Contract for Midwifery Care

Philosophy of Practice

        It is our mission to empower and support expecting families with compassionate, comprehensive care, communicating their immeasurable worth through words and service to them. Our practice is to love and support the ‘whole’ woman throughout her individual journey and transformation as a mother. We know women’s strongest feelings about pregnancy and birth, positive and negative, center on the way they are treated by those involved in their care.  NOVA believes that such a time deservingly invokes holistic care that seeks to acknowledge and value the mother’s physical, mental, emotional, spiritual and social well-being before, during and after childbirth. It is our deepest joy to assist your family to experience healthy and fulfilling childbearing years, as we believe such experiences profoundly affect women, babies, fathers, and families, and have important and long lasting effects on society as a whole.

 

Services Provided

    Your NOVA Midwife will be on call for you 24 hours a day, seven days a week, once your pregnancy reaches 37 weeks gestation. NOVA reserves the right to make decisions as to the best way to supply coverage for clients if more than one is in labor at the same time, and may have to leave a birth once the back up team has arrived to attend a second birth, though this happens rarely.

    As part of NOVA’s services, your midwife will meet with the mother and any other people she wishes, for educational purposes and routine prenatal visits in our facility once a month until your pregnancy reaches 30 weeks, then every two weeks until you are 36 weeks, then once a week until the baby is born. During these visits, routine procedures (blood pressure, measurements of your abdomen, checks for protein or glucose in your urine, weighing, listening to the baby’s heart beat) will be performed.

    Any needed treatments or procedures can be arranged through a consulting physician with advance notice. The state law requires that care providers for mothers and babies perform certain procedures. If you refuse any required procedures, or if you should decide to disregard our suggestions in reference to your care, you will be required to sign a waiver assuming responsibility for the consequences related to your choice.

    NOVA Birth Services currently collaborates with other midwives, obstetricians, and FNPs in the area, and may discuss your specific case in order to ensure you receive the best care. We are required by state law to have a consulting physician, and to send this physician an emergency care plan. The physician may request to see you at some point during your pregnancy.

    At the first sign of labor, you should notify your NOVA Midwife, regardless of the time of day or night. Your midwife and/or an assistant will be at your side to render support whenever active labor begins. NOVA Midwives do have oxygen, IV fluids and some medications, as well as natural remedies available if needed. After the birth, your midwife will stay with you until both you and the baby are stable, usually a minimum of 2 hours. 

    Your NOVA Midwife will visit you and the baby between 24-48 hours for your first postpartum exam. At that time, your midwife is capable of performing the Newborn Metabolic Screening test (or PKU test) and CCHD (Critical Congenital Heart Defects) test if you are not planning to have it done at the office of the pediatrician. NOVA will also refer for hearing screening.  Depending on your labor, your midwife will see you at 2 weeks (if needed) and then at 6 weeks for your final postpartum exam.

    

NOVA Midwives routinely collaborate with FNP Jaimee Arroyo, of Hopewell Family Care.

 

 

    *By initialing here         , I give my NOVA Midwife permission to discuss aspects of my 

    care with FNP Jaimee Arroyo, as she deems necessary to ensure the health of myself and my 

    baby. 

 

Malpractice Insurance

NOVA Birth services carries professional liability insurance through The Midwife Plan.

 

 

    *By initialing here         , I understand that this liability insurance excludes clients who are choosing a vaginal birth after Cesarean, and I do not hold NOVA Birth Services, LLC liable for any damages to person or property that come as a result of my choice to birth at home after a previous Cesarean.

 

Refunds

The initial deposit of $500 is non-refundable. Refunds below are calculated based on any fees paid above the $500 deposit. 

 

Before 36 weeks gestation: NOVA will calculate fees to cover services already rendered. You will be charged $200 (two hundred dollars) for the initial visit, plus $100 (one hundred dollars) per additional visit, travel  and administrative charges for prenatal visits and any labs or other procedures. The payments made to NOVA Birth Services in excess of these charges will be refunded to patients requesting termination of our working relationship in writing. 

 

After 36 weeks gestation: refunds of cash payments will not be made. Refunds are not made if the midwife arrives after the birth due to a delay in notification or precipitous birth.

 

In the case of a transfer to the hospital, Comprehensive Care clients may choose not to utilize the 24 hour postpartum doula care and be refunded $250.00. No refund will be given for Basic Midwifery clients in the case of transfer to the hospital.

 

Grievance Process

In the event you wish to file a complaint against the services of one of our CPMs, you may do so with NARM (North American Registry of Midwives) by navigating to the following website and filling out the associated form:

http://www.tennesseemidwives.com/documents.html

 

Limitations of Service

    NOVA’s homebirth services are for women with low risk pregnancies. Clients who become HIGH risk will be referred out to a Physician for their care. For a complete list of reasons for transfer of care as well as the treatments and procedures that midwives employed by NOVA Birth Services can perform in the home setting, please see the Tennessee Midwives Association Practice Guidelines, which can be found in NOVA’s consult folder, on your Mobile Midwife client file, or at https://www.tn.gov/assets/entities/health/attachments/g5062255.pdf

    NOVA has the right to discontinue services if you should move more than a 1 hour driving distance from, Old Hickory, TN, if you should fall out of the low risk category, or if you should be non-compliant with our suggestions regarding your health, and/or safety of a home birth.If we are to transfer to the hospital for any reason, another Care Provider will assume your care. Your NOVA Midwife will not be allowed to deliver your baby in the hospital. However, your midwife will stay with you as a doula and to inform the hospital staff of medical history, as long as you wish. 

    NOVA does not use any pain-relieving medications, other than a local anesthetic (Lidocaine) for suturing.

 

Client Responsibilities

    Be honest and communicate.  Your goals and desires are very important to NOVA.  The quality of care that your midwife is able to provide is compromised when you withhold information or are untruthful about your health/pregnancy/financial situations.

    If this is your first baby, or you have not had a vaginal birth, you are required to take the NOVA Homebirth Essentials Course. If this is not your first baby, but you would like education specific to home birth, a 3 hour crash course on Home Birth is available at the cost of $150.

 

Financial Information

    NOVA Birth Services requires all clients to submit a credit card authorization form that can be kept on file with NOVA Administration. If a client has not paid in full by 37 weeks gestation, the card will be charged for client’s the remaining balance. If the credit card on file is declined, an additional $50.00 per week will be added to the total  due until the time that payment is complete. Please check the package that you would like.

Comprehensive Care for Mother and Baby includes Midwifery Services, a NOVA Homebirth Essentials Course, along with a Labor Doula, Birth pool, Postpartum doula for the first 24 hours after birth, and an in-home Lactation Consultation. The cost of this service is $5,200.

Basic Midwifery Care includes the initial visit, all prenatal visits, the birth, postnatal visits, and the cost of the assistant midwife, as well as a NOVA Homebirth Essentials Course. The cost of this service is $4,200.

Fees do not include:

  • Birth Kit (This is purchased directly by the client)
  • RhoGam injections (normally $140.00)
  • Laboratory tests (prices vary and change as the lab service changes our cost)
  • Any medications other than Pitocin, Vitamin K injection, Erythromycin eye ointment, and Cytotec.
  • Any other care provider’s fees, including ambulance or doctors and hospitals, should a complication arise. You will need to have a back up plan in case of an emergency.
  • Travel Fees: NOVA charges a flat rate of $75 for clients that reside outside of a 1 hour radius from NOVA’s office at 401 Center, Old Hickory, 37138.

 

Payment Schedule

Payments for Comprehensive Care should be made according to the payment schedule below:

        1st Payment: $500.00

        20 Weeks: $1,250.00

        28 Weeks: $1,250.00

        32 Weeks: $1,200.00

        36 Weeks: $1,000.00

Payments for Basic Midwifery Care should be made according to the payment schedule below:

        1st Payment: $500.00

        20 Weeks: $1,200.00

        28 Weeks: $1,200.00

        32 Weeks: $625.00

        36 Weeks: $625.00        

 

    Discounts are not offered for care that is started after 20 weeks gestation. A new payment schedule will be agreed upon in the case that a client begins care after 20 weeks gestation.

 

Release of Liability

    Before signing this agreement, I (also referred to as client, we, I, they, us or her) have had an opportunity to discuss NOVA Birth Services Midwifery care and home birth with my spouse, partner or parent, if that parent is a legal guardian; with a medical care provider or other knowledgeable person, if needed, and with my midwife and ask her questions. My Midwife has discussed her limitations as a midwife; model of care as well as her philosophy with me/us. NOVA Birth Services has not represented to the clients that agreeing to her services guarantees in any way a risk free or emergency free labor and birth experience. 

    We have chosen to have a home birth. We have asked the midwives with NOVA Birth Services to assist us in our home birth. The clients (jointly and separately), the clients’ heirs/family, administrators, personal representative, executors and assigns, release and forever discharge the NOVA Midwife’s assistants and any collaborating providers, from all damages or of action, either at law or in equity, which the clients may have or acquire or which may accrue to the clients or the clients heirs, administrators, personal representatives, executors or assigns as a result of using the midwifery services of NOVA Birth Services.The clients are signing a complete release and bar to any claims which the clients have or believe the clients may have resulting from our agreement for midwifery services. 

    I/We hereby release NOVA Birth Services, the midwife’s assistants and any collaborating provider(s) from all complications that may arise during the course of my pregnancy, birth or postpartum as a result of my decisions and my choice to birth my child at home. I/We further acknowledge that I/We have had an opportunity to have any questions answered regarding the benefits and risks specific to home birth.

    We as parents have chosen to give birth at home, as long as the pregnancy is considered to be normal and low risk. We have read and understand the above information. We understand that the midwives with NOVA Birth services are not physicians and that we are accepting full responsibility for the pregnancy and for the birth. We realize that in a small percentage of cases, complications may arise which cannot be adequately dealt with at home. A few of these complications could possibly be prevented or minimized in the hospital. In other cases the results would be inevitable. Despite this we feel that the benefits of home delivery outweigh the possible risk involved. 

    We hereby give consent for our NOVA Midwife to transfer my baby’s records and/or my records either of us needs to have care with an institution or with another care provider. This agreement, encompasses the entire agreement of the parties, and supersedes all previous understandings and agreements between the parties, whether oral or written. The parties hereby acknowledge and represent, by affixing their hands and seals hereto, that said parties have not relied on any representation, assertion, guarantee, warranty, collateral contract or other assurance, except those set out in this document.

 

I have read, understand, and agree to the contents of this document;

 

Mother and Father of Baby:                                             

                

Mother of Baby  Signature and Date 

 

 

Father of Baby Signature and Date 

               

 

Midwife Signature and Date