Yes, we do. 

Maternal Fetal Medicine (MFM)
We collaborate with Dr. Dexter Reneer at Maternal Fetal Medicine Specialists of TN

Centennial Women’s Hospital

We maintain an official transfer agreement and strong collaborative relationship with the OBs and midwives at Centennial Women's Hospital in Nashville

• Services Offered:

  • Access to their excellent Obstetrics Emergency Department (OBED).

  • Smooth acceptance of clients in labor for transfers, when necessary.

  • Ability to schedule inductions with their staff, if needed.

Emergency Transfers

In emergencies, we prioritize your safety by transferring to the closest hospital with maternity services.

We are dedicated to helping you access the best care possible, whether through our facility or a trusted hospital and physician network. If you’d like to learn more, we’d be happy to set up a free group consultation to discuss our transfer process in detail!

Community birth and midwifery care are designed for individuals with low-risk pregnancies. Pregnancy is a normal physiological process, and most people can experience a healthy pregnancy and birth without complications.

Midwives provide thorough prenatal care to continually assess and evaluate your risk status. Continued assessment for risk throughout pregnancy.

Please take our Risk Assessment Survey and call or email to set up a free group tour.

Out of hospital, community birth, is an option for healthy, low-risk pregnancies. Certain medical, obstetric, or pregnancy-related conditions may increase risk and make home birth unsafe. These may include, but are not limited to:

Medical History

• Chronic hypertension or pregnancy-induced hypertension requiring medication

• Pre-existing diabetes or gestational diabetes requiring medication

• Significant heart, lung, kidney, or autoimmune disease

• Bleeding or clotting disorders

• Seizure disorders

• Certain infectious diseases that pose a risk during labor or birth

Pregnancy-Related Factors

• Multiple gestation (twins or higher-order multiples)

• Breech or other non-vertex presentation at term

• Placenta previa or suspected placental abruption

• Preterm labor or birth prior to 37 weeks

• Post-term pregnancy beyond guideline limits

• Significant anemia not responsive to treatment

• Intrauterine growth restriction (IUGR) or suspected fetal compromise

• Polyhydramnios or oligohydramnios outside of normal limits

Labor & Birth Considerations

• Need for continuous electronic fetal monitoring

• Prolonged rupture of membranes with signs of infection

• Induction of labor requiring medications not appropriate for home birth

• Failure to progress with signs of maternal or fetal distress

Prior Birth History

• Prior cesarean birth 

• History of severe postpartum hemorrhage

• History of shoulder dystocia with injury

• History of severe preeclampsia or eclampsia

No, we do not provide delivery-only services. It’s essential for us to ensure that you are a good candidate for community birth. Preparing your family for a safe and successful birth involves reviewing all of your medical records, conducting thorough assessments, and building a trusting relationship.

However, we do accept transfers of care, even late into pregnancy. If you’re considering transferring care, please contact us as soon as possible so we can discuss your situation and ensure a smooth transition.

We fully support families in making the birth choices they feel are best for them. However, our practice does not attend VBACs, planned breech births, or planned twin/multiple births.

YES! We order all necessary labs and diagnostic ultrasounds as part of your care. However, like many small practices, we do not perform these services in-house. Instead, they will be completed at a local lab (ex: LabCorp or Quest) or imaging facility (ex: Inner Vision, Premier Radiology, The Perinatal Group, or Maternal-Fetal Medicine Specialist of Tennessee) . 

Since these services are provided by another facility, you will be billed directly by them for their services.

If you have any questions about where to go or how to schedule, we’re happy to help!

Yes, you have full autonomy over what goes into your body. If you choose to decline recommended testing, we ask you to choose an evidence-based alternative so we can accurately evaluate your risk and ensure that community birth remains a safe option for you. If you choose to decline evidence-based options as recommended we may not be able to determine your risk level and you may not qualify for a community birth with Clarksville Midwifery and Birth Center. As we try to individualize our families, how we determine this may vary from person to person.  

We also support your decision to use herbs or homeopathy as part of your care and are happy to discuss how these choices can be integrated into your plan while prioritizing safety and informed decision-making.

Please feel free to reach out with any questions or concerns—we’re here to provide guidance and support!

No, we do not.

We believe it is your right to decide what is best for your family. Our approach is grounded in informed consent and shared decision-making, ensuring you have the information and support needed to make thoughtful choices.

While we will discuss recommended vaccines during pregnancy for you and your baby, the decision is entirely yours.

If you choose to get vaccines, please note that our office does not carry vaccines, and you will need to visit a local pharmacy, the health department, your PCP, or pediatric provider to receive them.

If you have any questions or would like more information about our policy, please feel free to reach out. 

We understand that nobody enjoys the Gestational Diabetes (GDM) test—not even us. However, knowing whether you have gestational diabetes  is essential to ensure you are low-risk and suitable for community birth (see below for preferred and alternative testing options). Uncontrolled GDM can lead to significant complications for both you and your baby.

The good news is that, for most people, GDM can be managed effectively with diet and exercise—eliminating these potential complications. The key is identifying it early through testing.

Below, we outline our preferred method for determining if you have GDM. We are also open to exploring evidence-based alternative testing methods to suit your needs.

For more information on testing options or to discuss your preferences, please consider scheduling a free group consultation with us. 

Preferred Testing Method

Our preferred method for testing is the 75-gram Oral Glucose Tolerance Test (OGTT):

• Procedure:

  You drink a glucose solution (“sugar drink”). Your blood sugar is measured at three intervals:

  While fasting, 1 hour after drinking the solution, 2 hours after drinking the solution. If one or more of your results are outside the normal range, you are diagnosed with GDM.

  Advantage:

  Evidence Based Option

  This is a one-step (one and done) diagnostic test.

Options for the Glucose Drink

1. Fresh Test: A natural, evidence-based alternative to the standard glucose drink, available for purchase at our office.

2. Glucola: A Free Glucose Drink: Provided by the lab

 Alternative Testing Options

If you are uncomfortable with the preferred testing method, we are happy to explore other evidence-based options, such as:

• 1-Hour Glucose Screen: A preliminary test with fewer blood draws. (3-Hour glucose test or at home glucose monitoring for the remainder of your pregnancy would be required if this screen is not passed.)

• At Home 2-Week Glucose Monitoring:

• Measure blood sugar levels 4 times a day for two weeks using finger sticks.

• Maintain a food log for two weeks.

Your health and comfort are our priority. Please reach out if you have concerns or want to discuss the best testing method for you!

Not usually—most clients with Gestational Diabetes (GDM) are able to control their blood sugar levels through dietary changes and exercise.

• What’s Required:

  • Measure blood sugar levels 4 times a day using finger sticks.

  • Maintain a daily food log for the rest of your pregnancy.

• Diet and Exercise:

  • Many people find that minor adjustments to their diet are enough to maintain normal blood sugar levels.

  • Others may require more significant changes to keep their glucose levels in check.

• When Hospital Birth May Be Recommended:

  • If your glucose levels remain abnormal and more than 10% of your readings are outside the target range, we recommend transitioning to a planned hospital birth.

  • We have a good working relationship with Centennial Women’s Hospital in Nashville, TN and can schedule an induction if it becomes needed. 

• Co-Care with MFM:

  • Most clients choose to stay in our care even if hospital birth becomes necessary. In these cases, we provide co-care alongside Maternal Fetal Medicine (MFM) specialists to ensure comprehensive support.

We are here to guide and support you through this process if needed and work for the best outcome for you and your baby. Let us know if you have questions or concerns about managing GDM!

Midwifery care is designed for low-risk pregnancies. Certain medical conditions are considered high risk and are not suitable for a birth center setting, including:

• Insulin-dependent diabetes

• Preeclampsia

• Chronic high blood pressure

• Medication managed blood pressure

• Gestational diabetes requiring medication to control

• Preterm birth (Before 37 wks)

• Post term birth (birth past 42 wks)

If you have questions about your eligibility for care at the birth center or wish to discuss your specific circumstances, please feel free to contact us. Your safety and the health of your baby are our top priorities.

Community birth is designed for low-risk pregnancies and does not include certain procedures or interventions that are typically available in a hospital setting. These include:

• Pitocin induction or augmentation

• Vacuum or forceps-assisted delivery

• Cesarean section

• Blood transfusion

• Anesthesia (e.g., epidurals or IV pain medications that may cause respiratory depression in the baby)

• Continuous fetal monitoring
  (Evidence has shown that in low-risk pregnancies, continuous fetal monitoring increases cesarean section rates without improving fetal outcomes.)

Community birth focuses on natural, low-intervention care. If your pregnancy requires any of these services or interventions, a hospital setting would be more appropriate to ensure the safety of you and your baby.

If you have questions about community birth or your specific needs, please don’t hesitate to reach out to us.

It depends on the situation.

Emergency Transfers

Emergency transfers are rare, occurring approximately 1-2 times per year.

• In the case of an emergency transfer, clients are typically transported via EMS, which allows for faster and more efficient transfer to a higher level of care. 

• When possible a member of our team will accompany you to the nearest hospital.

• We provide a direct report to the on-call provider, share relevant information, and facilitate as smooth a transition of care as possible.

• Once your care has been handed off and you are settled, the midwife team will depart.

Non-Urgent Transfers

In non-emergency situations where a hospital birth is recommended or desired:

• Clients typically transfer via their own private vehicle.

• We most often transfer clients to Centennial Hospital in Nashville, known for prioritizing safety and patient-centered care. We have a transfer agreement in place.

• Our team provides a verbal report to the on-call provider at the hospital.

• Your medical records are faxed to ensure the hospital has all the necessary information for your care.

• While we do not accompany clients during non-urgent transfers, we remain available via pager to answer any questions you may have.

Post-Hospital Care

• After discharge, we typically continue providing in-office postpartum care.

• Your newborn will be seen by your prefered newborn care provider.

If you have any questions about our transfer process, please don’t hesitate to reach out. Our goal is to make your experience as seamless and supportive as possible.

The $500 deposit you paid is non-refundable, as stated in Clarksville Midwifery and Birth Center’s financial agreement that you sign at your first visit. Unfortunately, this means it cannot be returned, even if you decide to discontinue care after just one visit. This deposit ensures your place in our care and means we may have turned others away when we committed to you. This also covers the additional administrative costs incurred when you sign up and then transfer out of care. 

If you have concerns or questions about the deposit or your care plan, feel free to contact the office for further clarification.

If you are discontinuing care for any reason, whether you can receive a partial refund depends on the specifics of your payment agreement and the services already rendered. 

Here’s how it typically works:

1. Non-Refundable Deposit: As stated, the initial deposit is non-refundable.

2. Additional Payments Made: Refunds for additional payments may be available, depending on:

   • The number of visits or services you’ve received.

   • Costs already incurred by Clarksville Midwifery and Birth Center for your care.

   • In some cases, the cost of the services already provided by Clarksville Midwifery and Birth Center may exceed the amount you have paid. If you have an outstanding balance you may owe an additional amount to cover the cost of services rendered.

To determine if you’re eligible for a partial refund, contact Clarksville Midwifery and Birth Center directly. We will review your records and submit them to our biller for itemization. They can provide a detailed breakdown of charges and help clarify what portion, if any, may be refunded.
3. Processing Times:
Insurance Processing: Itemized billing take time. While we aim to complete it as quickly as possible, it is common for insurance claims to take 6 months or longer. 
Cash Pay/Early Pay Discount: Partial refunds for itemized Cash Pay/Early Pay typically process much faster as we do not have to wait for insurance to finalize your bill. 

If your care has been discontinued, or you had a hospital birth, and wish to determine eligibility for a partial refund (excluding the non-refundable deposit), please follow these steps:

1. Contact Us: Reach out to Clarksville Midwifery and Birth Center directly to request a review of your account.

2. Review Process:

   • We will review your records and submit them to our billing department.

   • The biller will provide a detailed breakdown of charges and clarify what portion, if any, may be refunded, or if you still owe us for rendered services.

   • Depending on services already rendered by Clarksville Midwifery and Birth Center the cost of services may exceed the amount you have paid. If you have an outstanding balance you may owe an additional amount to cover the cost of services provided.

3. Processing Time:
   Insurance Processing: Itemized billing take time. While we aim to complete it as quickly as possible, it is common for insurance claims to take 6 months or longer. 
   Cash Pay/Early Pay Discount: Partial refunds for itemized Cash Pay/Early Pay Discount typically process much faster as we do not have to wait for insurance to finalize your bill. 

If you have further questions or need assistance initiating this process, don’t hesitate to contact us. We appreciate your patience and understanding.

The early-pay/self-pay discount is a savings of over $2000 just for the prenatal appointments, birth, and postpartum appointments. By bundling our services this way we are able to pass a discount onto our clients by not using a biller to charge for each encounter. If we unbundle our services and charge you for each of the appointments that you are doing based on the full cost of each appointment most people pay more than if you just did the early-pay/self-pay discount to begin with. 

Complications That Can Be Managed in the Community Setting
Midwives are trained to handle certain complications that may arise during labor, delivery, or postpartum in the community setting. These include:

• Neonatal resuscitation
  Midwives are skilled in providing immediate care to stabilize newborns if needed.

• Management of hemorrhage
  Techniques and medications are available to control bleeding after delivery.

• Repair of tears
  Lidocaine is used to provide pain relief for stitching and repair of perineal tears.

• Dehydration
  IV fluids can be administered to address dehydration if necessary.

These capabilities ensure that many common complications can be safely and effectively managed. However, if further medical intervention becomes necessary, midwives are prepared to coordinate a transfer to a hospital to ensure the best outcomes for both parent and baby.

If you have any questions about the safety measures in place during a community birth, we’d be happy to discuss them with you.

Please fill out this risk assessment survey and call or email us to sign up for a free group tour. 

Link: Risk Assessment Survey

If you still have additional questions and do not see the answers here, please contact us at clarksvillemidwifery@gmail.com.