The Collaborative Model Of Care
The oldest hospital-based midwifery practice in Austin, we combine the non-interventionist approach of midwifery with the safety net of western medicine. Our goal is to allow the onset of natural labor and have patience with labor’s progress given the wide variation in each woman’s labor course. Our patients meet all six of our providers (Dr. Sebestyen, Dr. Schiemenz, Siobhan Kubesh, CNM, Lisa Carlile CNM, and Kathy Harrison-Short CNM) as they journey through their prenatal care. This guarantees that each patient will always know the provider that assists them with their labor as the five of us share labor & delivery call equally with the midwives always backed-up by a physician. As we all hold the same philosophy about non-interventionist care, our patients have the safety of knowing that the care provided will be consistent and respectful of their birth intentions.
Provider on Call
Our call scheudle rotates every 24hrs with a primary provider covering the hospital for deliveries.
Sunday - Siobhan Kubesh, CNM
Monday - Christina Sebestyen, MD
Tuesday - April Schiemenz, MD
Wednesday - Tesa Miller, MD
Thursday - Martha Schmitz, MD - Call Partner Only
Friday - Lisa Carlile, CNM
Saturday - Rotating, CNM/MD
Natural Labor And Childbirth
Labor is truly a marathon that requires physical and mental preparation to endure the long journey to an exhilarating birth. We advocate for women to stay mobile in labor – walking, showering, squatting – to aid in the progress and tolerance of labor. We use intermittent fetal monitoring (low-risk patients) and heplocks (IV base only) to facilitate this movement. We encourage comprehensive childbirth education such as the Bradley method, hypnobirthing/babies, and conscious birthing, to ensure a strong preparation.
Pain Relief In Labor
Although strong advocates for natural birth, we are not the “anti-epidural” practice. We empower women to make their own choices about pain-relief in labor – understanding both the risks and benefits. Rather than driving the golf-cart urging the marathon runner to get in, we allow each woman to make that decision for herself whenever she reaches a threshold where she needs help.
Inductions Of Labor
We minimize inductions of labor to only true medical indications that threaten maternal/fetal health in order to limit the risks of inductions, particularly cesarean section. When inductions are necessary, we often employ non-medication methods, such as mechanical balloon cervical dilation and artificial rupture of membranes. Cervical ripening agents (cervidil) and pitocin have their place, but are used judiciously to closely mimic the natural onset of labor. Our pitocin protocol is half the strength of the traditional induction protocol – beginning with only 1 milliunit and increasing by 1 milliunit ever 15-30 minutes.
Vaginal Births After Cesarean Sections
We encourage VBACs for women with one prior cesarean section, which although not done by many practices in Austin, is clearly sanctioned by the American College of Obstetrics and Gynecology in hospitals with 24-hour anesthesia coverage. We also allow women to VBAC who have had two prior cesarean sections, but also a previous successful vaginal birth. VBACs require a special commitment from both patient and provider due to the slight risk for uterine rupture, approximately 1% of which the majority are NOT catastrophic. Each woman approaching VBAC must change the circumstances from her first birth to increase the likelihood for success, such as allowing spontaneous labor, delaying epidural use, limiting weight gain, and increasing exercise. Because of the increased risk with VBACs, we do require continuous monitoring which allows for early detection of any fetal compromise. Thankfully, with the advent of mobile telemonitors, this can be accomplished while still allowing complete mobility.
Our cesarean section rate of 20-25% is well below the Austin hospital average of 40-50%, and is artificially elevated by the large number of women attempting VBACs in our practice. Because of the number of women that we care for each month, we do about ten cesarean sections per month and are skilled at the surgical art of surgical delivery. Although a vaginal birth may be preferable, cesarean section is the safety net for the approximately 15% of women that the World Health Organization estimates require surgical birth for the safe passage of the newborn and mother through childbirth.
We care for many sets of twins each month, often in conjunction with a Maternal-Fetal Medicine specialist (David Berry MD and Celeste Sheppard MD). We advocate for vaginal birth assuming both babies are vertex (head-down), or the first baby is vertex and the second (regardless of position) is the same size of smaller than the first. Both physicians in our practice are skilled at breech delivery of second-twins which when done appropriately is very safe and sanctioned by the American College of Obstetrics and Gynecology.
Many of our patients are high-risk with a history of high-blood pressure, diabetes, leg/brain clots, aneurysms, recurrent miscarriage, in-vitro fertilization, etc. These patients receive care from both physicians and midwives in the practice, often in conjunction with a Maternal-Fetal Medicine specialist (David Berry MD and Celeste Sheppard MD). We are able to fully monitor the progress of the pregnancy and fetal well-being through regular ultrasound and fetal heart rate monitoring to ensure both maternal and fetal safety. When in labor, these patients often receive team care from both the midwife and physician on call, working together to provide the highest quality of care possible.
Both of our physicians and one midwife are trained in the performance and interpretation of ultrasound. We have a seasoned licensed sonographer who also performs ultrasounds all day on Wednesdays and Fridays. We are able to complete all types of obstetrical ultrasound in the office including first-trimester scans for dating, bleeding, pain; second-trimester basic and detailed anatomy surveys; and third-trimester scans for size/date discrepancies, amniotic fluid assessments, and post-dates reassurance. We also do genetic screenings for patients who desire such testing with both the first-screens (12 week ultrasound and blood draw for Down syndrome and Trisomy 18 risk assessment) and quad-screens (16 week blood draw only for Down syndrome, trisomy 18, and neural tube defects). Although some offices in town perform ultrasounds at every prenatal visit, we advocate against this for fetal safety, and use ultrasound only when medically indicated.
We are all supportive of a woman’s right to choose not only the nature of her birth experience, but the location as well. For low-risk patients, home-birth may be an appealing option. We provide in-office consultation services to the home-birthing midwifery community for pregnancy complications including bleeding, high-blood pressure, and diabetes. We also offer ultrasound for these women as needed. Transfers of care are accepted when patients develop high-risk conditions (such as pre-eclampsia, medication-requiring diabetes of pregnancy, etc.) that are outside of the scope of practice for homebirthing midwives. Thankfully, transports in labor are relatively rare and are accepted on a case-by-case basis when certain criteria for safety are clearly met. We do NOT accept transport patients that transferred out from our practice to a home-birthing midwife due to the legal implications of dismissal of our practice as the active care provider. The complete criteria for consultation, transfer, and transport, as well as the self-pay charges for common services, are available HERE (link to information for all home birthing CNMs).
We accept transfer patients who have had previous prenatal care and are less than 35 gestational weeks on a case by case basis. This is to ensure that all transfer patients are able to fully gain the experience of our collaborative model.