Questions? We Have Answers.

Frequently Asked Questions

You've likely got a few questions for us. This is a good place to begin, offering you a solid overview of our services and the experience of community-based birth.

When you're ready, we encourage you to take the next step and book an initial free consultation with us. This is the best way to discover if a community-based birth with our midwife team is the right choice for you.

- Ginny Miller, CNM & Kirsten Kowalski, CNM, WHNP
What is a freestanding birth center?

A freestanding birth center is a homelike, out-of- hospital facility where a person’s choices in reproductive care, pregnancy, birth and postpartum are supported and respected. Seven Sisters Midwifery and Community Birth Center meets all local, state, and federal health, fire and safety regulations. Our building meets all the requirements of the MA Department of Public Health and is licensed by DPH. We are also accredited by CABC, the Commission for the Accreditation of Birth Centers.

Birthing families can feel safe and secure in the fact that midwives and consulting physicians work together as part of a unified system of quality healthcare. Most of all, a birth center provides a package of care that gives an individual and their family the support and confidence to give birth. At the birth center we do this by balancing the need for human touch and companionship, guidance and information, and access to technology and medical intervention as needed.

What is the difference between a hospital “birth center” and an actual free-standing birth center?

The major difference between freestanding birth centers and hospital birth centers is that hospitals create system-wide institutional policies to care for a wide range of people who are generally sick. Many of these policies have the ability to negatively impact the birthing process for a normal and healthy pregnant person. At a free-standing, midwife-led birthing center, our protocols and procedures are based on evidence-based research, the midwifery model of care and recommendations from the American College of Nurse Midwives (ACNM), the American Association of Birth Center (AABC), and American College of Obstetricians and Gynecologists (ACOG).

A freestanding birth center is also able to FULLY embrace the midwifery model of care that approaches pregnancy and birth as a normal family-oriented physiological event until proven otherwise. This includes having midwives practice to the full scope of their license with the support of carefully selected physician consultants. Freestanding birth centers offer both personal and comprehensive care to those seeking reproductive health, prenatal, birth and postpartum care.

Am I a good candidate for delivering at a Birth Center?

If you are a pregnant person who is in general good health, and is interested in a collaborative relationship with your healthcare providers, then the answer is very likely yes! If you are unsure of whether you fall into this category, reach out to us. We would love to give you a tour of the center and talk more about your questions and concerns.

Who owns Seven Sisters Midwifery and Community Birth Center?

The center is an equal partnership between Ginny Miller CNM and Kirsten Kowalski Lane CNM, WHNP. There are no outside investors and no ownership by any local hospitals.

Who is your transfer hospital and consulting MD?

The MA Department of Public Health requires that we have a written transfer agreement and a consulting physician. Our transfer hospital is Cooley Dickinson Hospital and our consulting physician is Gretchen Loebel MD. We will continue to work closely with the CDH midwives and MDs to make our joint care as seamless as possible.

Are birth centers safe?

Birth centers have been shown to be as safe or safer for low-risk, healthy birthing people, offering the comfort and reduced stress of a home-like environment with the benefits of a well-equipped health facility. The National Birth Center Study II, published in the Journal of Midwifery and Women’s Health, has shown that birth centers have excellent outcomes for mothers and babies, with a significantly lower rate of cesarean sections.

Among the 15,574 women intending to birth in birth centers:

  • 94% of women admitted in labor achieved a vaginal birth indicating a 6% c-section rate vs. the national average of 31% for low-risk women;
  • Less than 1% of women were transferred for emergent reasons during labor;
  • Less than 0.5% transferred for emergent reasons for mother or baby after birth; and
  • There were 0 maternal deaths
  • The rate of stillbirth was 0.47% (defined as term neonatal deaths prior to labor/birth)
  • The neonatal death rate was 0.40% (defined as term neonatal deaths after birth until 28 days post delivery – there is currently no matched hospital data although the overall term neonatal mortality rate in the US is approximately 4%)
  • Among women who gave birth in hospitals:

  • 85-90% are considered low-risk and eligible for care at a birth center;
  • 87% who labor in hospitals undergo continuous electronic fetal monitoring;
  • 80% receive intravenous fluids;
  • 47% have labor artificially accelerated with medications;
  • 43% of first-time moms have labor artificially induced;
  • 60% of women giving birth in hospitals are not allowed to eat or drink;
  • 76% are restricted to bed; and
  • 92% give birth lying on their backs.
  • There is strong evidence that routine use of these practices, when carried out without medical indications, has few benefits and often introduces potential risks for healthy mothers and babies.

    Who provides the care at Seven Sisters?

    We offer comprehensive prenatal, birth, postpartum and gyn care by Certified Nurse-Midwives (CNMs). All CNMs are Registered Nurses licensed by the MA Board of Nursing and accredited by the American Midwifery Certification Board. CNMs have advanced training and graduate education in midwifery. The CNM scope of practice includes all prenatal, labor and birth care as well as life-long gynecological care. During labor and birth, midwives are aided by Registered Nurses (RN). Currently, Ginny Miller, Kirsten Kowalski, Danielle Warneau, Shoshana Sanders, and Kelly Ostrowski make up our CNM team. Additionally, we have an IBCLC on staff as well as a team of 3 dedicated RNs, and 8 per diem RN’s. Every birth is attended by at least one CNM and one RN. As our capacity increases, we also anticipate including student midwives on our team. Additionally we have Cathy Hardie, PT who is our in-house physical therapist with focus in pelvic floor therapy.

    Our future plans also include adding allied providers to our team; specifically an LICSW, whom we hope to welcome in the next 6 months.

    Will Seven Sisters be covered by insurance?

    We currently accept most major commercial insurances for both birth and gynecological care and are proud to accept Masshealth. If we do not take your insurance, we can attempt to get an out-of-network exception or consider self-pay options.

    Will you do ultrasounds and lab work?

    We will offer in-office ultrasounds for confirmation of pregnancy, early dating, fetal position and AFI when needed. At this time, our anatomy scans and other advanced ultrasound will be referred out to Baystate Medical Center, or another service provider of the client’s choosing. We offer our own lab drawing services, as well as currently working with Quest labs, CDH and Baystate labs. Most labs will be done in office, while others may be referred out to a local lab of the client’s choosing.

    What types of comfort measures will Seven Sisters birth suites have?

    Continuous labor support from your midwifery team
    Family/Doula/other support people welcome
    Edel Immersys tubs for labor and waterbirth
    Nitrous Oxide
    Open concept walk-in tiled shower
    Variety of Birth Balls
    Birthing Stool
    No restrictions on eating or drinking
    Freedom to use music, lighting, aromatherapy, etc. as desired
    Freedom to walk outside (when weather permits) in our lovely Florence neighborhood

    Can I have a waterbirth?

    Yes! We love waterbirths, and our labor tubs are the perfect size and depth for safely delivering in the tub if you so desire. Hydrotherapy achieved from use of our tubs, or open-concept showers, are a wonderful way to manage the work of labor and birth. Additionally, babies love being born in the water! They are transitioning from a warm water-based environment to the outside world, and the warm water of the tub allows for this to be the most gentle of processes.

    As for safety, studies have shown that hydrotherapy reduces:
    Perceived pain

  • Use of pain medication
  • Need for augmentation to speed up labor
  • Maternal/birthing person anxiety
  • Hydrotherapy has also been shown to improve fetal positioning in the pelvis, making for an easier birth process. To learn more, Evidence Based Birth is a wonderful website that provides multiple resources on their website reviewing the risks and benefits determined from all the major waterbirth studies to date.

    What medications are available at the center?

    As CNMs in MA (where we are licensed as independent providers) we are able to prescribe all medications necessary to provide full-scope midwifery care to our clients. This means we can provide contraception, antibiotics for infections we are trained to treat, supportive medications for menstrual issues, PCOS, peri-menopause and menopause as well as medications for postpartum depression when needed and in conjunction with therapy.

    For labor and birth, we carry all of the same medications that are available on a hospital labor and delivery unit for treatment of complications including medications for hemorrhage, IV fluids, oxygen set ups for the birthing person and baby, IV antibiotics, suture and local anesthesia for repairs/pain relief. We DO NOT stock any narcotic pain medication and cannot provide epidural anesthesia.

    What is our approach to the end of pregnancy?

    Seven Sisters’ approach to the end of pregnancy is guided by evidence-based recommendations from ACNM, ACOG, and CABC. Many pregnancies progress past 40 weeks, especially first time pregnancies. If a pregnancy reaches 41 weeks you can expect to have an informed discussion with one of the midwives about possible next steps. If at 41 weeks a person decides they would prefer to be induced after fully discussing pros and cons, a plan will be made to transfer you to hospital care. If a person prefers to continue the pregnancy, and all other health indicators are normal, we will provide testing to confirm your baby is continuing to thrive in their uterine environment. This testing will include:

  • An in-house ultrasound to confirm a normal amount of amniotic fluid surrounds your baby.
  • An in-house non-stress test, which involves placing monitors on your belly to assess the baby's heart rate over the course of 20-40 minutes.
  • If you are still gestating at 41.5 weeks, we will recommend a biophysical profile for fetal well-being.
  • We will also be discussing natural methods for encouraging labor between weeks 40 and 42. If you reach 42 weeks without going into labor, you risk out of the option to give birth at the center. At that point your care would be transferred to the hospital, and you would need to birth in the hospital setting. Our birth center is bound to the accrediting body protocols of CABC, and dictate that we only attend births in the center between 37 and 42 weeks.

    What happens when care is transferred to the hospital?

    When needed, we transfer to the Cooley Dickinson (CDH) OB-GYN and Midwifery Group. When appropriate, we transfer our clients directly into the midwifery service. At this time, whenever able, we may attend transfer births at the hospital in a labor support capacity but DO NOT have hospital privileges. However, we do have community privileges at CDH and whenever possible, we will come to the hospital to check in on you after your birth. We are happy to resume postpartum care and offer lactation support as you need and desire.

    What is the immediate postpartum time like at the birth center?

    After the birth, baby will be placed on the mother or birthing person’s chest for immediate skin-to-skin contact. Your nurse and midwife will make everyone comfortable in the queen-size bed. All your vitals and well-being for you and baby will be calmly and carefully monitored in an effort to preserve the initial “golden hour” of the immediate postpartum period. Partners, friends, older children will be brought into this time as much or as little as the birthing person desires. Delayed cord clamping and waiting to do any repairs, assuming bleeding is well controlled, are also honored. We provide a nourishing light snack and warm tea as the birthing person desires during this time. Families are also encouraged to bring or procure their own food to the center for a sustaining postpartum meal. We will have a kitchen stocked with light nibbles and beverages.

    The midwife team will assist with breastfeeding while continually monitoring you and your baby’s health during the immediate postpartum period. The midwife will do a complete physical exam on your baby, including a cardiac evaluation, at approximately 1-2 hours of life as well as a full postpartum evaluation of the birthing person. Families stay at the birth center an average of 4-8 hours after birth.

    An Early Home Care class that is required of all people birthing at the center for the first time, thoroughly equips families to care for their babies and themselves at home postpartum. Before departing the birth center, all birth certificate information will be collected, a type and screen from baby’s cord blood is collected, Vitamin K and Erythromycin are offered, and families will be instructed in car-seat safety and be assisted in getting your baby safely into the car. A birth record will be faxed to the family’s pediatrician and a call will be placed to the pediatric office to alert them that the baby has been born and should be seen by them at approximately 7 days postpartum unless otherwise advised. A follow-up 1-2 week in-office appointment is also made with one of the midwives at this time as well.

    What happens once a family returns home?

    A midwife or nurse will do a follow-up visit at home (within 1 hour of the center) approximately 24-36 hours after the birth. Head to toe assessments will be done on the mother-baby dyad. At this time the baby will have its newborn screening and subcutaneous bilirubin testing done. These are all tests standardly done >24 hours after birth. This is also a time where we troubleshoot feeding issues and help with any new parenting issues that have cropped up. Additional home visits and lactation support visits can be scheduled in the ensuing weeks as needed either at home or at the center. In office visits are planned at a minimum for 1-2 weeks, 6 weeks and 12 weeks postpartum.