Your questions are welcome here!
Can I have a Trial of Labor After Cesarean (TOLAC) at a birth center?
- Our Certified Nurse-Midwives spend a lot of time with their clients
- Breath of Life has a birth class specially-designed to help prepare you for a TOLAC at Morton Plant
- The entire staff supports your choice to have a TOLAC
- All blood draws are done on-site
- Ultrasounds are available on-site
Am I eligible for Birth Center Care?
First, check and see if your insurance company will pay for you to be cared for at Breath of Life. Most do — you can see the list here — and if not, we have special payment plans for self-paying clients.
Next, let’s look at your health. Most pregnant women who are low-risk and meet specific guidelines can be cared for and give birth at Breath of Life Birth Center. But some women with certain pre-existing medical conditions, or medical conditions that arise in pregnancy or labor, may be prohibited by state guidelines to receive care from a birth center, or for medical reasons, it might be decided that a birth center is a less than optimal choice for the type of care a higher-risk woman might need.
Florida’s Agency for Health Care Administration has a list of conditions that would require a birth center client to transfer to the care of a physician. Keep in mind that just because a condition is listed here doesn’t automatically mean a woman can’t have her baby here. Each situation is considered on a case-by-case basis, so give us a call and you can speak with one of our Registered Nurses about your particular situation.
These are the guidelines and medical criteria Florida birth centers use to determine whether a birth center is the ideal setting for a pregnant woman’s prenatal care, labor and birth:
- Client must be considered low-risk at the initial evaluation
- Age limits are determined on an individual basis
- Major medical problems include but are not limited to:
- Chronic hypertension, heart disease, or pulmonary embolus
- Congenital heart defects assessed as pathological by a cardiologist, placing mother and/or fetus at risk
- Severe renal disease
- Drug addiction or required use of anticonvulsant drugs
- Diabetes mellitus or thyroid disease which is not maintained in a euthyroid state
- Bleeding disorder or hemolytic disease
- Previous history of significant obstetrical complications include but are not limited to:
- Previous Cesarean birth or other uterine wall surgery
- Rh sensitization
- Seven or more term pregnancies
- Previous placenta abruption
- Significant signs or symptoms of:
- Hypertensive disorders, such as preexisting hypertension, gestational hypertension, preeclampsia, eclampsia, HELLP syndrome
- Poly or oligo hydramnios
- Certain placental disorders or infections
- Malformed fetus
- Multiple gestation
- Intrauterine growth restriction
- Fetal distress
- Alcoholism or drug addiction
Will my insurance pay for it?
Please contact your insurance company to verify your maternity and birth center benefits and anticipated financial cost share for your particular plan. A financial agreement will be drawn up based on your current plan benefits. Please note that the benefits in place as of the date your baby is expected to be born are what determines your financial responsibility.
Required FEES not paid for by insurance plans or Medicaid:
- Administrative Fee (non-refundable and due at the first prenatal appointment) – $195
- Natural Childbirth Prep Course (due at the first class in the series) – $175
Optional fees not paid for by insurance plans or Medicaid and which must be prepaid:
- Nitrous Oxide (due at 36 wks) – $250
- Cord Blood & Tissue Banking Collection ( due at 36 wks) – Varies
Our insurance in-network providers include:
◦CIGNA (except CIGNA BayCare)
◦Florida Blue (BCBS)
◦First Health Network
◦UnitedHealthOne (Golden Rule)
◦Veterans Administration Fee-for-Service Benefits
Medicaid Managed Care Plan: Staywell Health Plan
I don’t have insurance. How much does it cost?
We believe the quality of personalized care and attention received at Breath of Life is worth the investment. Midwives and birth centers enjoy better health outcomes for mothers and babies than hospital care. There is no comparison!
Are maternity and newborn care the most costly hospital conditions in the U.S.?
Due to the technology-intensive style of care, hospital charges for maternity care for mothers and newborns far exceed charges for any other hospital condition at over $100 billion/year in the U.S.
• Rising Cesarean Section rates … most common operating room procedure in U.S.
• Six of the ten most common hospital procedures in the country are maternity-related (1)
• Tampa Bay area has a C-Section rate of 35-40% (2); World Health Organization recommends 5-10% C-Section rate (3)
Birth center care facilitates physiologic childbirth which is less costly. Care is provided in an outpatient setting and is an excellent value for health care dollars.
How do I contact you?
For general questions and inquiries, you can call us at the office (727-216-1420) during regular office hours, Monday through Thursday from 9 AM to 5 PM (closed for lunch from noon to 1:30 PM). For our midwifery clients (during pregnancy and up to six weeks postpartum), a paging system is in place through our answering service should you need us for emergencies or labor after business hours and on weekends (Direct Number to Answering Service: 727-777-6860).
I would like to have my baby born at home. Do you offer home birth services?
While we pride ourselves on offering a home-like setting for birth at the birth center, we are not providing home birth services.
I would like to have a VBAC (Vaginal Birth after Cesarean). Can I do that at the birth center?
Am I too “high-risk” to have my baby outside of the hospital?
Women of any age who begin their pregnancy in a healthy state generally remain healthy and have a normal delivery. During regular prenatal visits, we conduct thorough screening to ensure that you remain healthy and normal. We also use education and encourage nutrition and exercise to prevent problems. We can manage most of the common pregnancy complications.
Florida Law regulating birth centers requires that women who plan to deliver out-of-hospital be medically low-risk and be expected to have an uncomplicated birth.
The following conditions would place a woman in the “higher-risk” category, according to state regulations, and she and her baby would be better off being cared for by a physician (or a nurse-Midwife working with a physician) and giving birth in a hospital:
- Chronic High Blood Pressure
- Heart Disease
- Kidney Disease
- Current addiction to drugs or alcohol
- Bleeding or Blood Clotting Disease
- Prior Cesarean Section
- Multiple Pregnancy (twins or triplets)
- 7 or more childbirths
- Toxemia (Pre-eclampsia) in current pregnancy
- History of Placental Abruption
- Extreme obesity
- Women on certain medications.
*Note: Gestational Diabetes in a prior pregnancy does not automatically exclude you from consideration for a birth center birth.
Except for women with these conditions, most pregnant women are eligible for care by the nurse-midwives at Breath of Life Birth Center. We suggest you call us to discuss your questions or schedule a free tour/consultation of the birth center.
We are sad that we cannot care for women with a prior cesarean section, but the current guidelines require that VBAC (Vaginal Birth After Cesarean) be attempted in a hospital setting.
I have realized that my doctor (or hospital) isn’t meeting my needs. Can I become a client after starting care with another provider?
Women who have had adequate prenatal care may transfer to the Breath of Life Birth Center. We get phone calls every week from women who have discovered that their hospital or doctor isn’t meeting their needs. Some women need some time to realize that their fears about birth are misplaced and that they want to follow their heart and have their baby in a private, relaxed setting, rather than in the hustle and bustle of the hospital.
Becomng a client is a simple matter of completing the “Take Your First Step” questionnaire at the top of this page. After completing it please call us to discuss the process which includes getting your prenatal care records from your current care provider so our nurse-midwives can review them to verify that you are eligible for birth center birth.
Some women who are considering switching care providers worry about offending or disappointing their current provider. While this displays a great deal of thoughtfulness on your part, you should know that no doctor wants an unhappy patient. You have the right to exactly the care you desire and if you can’t get it with your current provider, no one should fault you for switching.
What is the significance of the CABC Accreditation for Breath of Life?
Accreditation is seen as a symbol of excellence to not only the consumer but to insurers as well. Many insurers currently require accreditation for reimbursement, and the trend among managed care providers is to also look for accreditation.
The CABC is the only birth center accrediting body whose site visitors are specifically trained to perform a visit in a birth center and whose review panels have first-hand knowledge of the philosophy, purpose, and operation of birth centers. It is dedicated to the promotion of quality care through a rigorous process of evaluation and accreditation.
Where does the U.S. rank in Maternal Mortality?
• Maternal Mortality
• Neonatal Mortality
• Low Birth Weight
Although most childbearing women and their babies are healthy, those who give birth in U.S. hospitals experience high rates of interventions with risks of adverse effects.
Many practices, such as labor induction, continuous electronic fetal monitoring, epidurals, episiotomy and cesarean-section, originally developed to address specific problems are being used liberally and routinely in healthy women. Excess C-Sections do not reduce maternal and newborn deaths, rather cause unneeded exposure to dozens of adverse effects. These practices, disproved or appropriate in limited circumstances, are in wide use whereas beneficial practices are underused.
In contrast, increased use of beneficial practices, such as continuous support throughout labor, relaxation techniques and comfort measures, water labor/birth, freedom to change positions, delayed cord clamping, early mom-baby skin-to-skin contact would lead to improved outcomes for many mothers and babies.
Why would I want to have my baby in a birth center?
- Freedom – Not only are you allowed to walk around during labor and eat and drink, we actually encourage it. You can have your baby in any position and are never confined to a “birthing bed” or strapped to monitors. You will wear your own clothes, instead of a hospital gown. During
laborwe monitor the mother and baby and the progress of labor in a way that doesn’t interfere with your ability to move around. Studies have clearly shown that labor is shorter and easier if a woman is active and is able to eat and drink. The baby also suffers less distress if mom is upright during labor.
- Privacy – You and your family will have complete privacy and will never be taken care of by strangers. You will get to know our small staff during your pregnancy and by the end we usually all feel like family. You can have as many or as few friends and family members as you like with you to welcome your new baby.
- Bonding – Your baby will never leave your side. Your partner will play a pivotal role in assisting you in labor. Your other children can be present for the labor and birth.
- Personalized care – During your pregnancy, we get to know what is important to you and your family, so that we can accommodate your wishes. Would you like to avoid an episiotomy? Would you like to avoid unnecessary labs and procedures? Would you like your partner to help “catch” the baby? Would you like to be the one to “announce” if your baby is a boy or a girl? All of these and more are routine at the birth center.
- Choices – Nurse-midwives believe that optimum health and safety are achieved when you are making the decisions regarding your care. We like to say that everything is up for discussion and nothing is routine. We will help you to be informed and educated about your choices, through teaching during pre-natal appointments and childbirth classes.
- Breastfeeding support – We will encourage and assist you to nurse your baby soon after birth. We have a pro-breastfeeding policy and actually require that you nurse successfully before you may leave the birth center. We follow up with frequent phone calls for the first
week,so that we can help you with any difficulties that arise. We have a La Leche League Leader on staff who can answer your questions and even make a home visit if you need extra help.
- Safety – Research has proven that out-of-hospital birth leads to fewer interventions and complications for both the mother and the baby. The chances of you having a cesarean, for example, are greatly reduced. Your baby will not be pulled out with forceps or vacuum. Your baby will not be subject to unneeded injections and examinations. Your body and your choices will be respected.
As a matter of fact, the American Association of Birth Centers statistics demonstrate that birth centers have very low cesarean rates and infant and maternal death and injury rates. A study comparing out-of-hospital birth to in-hospital birth showed that for first time mothers, out-of-hospital birth was as safe as in-hospital birth, and for mothers who have already had one baby, out-of-hospital births are actually safer than in-hospital births.
Labor & Birth
Can you explain more about nitrous oxide (N2O) labor analgesia?
- provides enough labor pain relief for many women
- may enable women to avoid, postpone, or limit narcotic or epidural pain medication, which have more serious adverse effects
- has a short lag time between requesting the gas and obtaining relief
- can be used at any time in labor right up to the birth
- increases sense of personal control, as woman chooses when to use it
- does not appear to interfere with labor progress or ability to push
- does not lower blood oxygen level
- does not appear to have adverse effects on the baby’s condition at birth
- can be discontinued more quickly than other pain medication, as its effects reverse rapidly when you stop inhaling it
- does not require the presence of an anesthesiologist for its administration and monitoring.
Currently, use of our NITRONOX® system is not covered by insurance or Medicaid and is charged to the client.
Resources for more information:
- American College of Nurse-Midwives – Nitrous Oxide for Labor Analgesia Position Statem
- Childbirth Connection –
What about tearing?
Water is a fabulous way to prevent tearing. We encourage you to at least spend some time soaking in the waterbirth tub in your birth suite, even if you don’t want to have a waterbirth. The water softens the tissue, allowing it to gently stretch during birth. Delivery underwater has been proven to dramatically reduce the risk of tearing, because the water not only softens the tissues, but the natural analgesic effect of the water makes it easier to deliver your baby slowly and gently.
Should you require stitches; the nurse-midwife will perform the repair after birth. We use local anesthetic for stitches. We also have self-administered nitrous oxide analgesia available for pain relief.
The nurse-midwives are also trained to cut an episiotomy in emergency situations. It is done very rarely, but the ability to perform an episiotomy is an important component of the nurse-midwife’s management of birth complications.
What procedures do you require on the newborn?
A Newborn Metabolic Screening Test (PKU), a heel stick for blood collection, will be offered between 2 and 6 days after birth at your postpartum visit. It is required of the State of Florida. You also have the option to decline the collection with a signed waiver.
Natural labor sounds like a good idea, but what if I want drugs?
- Water birth pool
- Sterile water injections
- Self-administered 50% nitrous oxide/50% oxygen gas (analgesia)
You will be thoroughly prepared to navigate labor in a relaxed state. The continued presence of the nurse-midwife during labor will also reassure you that you and your baby are safe.
Do you work with Doulas?
Achieving a natural birth is often a team event. Having a professional labor support person with you adds to the team. A doula can offer extra support, tricks and tips for dealing with labor as well as help your partner be the best labor support he can be.
Unlike the nurse-midwife and birth assistant, who have other duties and responsibilities during your birth, a doula is there just for you, to give you exactly what you need to achieve your goals.
Can I take pictures and/or videotape?
Who may I have with me at the birth?
We have a separate Family Lounge where people can be close by without actually witnessing the birth, allowing you privacy while still having your important people nearby.
Can my other children attend pre-natal visits and be present for the birth?
One of the greatest joys is helping a toddler come to terms with the enormous changes life with a new sibling brings. We help you introduce the concept of the new baby by welcoming your other children at pre-natal visits and making the birth center feel like a comfortable, welcoming place for them.
No need to hire a babysitter, just to come in for a check up. We love getting to know your entire family and making everyone feel at home and part of the process. You are creating a family; we are here to support you.
Very few children under three are interested in actually seeing the baby born, but they are often anxious to be the first to hold their new sibling. Older children, especially girls, are often fascinated by the process and want very much to be a part of the experience. Having your other children present for the birth can be an important part of their bonding experience and acceptance of the newest family member.
Little ones need their own support person while in the birth center (not daddy, because he will be busy with mommy). In our experience, they are usually content to play or nap and check in on mommy periodically. With basic age-appropriate preparation, children of any age can participate fully in the experience.
Will my pediatrician come to the birth center?
How long do I stay at the birth center after I have my baby?
Can’t imagine going home so soon after having your baby? Most of our clients feel great after their unmedicated labor and birth and are ready and anxious to get back to their own bed and their own home. It is amazing how much energy you have after accomplishing your goal.
Before you leave, the nurse-midwife does a thorough check of the mother and newborn.
At Breath of Life Birth Center, we take the “fourth trimester” as seriously as we do the three trimesters of pregnancy.
The midwife will call you regularly during the first few days. We expect you to have office visits at 2-3 days, 10 days and 6 weeks post-partum.
Adjusting to breastfeeding and life with a newborn can be confusing and challenging. We will remain your partner and support as you navigate these difficult waters.
The “PKU” test (Newborn Screening Test) on the baby can be done at the 2-3 day office visit.
Do you use a doppler or fetoscope?
How long are prenatal appointments?
What routine prenatal tests do you require?
Some of those screens are:
- “OB Panel” to show complete blood count (CBC), blood type, Rh factor, antibodies, rubella, hepatitis B, hepatitis C, and syphilis status, and a random glucose result (Hemoglobin A1c).
- HIV screening
- Pap smear offered if indicated or requested
- Gonorrhea and Chlamydia screening
- *Prenatal Screening (Quad Marker, Serum & Full Integrated Screenings)
- Diabetes Screening Test and Anemia screening at 28 weeks
- Group B Strep (GBS) screening at 36 weeks
- *Early ultrasound (indications may be suspected twins, unknown date of last menstrual period or conception)
- Urinalysis with culture & sensitivity
- *Non-stress test (NST)
- *Biophysical Profile (BPP)
- *Thyroid Testing if Indicated
* indicates test not routinely performed
How do I get my lab work done?
We will collect your lab work in the office or send you to a local lab. We will review the results with you.
I would like to have a VBAC (Vaginal Birth after Cesarean). Can I do that at the birth center?
What situations do you consult a doctor for?
We may also refer to an herbalist and homeopath, chiropractor or acupuncturist for natural remedies and support.
What emergency equipment and medicine do you have?
What complications do you handle?
Briefly, many complications can be and are handled in the birth center without further incident. For instance, a cord around the neck, GBS + mother, shoulder dystocia, fetal distress, maternal exhaustion, dehydration, retained placenta, postpartum hemorrhage, and newborn respiratory distress. If the situation cannot be stabilized, we will not hesitate to call “911” for emergency assistance and guidance. You will be transported by ambulance to the emergency room at Morton Plant Hospital, a 5 minute ambulance ride from Breath of Life. You will be cared for by the OB/GYN physician on call at the hospital.
In what situations will you transport?
If a woman should opt for analgesia or anesthesia, a transport becomes necessary as we do not have these medications available in our birth center. Such medications increase risk and must be monitored in the hospital. A woman may have become exhausted and in need of compassionate use of medication to help her rest and progress before complications arise due to her fatigue. If a non-emergency transport is recommended, it will be because we have exhausted all resources available.
What situations, should they occur, would be too high risk for birth center birth?
Due to ACOG guidelines, local standard of care, and politics, vaginal births after Cesareans (VBAC), and breech presentations
What if something goes wrong?
We do not handle high-risk pregnancies and you must be full term and essentially healthy to have your baby in the birth center. If we run into a problem with the mother or the baby, we have emergency equipment (including IVs, oxygen, medication to stop bleeding, antibiotics, and resuscitation medications), and all personnel are trained in emergency procedures (including CPR and neonatal resuscitation).
Stalled labor is, by far, our single most common reason for hospital transfer. Although we must resolve the situation in a timely manner, it is not truly an “emergency” and we generally have plenty of time to try various natural methods to get labor going again. By the time we decide to go to the hospital, generally the entire family is in agreement that it is the only reasonable course of action. Mothers can be driven to the hospital in their own car or via ambulance if needed. Mom’s care is then transferred to the OB Hospitalist Group at Morton Plant Hospital in Clearwater.
How long is the baby in the water after the birth?
How much does a waterbirth cost?
What is the temperature of the water?
What prevents a baby from breathing under water?
- Prostaglandin E2 levels from the placenta which cause a slowing down or stopping of the fetal breathing movements. When the baby is born and the Prostaglandin level is still high, the baby’s muscles for breathing simply don’t work, thus engaging the first inhibitory response.
- Babies are born experiencing mild hypoxia or lack of oxygen. Hypoxia causes apnea and swallowing, not breathing or gasping.
- Water is a hypo-tonic solution and lung fluids present in the fetus are hyper-tonic. So, even if water were to travel in past the larynx, they could not pass into the lungs based on the fact that hyper-tonic solutions are denser and prevent hypo-tonic solutions from merging or coming into their presence.
- The last important inhibitory factor is the Dive Reflex and revolves around the larynx. The larynx is covered all over with chemo-receptors or taste buds. The larynx has five times as many as taste buds as the whole surface of the tongue. So, when a solution hits the back of the throat, passing the larynx, the taste buds interprets what substance it is and the glottis automatically closes and the solution is then swallowed, not inhaled.
Is underwater birth safe?
The baby is protected by the “Dive Reflex.” Don’t forget that the baby has been “under water” the entire time he or she was in the womb. Water is the most natural environment for a baby.
Babies are born with all kinds of “reflexes” – automatic behaviors; one of them is the “Dive Reflex”. A newborn immersed in water will close its mouth and open its eyes (do not try this at home!). This reflex persists for several months and is the basis for infant swim training.
When the baby is born in water, it is still attached to the umbilical cord and receiving oxygen exactly as it was in the womb. As a matter of fact, a baby born under water doesn’t even realize it is born until you take him or her to the surface. It is a very gentle way to welcome a new life.
The nurse-midwife brings the baby out of the water within a few seconds of birth, to minimize any risk.
Water-birth has been proven through thousands of births around the world to not only be safe, but perhaps safer for the mother and baby.
See Barbara Harper’s (author of Gentle Birth Choices) website www.waterbirth.org for more information on water birth.