In the state of Florida, there are 2 pathways to practice midwifery legally- the certified nurse midwife (CNM) pathway and the licensed midwife (LM) pathway. Our midwives here at The Swell are LMs.

The LM pathway involves graduating from a direct entry 3-year intensive midwifery program accredited by the Midwifery Education Accreditation Council, as well as meeting all of the requirements to sit for and pass the national certification exam of the North American Registry of Midwives (passing this exam is specifically how the Certified Professional Midwife- CPM-  credential is earned).

The education for the LM pathway is based on the European model of midwifery that includes nursing, obstetrics, gynecology, and pharmacology, as well as hands-on clinical training. In Florida, the LM/CPM credential is the only midwifery credential that requires knowledge about and experience in out-of-hospital birth settings.

LM/CPMs work independently, providing comprehensive, holistic midwifery care from preconception to postpartum and beyond in low risk populations. LM/CPMs also work collaboratively with CNMs and physicians for higher risk populations, prescription medications, and treatment plans. LM/CPMs work in a variety of settings including health care clinics, physician offices, birth centers, and occasionally hospitals, in addition to providing home births. Our midwives at The Swell attend births exclusively in clients' homes.

Midwives and doulas both play important roles in birth work, but the difference between the roles is also important and should be clear.

Midwives (both CNMs and LM/CPMs) are licensed medical care providers who are qualified to catch babies, administer medications, and provide prenatal and postpartum care. Most midwives spend 3-7 years gaining their education and training prior to becoming licensed. 

Doulas are trained labor-support people, who are experienced in comfort measures and education for labor and birth. Many also provide postpartum services which can include infant care and meal prep. Emotional support is a key part of their role. Most doulas spend 2-6 months becoming certified.

Multiple research studies have shown that home birth for low-risk parents attended by trained and experienced midwives is as safe as (or safer than) birth taking place in the hospital. There are risks involved with any birth in any setting, and we are trained and skilled in managing emergencies and unexpected complications. We are happy to provide you with research and resources for more information upon request.

Many people meet the criteria to be considered low risk and good candidates for home birth, but the best way for us to answer this question for you individually is through a consultation. We can discuss your health & birth history and determine together where the safest place for you to birth might be. 

Pre-pregnancy factors that may tip you out of the low risk category and make home birth an unsafe choice include certain chronic illnesses and their medications, hypertension, diabetes, blood clotting disorders, and serious unresolved heart conditions/defects. Pregnancy-related factors such as certain types of prior cesareans (see the separate FAQ on VBAC for more information), twins/multiples, serious abnormalities in the fetus detected by ultrasound or genetic testing, high blood pressure, preeclampsia, gestational diabetes, etc are all higher risk situations, making OB care the safest option. 

You may have a VBAC (vaginal birth after cesarean) at home with a licensed midwife if you have been determined to be an appropriate TOLAC (trial of labor after cesarean) candidate by a physician. We will schedule a consultation between you and an OB to review your history and the details of your c-section, assess your current pregnancy, and discuss the risks and benefits of VBAC. Then, if you meet the criteria of TOLAC you may continue under the care of your midwives.

Yes, but for reimbursement purposes only.

Every policy has different benefits and different pay schedules, so we collect our fees upfront, then we partner with the maternity billing specialists at Birth Professional Billing to work directly with our clients, determining their specific insurance benefits and submitting a claim for the best possible reimbursement after their births. 

And here's some good news: Florida statutes require that "any policy of health insurance which provides coverage for maternity care must also cover the services of certified nurse-midwives and midwives licensed pursuant to chapter 467, and the services of birth centers licensed under ss. 383.30-383.332." This includes our midwives, who are licensed under chapter 467.

We follow the same schedule of care and offer the same tests that you can have with an OB. During a low-risk, uncomplicated pregnancy, there is no need to see an OB in addition to your midwife. There are certain complications or situations that may arise (for example, gestational diabetes), however, where we will want to consult with a physician. If this becomes necessary, your midwife will refer you to a local OB, CNM, or specialist, and will communicate and collaborate as needed to provide you with the safest plan of action.

Absolutely! You can switch over to a midwife no matter how far along you are. When you decide to switch over to a midwife, your midwife will request your prenatal records from your OB office & resume care where they left off. 

IV supplies, IV antibiotics, oxygen tank and O2 masks, neonatal resuscitation supplies, medications for postpartum bleeding, suturing supplies for cases of tearing during birth (including lidocaine for numbing), newborn prophylactic antibiotic eye ointment and injectable vitamin K, equipment for checking all vitals, urinary catheterization supplies, and more.

No, we don’t bring or administer any pain medications for contractions at a home birth. We do work throughout your prenatal care to rewire how we think about pain in childbirth, and we have a variety of pain-relieving techniques that can help parents to cope with labor successfully (including water immersion, acupressure, massage, positioning, homeopathy, etc). We do offer lidocaine to numb any tissues that need to be stitched after the birth.

Yes! In fact, rental service for an inflatable birth pool is included in our fee. Laboring in the water is a great way to rest and relieve discomfort, even if you end up getting out of the tub for birth.

Not at all! We attend births in all sorts of spaces - apartments, airbnb's, hotels, backyards, mobile homes, tiny homes - you name it. We require running water, electricity, & cell service. At 36 weeks, we will visit your birth space and work out any details.

It probably will! Labor often begins during the night due to hormonal shifts in our circadian rhythms. We are on call for you around the clock, and are very used to being called out at 2am!

Nope! We purposefully keep your home clean and tidy, and we make sure that any blood or fluids are immediately cleaned up following the birth. We like to leave your space as clean as (or cleaner than!) we found it. We provide a checklist of supplies to have on hand (most or all of which you already have), and we have you order a special birth kit, which all contributes to a smooth and organized process. 

At The Swell, we intentionally limit the number of families we accept into care each month so that we can commit to giving each family our full presence & competent care. As such, being called to another birth when a client is in labor is a very rare event, but it is always a possibility! The Swell is part of a strong community of midwives here in North East Florida and we support each other in situations such as this. So in the rare event that two or more labors are going on at the same time, we’ll call in help from our trusted community of midwives until The Swell team can get to your home.

Current evidence shows us that of all the folks planning to deliver outside of the hospital, 9-13% of them will require a change of scenery. While we can’t predict who this will occur to or when, we do our best to prepare you for these events throughout your prenatal care with informed choice discussions and an individualized, written transport plan for each family. We feel that speaking openly about the possibility of hospital transport can help families limit trauma and feel more prepared in the moment.

We are well trained in obstetric emergencies in the community setting. We stay up to date on CPR and neonatal resuscitation certification, and we participate in frequent peer review, continuing education, and skills drills. We carry medications and equipment (such as anti-hemorrhagics and IV fluids) to each birth to facilitate in emergency care. Additionally, we will spend ample time throughout your prenatal care discussing what to expect in an emergency situation and developing an individualized hospital transport plan. 

We do not limit the amount of people who may support you at your birth. We do, however, encourage all of our families to keep their birth intimate because we find that when our clients feel like they're hosting guests or being watched, their birth process can be a little less smooth.

As for your other children, making choices like this is one of the many benefits of planning a home birth! Some children are so incredibly involved and comfortable during a home birth that we couldn't imagine them not being there. Some children have zero interest whatsoever, or prefer to not be there. We trust you to make the best decisions for your family! We do ask that 1 adult who is not the laboring person or their primary support person be designated specifically for children under the age of 10, and any age children you generally prefer to have supervised. 

As a hobbyist surfer for most of her life, our midwife, Elizabeth, has looked to the ocean not just for the joy of surfing but also for awe and inspiration. During her pregnancies, Elizabeth discovered the coping technique of focused imagery and, can you guess what imagery made the biggest impact? Yep, waves. Waves swell, they peak, they recede, and learning to ride the waves of childbirth helped Elizabeth channel that awed and inspired surfer within. When it came time to name her midwifery practice, Elizabeth looked to the ocean once again for inspiration. Surfers are constantly assessing the swell during their decision-making process, not unlike how midwives are constantly assessing their clients. Add to this how our bodies swell to carry our pregnancies, and how our hearts swell to love our children, and there you have it, The Swell: Midwife Services was born.