / Informed Consent

INFORMED DISCLOSURE OF PRACTICE

I am an apprentice trained direct entry midwife. I am not a registered nurse, certified nurse midwife, or physician. I am not licensed or certified by the State of Georgia. I am an active member of the Georgia Midwifery Association, and am certified through the association and the North American Registry of Midwives (NARM). I hold current certification in both adult and infant CPR as well as neonatal resuscitation

I have been attending births as a primary midwife since 1982 and have been blessed to be a part of over 350 homebirths. Prior to that time, I observed and/or assisted at over 350 homebirths and hospital births. My transport rate is approximately 10% and my cesarean section rate is approximately 3%.

Although, I believe that every woman has the right to choose where and with whom she has her baby, my practice is limited to low risk pregnancies and births. Should your pregnancy fall out of the low risk category, other arrangements will have to be made for the birth.

I expect parents to be well informed and take responsibility for reading and educating themselves. I expect you to consider the gravity of the risk you are taking, and be willing to take full responsibility for the outcome of your birth. I cannot offer you any guarantees other than I will do my best, with the knowledge I have, to provide you with a safe and rewarding birth experience.

Even with low risk births, complications can arise. Usually there is ample time to transport to the hospital, but occasionally we must deal with the complication at home. Some of the complications I have dealt with are fetal distress, prolonged labor, dehydration, meconium, breech presentation, placenta abruptio, shoulder dystocia, prolapsed cord, postpartum hemorrhage, still births, birth defects, and respiratory distress in the baby.

You are responsible for arranging your own obstetrical and pediatric back-up. If you cannot find private obstetrical back-up, and you end up transporting, we will go to the closest hospital. Cobra laws mandates that hospitals may not refuse emergency care to pregnant women or women in labor. Some hospitals have certified nurse midwives who take care of all walk-ins, while other hospitals call in the obstetrician on call. In either case, without private physician back-up, you will not know who will handle your birth ahead of time. We can not guarantee what type of reception you will receive.

My fee is to be fully paid by the time of the home visit, approximately 3-4 weeks before your due date. The fee covers services that are provided by me and/or my assistant, and include prenatal care, a prenatal home visit, labor and birth, and a postpartum home visit (usually done 1-3 days after the birth.) Outside lab work, ultrasounds, physician and/or certified nurse midwife consultations, and birth supplies are not included in my fee. If I am notified when your labor begins and kept in touch with during your labor, it is very rare that I would miss your birth. If I am at another birth or off call, I always have a back-up midwife available. No refund will be given unless other arrangements for delivery are made prior to the beginning of labor. In that case, a partial refund will be made. In the event of transport to the hospital, I will make every effort to stay with you. With some hospitals, though, this is an impossibility. Regardless of whether I can remain with you or not, no refund will be made.

My main goal is a safe birth for both you and your baby. I look forward to a rich and rewarding experience sharing this time with you.

Mothers signature & date                 Fathers signature & date