Frequently Asked Questions
Most Often Asked Questions and Answers about our 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. Risa, you started practicing in New Jersey, and are now working at Lenox Hill Hospital in New York City? Why the switch?
Risa found an award winning northern New Jersey hospital where she could practice authentic midwifery. And she found an award winning obstetrician, the late Dr. Andrew Garber, to back her up.
In 2004 she felt she was able to avoid most of the fear that permeates and runs rampant on many New York labor and delivery floors. She co-managed Dr. Garber's patients at Pascack Valley Hospital, and then settled at Holy Name Medical Center which was a five minute drive over the GW Bridge.
Risa was happy and committed to serving families in New Jersey. With Dr. Andrew Garber as her collaborating, back up, and consulting perinatologist for 11 years, serving families in four northern New Jersey hospitals. Dr. Garber boasted he had the lowest c-section rate in northern New Jersey once Risa started working for him. Dr. Garber was her 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 her patients or their growing fetus. She referred to a perinatologist and obstetrician, any of her low risk clients to Dr. Garber if they developed either a high risk factor such as heart disease, blood disorder, high blood pressure, diabetes, obesity, or genetic or congenital challenges in their babies.
Over the years many of Risa's clients who lived in New York City and the tri-state area, and abroad (including loyal family and friends,) came to deliver with her in New Jersey – not caring what zip code their baby would be birthed in - they simply wanted her to be their midwife and deliver their babies.
When Dr. Garber retired from OB, it was the right time to focus in on bringing her midwifery practice to the New York City community in which she lived. Risa got hospital privileges at St. Luke's Roosevelt, and they were soon taken over by Mount Sinai, and the hospital was renamed, Mt. Sinai West.
Risa was honored to be offered the position of Director of Midwives at Northwell/Lenox Hill Hospital and is creating a safe midwifery practice in a hospital - her dream come true! The nursing management and obstetrical and Maternal Fetal Medicine staff at Lenox Hill Hospital, are extremely skilled, midwife friendly, and excited to have midwifery come on L&D!
3. Who do you consult and collaborate with?
The midwives collaborate and consult with Dr. Shane Wasden. He is the Director of Labor and Delivery and a Maternal Fetal Medicine Specialist. The attendings also back the midwives and the midwives 24/7 and several were trained by midwives! :) Some of the high risk perinatologists in the Maternal Fetal Medicine Department, knew Dr. Andrew Garber.
With that being said, for over eleven years, Risa was fortunate to be able to watch, listen, learn and co-manage Dr. Garber's high risk patients. 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. IVF women flocked to her practice for compassionate care. These clients have consequently provided Risa 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 Risa worked side by side with him going back to 2004, he had the lowest c section rate as a perinatologist in northern New Jersey!
We are fortunate to now have at Lenox Hill a group of like-minded OB/GYN’s and perinatologists who respect and support midwifery practice and philosophies. These accomplished physicians provide 24/7 back up coverage for our clients. We 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.
4. What is your C-section Rate? How do you handle and care for women who need C-sections?
Risa's rate has been 5-10% and all cesarean sections have been medically necessary. Guess what? Sometimes a woman needs a cesarean 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, cesarean sections are medically needed for women and babies who become high risk. These women or their fetuses may develop high risk conditions during the pregnancy, or may have a pre-existing condition that was co-managed with Dr. Shane Wasden, or the baby just can’t be born vaginally for a variety of medical reasons: I.E. Maternal pelvis type, size of baby’s head, short umbilical cord, umbilical cord compression due to low amniotic fluid, breech baby unable to turn even with ECV, or otherwise 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 "low risk" healthy women can encounter an unexpected challenge during labor, and a cesarean section will ultimately allow the baby to be born safely for an acute medical or pre-existing condition. 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, you can be assured that if you need a c section with me or one of our midwives, you will continue to receive midwifery guidance, support, and reassurance throughout the procedure. We strive for a "Gentle Cesarean Delivery," where the baby is checked by the pediatrician and then your midwife (if baby and mama are medically healthy,) brings your baby to you on the where you bond and breastfeeds on the operating room table.
Whether you have a vaginal birth or a cesarean section, a midwife will be with you, and it will be a beautiful birthing experience.
5. I heard Risa has been called baby turner. What does that mean?
Risa is proud to have earned the reputation as the baby turner, baby whisperer, and most recently magical midwife. She also heard that she made “The Risa Difference.” Without such training to either gently turn or move babies, many women will have cesarean sections. Many home birth transports were brought to Risa by other midwives for these very reasons, and she has 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 or do not understand the position of a baby’s head during labor or when to take action to turn the baby. 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. (I.E. 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! Our midwives pride ourselves in preparing each of our women for such open movement and open-minded and heartfelt connection to their babies. Risa credits Valerie for her exceptional training in this area, along with her intuition and instincts. Risa teaches these important skills, as often as she can, to midwives, medical students, and residents.
6. 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 our schedule permits we are happy to have you transfer into our midwifery practice. We can accept healthy, low-risk transfer mamas as late as 20 weeks gestation. (Okay, give or take a few weeks on either side with consult.) If you transfer to us, it means that we have a lot of catching up and bonding to do. You would need to send us a copy of your medical records from your current provider, and we 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, you fill in an intake form, and a nutrition diary, and we spend a lot of time together catching up and it is fun.
7. I am pregnant with twins. Can we work together?
Yes we can if you are healthy and Baby A, (lowest baby) and Baby B is head down. You will also be co - managed with my collaborating physician. Get ready to hear about doubling your protein!
8. I would like to try for a VBAC (Vaginal Birth After Cesarean). Can you help me?
We have helped many women have their VBAC babies and are most familiar with and sensitive to the special needs of VBAC mamas.
If you have had one prior cesarean section I can work with you however if you have had more, the practice will not be able to work with you.
To start the process we would have a TOLAC (trial of labor after cesarean) and VBAC consultation so we may learn about the unique circumstances leading to your cesarean section. You would bring a copy of your operative report and prenatal records. You will also meet our collaborating MFM physician and Director of Labor and Delivery, Shane Wasden, MD for confirmation that you are a medically appropriate TOLAC/VBAC client.
9. 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 the midwifery practice - one-on-one individualized care. This is what we do to foster excellent health care and have your questions answered, provide education, and address your emotional concerns - 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 Maternal Fetal Medicine perinatologists and genetic counselors are readily available for consult.
10. What other services do you provide in your midwifery practice?
In addition to pregnancy, birth, and post partum care, midwifery services include gynecological, contraceptive, and annual well-women care starting at the teenage years and spanning through the menopausal years. VBAC (vaginal birth after cesarean) and conscious conception counseling (preconception,) Holistic Birth Counseling sessions to help individuals reframe a past medical or birth experience that has left them feeling disempowered or disconnected from their baby. Counseling also helps those 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.
11. How do you feel about Birth Doulas?
Love Birth Doulas! I have a list of those I recommend. If you have a doula you love, she can come with you to your prenatal visit so we can meet in person or virtually. Certification is required. If you want a family member to be your doula, they should take a course!
12. I am over 40, and did IVF. Can I work with your midwifery practice?
Yes! We review your medical records, and you would also have a consult with Dr. Wasden, our consulting, collaborating, and co-managing Maternal Fetal Medicine physician..
13. If I need a Cesarean Delivery, can I have a "Gentle Cesarean?"
I have been the initiator of "Gentle cesareans" at Lenox Hill. If your baby is medically cleared by the pediatrician and by our stellar medical staff, your midwife who is with you from the onset of the procedure, will bring you your precious baby for skin-to-skin bonding and breast/chest feeding right on the operating room table until you are brought into the recovery room!
14. Who can I speak to regarding health insurance?
If you have any questions related to billing or insurance matters, please email us at: MidwiferyAtLenoxHill@northwell.edu. The office number is 212 434 4025.