Frequently Asked Questions

Most Often Asked Questions and Answers about my Midwifery Practice and Philosophies:

 

1. What is a Certified Nurse Midwife?

A certified nurse-midwife (CNM), is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives (ACNM). The ACNM believes that every family has a right to experience a safe and satisfying childbirth, attended by providers who respect cultural variations, human dignity, and the rights of consumers to freedom of choice and self determination. This includes respect for the client preferences regarding birth site. The education and preparation of Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) qualify them to practice in a variety of settings, including hospital, home and birth center.  Midwifery practice as conducted by CNMs and CMs is the independent management of women’s health care focusing particularly on common primary care issues, family planning and gynecologic needs of women, pregnancy, childbirth, the postpartum period and the care of the newborn. The certified nurse-midwife practices within a health care system that provides for consultation, collaborative management or referral as indicated by the health status of the client. Certified nurse-midwives and certified midwives practice in accord with the Standards for the Practice of Midwifery, as defined by the American College of Nurse-Midwives. You can go to the ACNM website to learn more about the organization. (http://www.midwife.org/)

 

2. You started practicing in New Jersey, now working at Mt. Sinai West in New York City? Why the switch?

 

I found an award winning northern New Jersey hospital easy to get to where I could practice authentic midwifery. And I found an award winning obstetrician, the late Dr. Andrew Garber, to back me up.

 

At the time in 2004 I felt I was able to avoid most of the fear that permeates and runs rampant on many New York labor and delivery floors.  Pascack Valley Hospital, and then when I settled at Holy Name Medical Center was a five minute drive once over the GW Bridge and in the day my families found nearby hotels, restaurants, shopping and convenience stores accommodating.

 

I was happy and committed to serving families in New Jersey. With Dr. Andrew Garber as my collaborating, back up, and consulting perinatologist for 11 years, we served families in four northern New Jersey hospitals. Dr. Garber boasted he had the lowest c section rate in northern New Jersey once I started working for him.

 

Over the years many of my clients living in New York City and the tri state area, and abroad (including loyal family and friends) came to deliver with me in New Jersey – not caring what zip code their baby would be birthed in - they simply wanted me to be their midwife and deliver their babies. 

 

When Dr. Garber retired from OB, I felt it was the right time to focus in on the New York City community in which I lived.

The obstetrical and nursing staff at Mount Sinai West are extremely skilled, midwife friendly,  and I am extremely happy to have privileges here.

 

3. Why do you deliver babies in a hospital when you are home birth trained? 

 

While there is a deep spiritual path I follow initially being trained in home birth, it is not always the appropriate path my couples who meet me and want me as their midwife want to follow. Most couples want a hospital birth. I respectfully serve women where ever I can make a difference! I bring the ideas and values of home birth into the hospital setting.  

 

I met Val at a midwifery conference in the city. I learned she delivered 4,000 babies.

She will tell you ‘when I saw Risa at the midwifery conference with that bow in her hair, I just knew I had to make her mine’. It was in this context of working and living side by side with an experienced home birth midwife that I learned the true art of midwifery. 

 

I flew from New York City to Dearborn, Michigan over a four year period. I would apprentice with Val for long weekends and at times for three to four weeks at a time.  I was investing in myself to receive meticulous training and guidance from a gifted and safe midwife. While many people thought I was extreme to travel such a far distance, it was imperative for me to become rooted in being the best midwife I could be.

 

I am forever grateful not only to Valerie for giving me the opportunity to learn so many vital midwifery skills from her, but to the many women and families that I met and whose babies I was honored to deliver. 

 

Under Valerie’s direction, I was also given the opportunity to teach midwifery skills to Amish midwives. I learned about my own heart and how to reach into the hearts of my moms.

 

I watched Valerie midwife, nurture and use her experienced hands to guide babies into the world. We would sit for hours on end and I would listen to her amazing birth stories. Lucky me! Valerie continues to be my dear friend and midwifery confidante. 

 

I bring this energy with me into the hospital and provide you with a balance of natural labor techniques while incorporating “hospital help” if medically needed.  The hospital setting is ideal for being able to use what I refer to as ‘intercessions’ rather than interventions (by the way intercessions may be required at home births.) 

 

Mount Sinai West is a hospital that is midwife friendly. It is setting where women and babies to receive my sensitive, relaxed, and thorough home birth approach. There is a tub in every L&D room.  I pride myself and my practice on providing skilled, thorough, and excellent care for my women and their babies in this unique hospital setting.

 

4. Who do you consult and collaborate with?

My collaborating and consulting physician is Dr. Jason Kanos. He is the Director of Quality Improvement at Mount Sinai West. The attendings also back me 24/7.  There is a group of high risk perinatologists on staff in the Maternal Fetal Medicine Department, many of whom also knew Dr. Andrew Garber. He had been my consulting and collaborating physician for co management in all facets of high risk well woman care. If a high risk medical challenge arose unexpectedly for one of my women or her growing fetus while I was working in New Jersey, Dr. Garber was who I worked closely with.

 

As a perinatologist and obstetrician, OB’s would also refer to him if they had a patient with either a high risk factor such as heart disease, blood disorder, high blood pressure, diabetes, obesity, or genetic or congenital defects in their babies.

 

With that being said, for over eleven years, I was fortunately able to watch, listen, learn and co-manage these high risk women with Dr. Garber. Consequently, the scope of my midwifery practice at times has traversed clients of diverse medical challenges and circumstances. 

 

Caring for these women has enabled me to gain a higher wisdom and respect for women who can’t have vaginal births, natural births, or at times get pregnant. These clients have consequently provided me with a wider, stronger, more medically diverse foundation of knowledge than I believe most midwives have acquired.  If you asked Dr. Garber, he would tell you that during the 11 years I worked side by side with him going back to 2004, he had the lowest c section rate as a perinatologist in northern New Jersey!

 

I am fortunate to now have at Mount Sinai West a group of like-minded OB/GYN’s and perinatologists who respect my midwifery practice and philosophies. These accomplished physicians provide 24/7 back up coverage for my clients.  I feel that it is vital for any pregnant woman to know that her midwife has distinguished collaborating physicians who respect her as an individual, professional, and have a longstanding working relationship.

 

5. What is your C section Rate? How do you handle and care for women who need C sections?

My rate is 5-10% and all have been medically necessary.

Guess what? Sometimes a woman needs a c section to birth her baby. Yes, I said ‘birth her baby’. I do not agree wholeheartedly with the anti c section advocates, or with what some of these new documentaries are preaching. They continue to blame the docs over and over again for C sections. In my midwifery practice, C sections are medically needed for either high risk women and babies for either pre-existing medical reasons, (co managed with Dr. Jason Kanos,) or because the baby just can’t be born vaginally for a variety of medical reasons: IE. Maternal pelvis type, size of baby’s head, short umbilical cord, umbilical cord compression that causes fetal distress and fetal intolerance to labor and it doesn’t go away with repositioning and or oxygen. These challenges can subside however at times they don’t. Even for ‘low risk’ healthy women planning home births. I have worked over the years with home birth moms who were transferred to the hospital for various medical reasons.  A c section will ultimately allow the baby to be born safely for an acute medical or pre-existing condition, and also if we have worked long and hard to get the baby to descend or engage into the pelvis and or move into an optimal position, and it is not happening.  If you need a c section with me as a your midwife, you will continue to receive my guidance, support, and reassurance  throughout the procedure. We strive for a gentle c section, where a clear drape is used for viewing and bonding, the baby is checked by the pediatrician and then breastfeeds on the operating room table.

 

Whether you have a vaginal birth or a c section, I will be with you and it will be a beautiful birthing experience.

 

 

6. I heard you have been called baby turner. What does that mean?

I am proud to have earned the reputation as the baby turner, baby whisperer, and most recently magical midwife. I’ve also heard that I made “The Risa Difference.”

Without such training to either gently turn or move babies, many women will have c sections. Many home birth transports were brought to me by other midwives for these very reasons, and I have helped many of these women avoid cesarean sections. Our country has such a high c section rate for many reasons, and one of them is because many well intentioned practitioners were either not trained and or do not understand the position of a baby’s head during labor or when to take action to turn the baby.. Many times it is vital to turn a baby from either a posterior, meaning, the back of baby’s head is at mom’s back, or from another position to ensure that the baby can optimally descend into and through the pelvis to dilate the cervix. (IE. moving a little hand, elbow or a cocked head!) Birth is about movement, and sometimes we need to move your body, hips, legs, and or pelvis into a position to help reposition your baby to emerge into the world with a bit more ease! Such birth postures and measures help you to give birth, especially when you are open and ready to be flexible! I pride myself in preparing each of my women for such open movement and open minded and heartfelt connection to their babies. I can credit Valerie for my exceptional training in their area, and my intuition and instincts.

 

7.  I would like to transfer into your practice. How ‘late’ can I transfer and what is the protocol?

 

It is always an honor to be asked to serve as midwife, and if my schedule permits I am happy to have you transfer into my midwifery practice. I have been known to accept clients as late as 32 weeks gestation. (OK, give or take a few weeks on either side)  If you transfer to me it means that we have a lot of catching up and bonding to do. You would need to bring a copy of your medical records from your current provider, and I can supply you with a Request to Release of Medical Records Form to give your previous provider. As part of our process in getting to know each other, we spend a lot of time together catching up and it is fun actually. 

 

8. I am pregnant with twins. Can we work together?

 

Yes we can if Baby A, (lowest baby) is head down. You will also be co managed with my collaborating physician Janson Kanos, MD. Get ready to hear about doubling your protein!

 

9.  I would like to try for a VBAC (Vaginal Birth After Cesarean). Can you help me?

 

I have helped many women have their VBAC babies and am most familiar with and sensitive to the special needs of VBAC women.

If you have had one or two prior c sections I can work with you however if you have had three or more, I will not be able to work with you. 

  

To start the process we would have a VBAC consultation so I may learn about the unique circumstances leading to your c section or sections. You would bring a copy of your surgical record with you from your delivery/deliveries. If we choose to work together you will also meet my collaborating obstetrician, Janson Kanos, MD.

 

 

10. How often will we be meeting for Prenatal Visits and what about Prenatal Testing?

These are very important questions however they are dictated by each individual woman and her or her baby’s needs. While the information below is given as a general overview, it can and many times does change based on how you and your baby are feeling and growing! If you happen to need me more or you need to make an extra prenatal visit or visits, we get together. This is the heart of my midwifery practice - one on one individualized care. This is what we do to foster excellent health care and have your questions answered, even if it’s just to talk.

To start, we meet once a month during the first two trimesters unless we need to repeat a test, administer a test, or just talk. At 28 weeks we meet twice a month until 36 weeks gestation. Starting at 37 weeks we meet weekly until the baby is born.

Some screening and diagnostic tests are optional and we will review and discuss what is and isn’t appropriate for you. The hospital staff Maternal Fetal Medicine perinatologists and genetic counselors are readily available for consult.

 

11.  What other services do you provide in your midwifery practice?

In addition to pregnancy, birth, and post partum care, my midwifery services include gynecological, contraceptive, and annual well women care starting at the teenage years and spanning through the menopausal years. I do VBAC (vaginal birth after cesarean) and conscious conception counseling. I also offer Holistic Birth Counseling sessions to help women reframe a past medical or birth experience that has left them feeling disempowered or disconnected from their baby. Counseling also helps women who have fears about pregnancy, labor, birth, or mothering. Unresolved fears will resurface and birth counseling is an important and constructive way to clear them.

 

12. Who can I speak to regarding health insurance?

If you have any inquires related to billing matters please email Risa at rlkbirth@aol.com and she will refer you to her billing manager.

© 2016 by Risa Klein

Tel: (917) 806-4992

Risa Klein, CNM

Manhattan Midwife

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