Our midwifery care includes pre-conception counsel, support with conceptions (including sperm washing and inseminations), prenatal care, homebirth, waterbirth, postpartum, and newborn care through 6 weeks postpartum.

Our well person gynecology care includes routine wellness visits, family planning (including contraceptive management and IUD placement), STI testing, and mental health support.

We are happy to bill most insurance providers for our care. We are currently in-network with Blue Cross, United Healthcare, Aetna, Cigna, OHP, and select Moda plans. We are not in network with and rarely get reimbursed by Providence and Kaiser. Other insurance companies can be billed, but out of network rates would apply.

Most insurance companies will reimburse us for a portion, if not all, of our care, subject to your deductable and co-insurance. Though we would love to support everyone on OHP, we are only able to take a limited number of OHP clients for midwifery care. We are glad to obtain an estimate of how much your insurance is likely to pay and what your out of pocket responsibility would be and encourage you to do the same!

There reasons are numerous and this list is not exhaustive, but here are a few:

Partnership - Midwifery care is individualized and relationship based. We deeply appreciate the opportunity to get to know each of our clients as individuals and families. love getting to know each other prenatally and building trust. We believe that this makes for a more positive birth experience, even if things don’t go as planned. With a foundation of trust, there is a feeling of safety that is hard to establish with a provider you are just meeting at the time of birth.

Longer visits - We generally spend 45-60 minutes with our clients. We discuss your medical needs as well as the emotional and day-to-day needs of pregnancy. We approach birth holistically, and can talk about nutrition and alternative care. During these visits we are not only providing care but building a relationship. Informed Choice - We offer all of the same tests and procedures that you would receive in a hospital but we talk about them ahead of time and offer alternative options, discussing risks and benefits in an unbiased atmosphere. We believe the best care comes from our clients having the knowledge to choose the care that fits their unique values, needs, and concerns.

Availability - We are on call for you 24-7. Though we appreciate you contacting us responsibly and within office hours when possible, we are available anytime of day for emergent concerns and labor.

Staying Home - Many people feel most comfortable at home, in their own, known space. With midwives, you don’t have to leave your house during labor or birth, or postpartum. You have access to all your own comforts; your clothes, food, bed, bathroom, children (if you want them there) and pets. We think the home-based postpartum care is one of the best parts of midwifery care! We come to you 4 times in the first 2 weeks, making sure that you and baby are healthy and getting the support you need. No need to strap you or baby into the car!

Home birth is safe for many people, but it is not for everyone. In a normal, uncomplicated pregnancy, homebirth is often a safe option. There are certain complications that make a homebirth unsafe. We take a thorough health history of all our clients, and monitor mom and baby throughout pregnancy to make sure that they are good candidates for a home birth.

Though it has not been studied, we believe that when a mom feels safe, the birth unfolds more naturally. So, if a mom feels more comfortable at home, this may be a safer place for the birth. Likewise, if a mom feels more comfortable at a hospital, this is the right place for her.

Below are links to the most current studies on home birth. The studies reveal that rates of interventions and c-section are lower for homebirths than hospital births for low-risk women. Infant and maternal mortality rates for home birth are similar to the hospital rates for low-risk women.

The Oregon Midwifery Council Website has a great page on the safety of homebirth: https://oregonmidwiferycouncil.org/oregon-midwives-info-for-families/is-homebirth-safe/

The British Medical Journal: Outcomes of Planned Homebirths with CPM's Midwives Alliance of North America (MANA): New Studies Confirm Safety of Home Birth With Midwives in the U.S. Journal of Midwifery and Women's Health: Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 "https://www.mana.org/pdfs/HomeBirthAnnotatedGuidetotheLiteratureDec5-2012FINAL.pdf"

A Certified Nurse Midwife (CNM) is a registered nurse with a graduate degree in midwifery. They have had formal schooling at a college or university that is accredited by the American College of Nurse-Midwives. They must pass a national exam in order to become certified and then are legal and eligible to become licensed in all 50 states. They are primarily trained and work in the hospital setting.

A Direct-Entry Midwife (DEM) learns midwifery through self-study, apprenticeship, a midwifery school, or a college or university-based program distinct from nursing. They are trained and work primarily in the out of hospital setting such as home or birth center.

Under the umbrella of "Direct-Entry Midwife" are several types of midwives:

A Certified Professional Midwife (CPM) is an independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings.

A Licensed Direct-Entry Midwife (LDM) is a midwife who is licensed to practice in the state they are licensed in. Currently, licensure for direct-entry midwives is available in 27 states, including Oregon and Washington.

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, just that the midwife either chose not to become certified or licensed, or there was no certification available for her type of education. Other similar terms to describe uncertified or unlicensed midwives are traditional midwife, traditional birth attendant, granny midwife and independent midwife.

Flourish consists of 2 midwives; Alisha Madrone, NP/CNM and Nicole Bendotoff, CPM/LDM. Our unique combination of CNM and CPM provides well rounded care for our clients.

Alisha began her career as a labor and delivery nurse, then worked for many years in the hospital as a midwife, caring for a wide range of low and higher risk clients. Nicole was specifically trained in out of hospital birth, learning to care for clients in this setting. We feel our backgrounds and years of experience blends both solid, evidence based clinical care as well and the art of caring for clients in a connected and individualized way.

You will be seen by both midwives over the course of your prenatal and postpartum care and both midwives will attend your birth.

We attend 2-4 births per month and have found this to be the perfect number of births to keep us committed to quality care and sustainable presence for ourselves, our clients, and our families.

We always like to have 2 providers at a birth and while most clients wait for both of us to be available, we do occasionally take vacation or have sick days. If one of us is out of town or sick, the other will attend your birth with another qualified nurse or midwife, whom you may or may not have met ahead of time. Similarly, if two clients are in labor at the same time, we will split up, each attending one birth along with another qualified provider.

Generally, clients start care with us between weeks 6 and 12 of their pregnancy. You will have one appointment per month for the first 2 trimesters. Beginning in the third trimester, you will have appointments every 2 weeks until the last month of your pregnancy when we will do a homevisit at 36 weeks and then have you return to the office for weekly appointments until your birth. We provide postpartum and newborn visits in your home day 1, day 3, day 7, and day 14. You will return to the office for your final postpartum and newborn visits week 4 and week 6.

YES!!! We are trained in water birth and are happy to facilitate waterbirth. Many of our clients choose waterbirth. Whether baby is born in the water or not, the water is wonderful for relief during labor. Waterbirth is considered a safe gentle way to bring babies into the world. We have inflatable tubs that we rent if you are interested in a water birth.

We are trained to manage many common complications that can arise during pregnancy, labor, and delivery. For situations that fall out of the midwifery scope of practice, we consult with or refer to our collaborating physicians and practitioners. When certain risk factors are identified, we may send you for consultation with a Maternal-Fetal Medicine specialist. If something arises that makes a home birth unsafe, we will refer you to a hospital based provider. In this situation we may be able to continue prenatal and postpartum care with you, or collaborate with your other providers for your care.

We can be reached with questions or concerns 24 hours a day. During pregnancy if there were an emergency, we would likely discuss the risks and options, then proceed by providing care to you or referring you to the hospital.

Prevention of emergencies during labor is a main goal of ours. We do this by staying present and in communication with you throughout labor, birth and the postpartum. We regularly monitor your vitals and watch for signs of dehydration, exhaustion, abnormal bleeding and shock. We monitor baby by listening to the heartbeat often during labor to catch changes that might indicate a problem. After birth we watch babies carefully to make sure that they are breathing and transitioning well. If we are worried about the health of the mother or baby we will discuss this with you, and most likely transfer to a hospital so that we can have the type of support we need.

If an emergency does occur at home, we are prepared and have many resources. We carry oxygen, anti-hemorrhagic medication to stop bleeding, IV equipment and suturing materials. We are well trained in maternal and neonatal resuscitation, IV therapy, shock treatment, and suturing. Our training in these areas is renewed every 2 years. These are the same emergency resources that are available at a birth center.

The emergency measures we cannot take at home include a cesarean delivery, other surgery or a blood transfusion. If an emergency occurs that we cannot handle quickly, we would call 911 and transfer to a hospital. We create an emergency transfer plan with all of our clients ahead of time.

We love to witness and honor the first moments of your baby’s life. After they are born, though we are close by, we maintain a quiet, unintrusive space to welcome and meet your baby. We are observing you and baby closely to ensure that baby is transitioning well and that your bleeding is normal. We will listen to baby’s heart and lungs as needed, monitor your vitals, and facilitate the birth of the placenta. Occasionally baby’s do need some help transitioning to life outside the womb. We may provide physical stimulation, positioning, suction and/or resuscitation. We are generally able to do this without cutting the cord and keeping baby with you.

After you get some time together, we will cut the umbilical cord (always much delayed), do a full exam of the newborn, continue to monitor your bleeding, examine your perineum for tears, suture as needed, help with initial breastfeeding, and make sure everyone is hydrated and fed. We generally stay about 3 hrs after the birth. Before departing we ensure that everyone is stable, you understand the postpartum instructions and clean up your house and the tub (if used).

Pain relief options at home include water, positioning, massage/pressure, heating pads, use of a rebozo, and emotional support. We strongly believe in the mind-body connection and that if you are in a good place emotionally, the intensity of labor will be more manageable.

Yes, we do provide care for women who have a history of 1 cesarean birth. There are some requirements you have to meet, which we can discuss to see if you are a good candidate for a homebirth VBAC.