Frequently Asked Questions

What are the different types of midwives (DEM, CPM, CM, CNM)?

April is the only Certified Nurse-Midwife attending births outside the hospital in Southern Nevada.

Comparison of Certified Nurse-Midwives, Certified Midwives, and Certified Professional Midwives

Certified Nurse-Midwife (CNM)

  • Licensed and trained as a Registered Nurse and in midwifery.
  • Experience as a registered nurse (generally labor and delivery, postpartum, or neonatal). April has experience working as a RN on all of these units.
  • In Nevada CNM’s are licensed through the Nevada state board of Nursing and required to maintain continuing education in their specialty.
  • Entry-level education: Master’s Degree
  • Can practice in all states
  • Can deliver in all settings (home, birth center or hospital)
  • Can provide care from “menarche through menopause” (menarche being the first menstrual cycle).
  • Does not require any physician oversight in the state of Nevada
  • Can write prescriptions and legally carry prescription medication to births
  • Many insurance companies require a midwife be a CNM for reimbursement. Teacher’s Health Trust, TriCare, and Culinary are a just a few of the insurances that only recognize the CNM license.

Certified Professional Midwives (CPM)

  • Licensed and trained in midwifery only.
  • You can become a CPM without going to a school. This is accomplished via apprenticeship and licensure requires PEP (Portfolio Evaluation Process).
  • If you go to school, you can go to an MEAC accredited school or one that isn’t accredited. Non-accredited schooling requires PEP as well.
  • Entry-level education: high school diploma
  • Can practice in most states, but some states will not license CPMs. Nevada does NOT license CPM’s
  • Can only attend deliveries Out of Hospital (OOH)
  • Cannot write prescriptions or legally carry any prescription medication in Nevada
  • Care is limited to pregnant or post-partum women in some states. Other states allow well-woman care as well

Are there laws regulating home birth midwives?

Nevada currently only regulates certified nurse-midwives. This means that any other type of midwife isn’t regulated in our state. This has both risks and benefits for consumers. It means that anyone can legally call themselves a midwife and practice in Nevada and they wouldn’t be breaking any state law in doing so. This puts a lot of responsibility for parents to choose a midwife wisely. It’s very important to interview a prospective midwife and ask for educational background, clinical experience, number of births attended, and references. Here is April’s resume:

Experience

Certified Nurse-Midwife & Certified Professional Midwife, Baby’s 1st Day, Las Vegas, NV — 2008-Present
Founder and president of Baby’s 1st Day, Midwifery Services. Attending sixty home births per year. Providing complete antepartum, intrapartum, postpartum, and newborn care.

Certified Nurse-Midwife, Deseret Women’s Health Care, Henderson, NV — 2005-2008
Managing practice partner with collaborating OB/GYN, and physician assistant. Attended 240 hospital births per year. Cesarean first assistant in the operating room. Complete GYN care in office including family planning, menopausal management, and well woman care.

Certified Nurse-Midwife, Fremont Women’s Health Care, Las Vegas, NV — 2004-2005
Worked with four collaborating physicians in a busy OB/GYN practice. Complete GYN care provided including family planning, birth control, annual exams, menopausal management, colposcopy, IUD placement, and fertility care.

Student Nurse-Midwife, Frontier University, Hyden, KY — 2002-2004
Attended births in birthing centers, at home, and in the hospital. Attended 87 births as the primary midwife under supervision.

Registered Nurse Labor and Delivery, Sunrise Hospital, Las Vegas, NV — 2000-2004
Provided care to high risk antepartum women, routine intrapartum care including circulating operating room nurse, neonatal intensive care experience, and postpartum couplet care. Electronic fetal monitor certified, advanced cardiovascular life support trained, and neonatal resuscitation certified.

Education

Masters in Nursing
Case Western Reserve University, Cleveland, OH – 2004

Masters in Midwifery
Frontier School of Nurse-Midwifery, Hyden, KY – 2004

Bachelors in Nursing
University of Nevada Las Vegas, Las Vegas, NV – 2000

Board Certifications

American College of Nurse Midwives
Board certified as a nurse-midwife since 2004 – certification # 24678

North American Registry of Midwives
Board certified as a certified professional midwife since 2008 – certification # 08030008

Licenses

Registered Nurse
Arizona license # RN160290
Nevada license # RN36201

Advanced Practice Nurse
Arizona license # AP3487
Nevada license # APN000807

How many births has April attended?

This is one of the things that set April apart from other midwives practicing home birth in Southern Nevada. Due to April’s hospital experience and the difference in volume that a hospital based midwife attends and a home birth midwife attends April has attended more births than any other home birth midwife in Nevada. This is valuable as most obstetrical emergencies happen in less than 1% of pregnancies and births, this is further decreased by only selecting low risk women. For a midwife to see complications she has to attended hundreds of births as most of the time birth happens without a hitch. April’s experience gives her confidence in managing complications.

2000-2002: April worked 4 twelve hour shifts a week. At that time UMC Hospital and Sunrise Hospital had the only neonatal intensive care units (NICU) in town. This meant that Sunrise (where April worked as a L&D nurse) was very busy. During that time Sunrise Hospital averaged 400-450 births a month. This meant that in a typical 12 hour shift a RN would attend anywhere from 1-4 births. April went to part time at Sunrise Hospital when she started graduate school in 2002. From 2002-2004 April worked 2 twelve hour shifts a week as a labor and delivery nurse. April did not document number of births she attended as a labor and delivery nurse, but a conservative estimate during this time is 1,500 births.

2002-2004: April attended 87 births as a student nurse-midwife. These were at home births, birth center births, and hospital births.

2004-2008: April practiced as CNM out of St. Rose Hospital. She attended 962 as the primary midwife over these years. This does not include cesarean births that she first assisted with, or births when she shared call with her OB/GYN partners.

2008-Present: April practiced as a CNM/CPM with Baby’s 1st Day. As of January 2017 April has attended 588 home births.

That makes for 3,136 babies!!

Are your services covered by insurance?

April is an out-of-network provider with nearly all insurances. Read your particular policy and look for specific terminology. Does it allow for a Certified Nurse-Midwife or advanced practice nurse? Does it mention homebirth by name? April works with an insurance billing company that can answer all of your insurance billing questions: Larsen Billing

What if I decide to have medication during labor?

The option of going to the hospital at any point in your labor is always available. Having said this, it is very uncommon in a labor that is progressing normally that women opt to go to the hospital. Having the ability to eat, drink, move, and having the constant support of loves ones makes an incredible difference in ones ability to cope with the hard work of labor.

Will I need to see an OB/GYN during my pregnancy?

It is up to you, the pregnant woman, if you want to see an OB/GYN during your pregnancy. Clients generally find this dual care redundant as all of the lab work , ultrasounds, and prenatal assessment that you would get with an OB/GYN is available at April’s office. Some women like the security of being able to say they have a physician relationship, just in case a hospital transport is necessary during the birth. April does work with a physician group in town if a

Will I get an ultrasound during my pregnancy?

April has a small portable ultrasound machine in her office. Most of April’s clients opt to have a higher level ultrasound around 20 weeks of pregnancy. This “anatomy” ultrasound is scheduled at an imaging facility.

What are the benefits of using water during labor and/or birth?

Water removes 75% of gravity, which significantly decreases the amount of pain you experience during labor and pushing. It also allows you to be more relaxed and mobile, and because of that, shortens your labor. Being able to change positions frequently and easily allows the birthing woman to be more aware of how her labor is progressing and to feel a direct connection with what is happening. Water provides an increase in oxygen to the baby and the uterine muscles, decreasing the potential risks of fetal distress and prolonged, often ineffectual labor.

How long does the midwife stay after the birth?

It is more of a checklist of milestones that need to be reached rather than time frame that determines when the midwife leaves after delivery. We monitor the mother, observe that placenta has delivered and bleeding is stable, breastfeeding is off to a good start, mom has eaten, been up to urinate, baby has a head to toe newborn exam, we also clean up during this time. By the time we leave, no one will know you had the baby at home by looking around the house; except there is the newborn in the bed with a proud Mama and family!

If, for any reason, the mother and baby are not doing just fine, we stay until the situation is resolved or go with one or both of you to the hospital.

What about the birth certificate? Social Security Number?

Your midwife will complete a “Registration Of A Live Birth” form and send it in within 10 days of the birth. One of the questions on the form is for assigning a social security number at birth. We can check ”yes” or “no.” If you choose “no,” you must then register the child for a social security number by the age of sixteen. Approximately 3 weeks after the registration of the live birth you can visit VitalChek and order the official, state-documented birth certificate.