Welcome to our Practice

We provide holistic care in Monterey County for pregnancy, birth and beyond.

   

Meet the Midwives

 

Jacqueline graduated Summa Cum Laude from the University of Maryland with a Bachelors Degree in Women’s Studies. She was awarded a scholarship to conduct original research in women’s health. Within a few years, Jacqueline assisted in managing a busy birth center in Los Angeles, while teaching Childbirth Education classes to out-of-hospital birth families. Next she began her Midwifery studies, and had the opportunity to work with many practitioners: Licensed Midwives, Certified Nurse Midwives, Naturopathic Doctors, Nurse Practitioners and Obstetricians within a holistic woman-centered model of care. Jacqueline received her CA Midwifery License and national, Certified Professional Midwifery license in 2012.

While evidence and feminist ideals initially drew Jacqueline to midwifery, the opportunity to work closely with the strong, directed and intelligent people that home birth attracts continues to enrich her enthusiasm. She values the meaningful and intimate relationships midwifery care offers, and believes that connection is an important facilitator in the physical and emotional transformations of pregnancy, birth and parenthood.

 

Caroline is licensed by the Medical Board of California and certified by the North American Registry of Midwives. She graduated from the National Midwifery Institute and received her clinical training during a seven year apprenticeship with her midwife and mentor. After the completion of her midwifery training, Caroline joined forces with her mentor to form a practice that strives to provide excellent midwifery care to the families of Monterey County.

Caroline believes that birth is a normal, physiologic process that is safe and rewarding. She came to the practice of midwifery in the hopes that she could offer the kind of excellent maternity care she had been so fortunate to receive. Caroline provides the Midwives Model of Care addressing many facets of pregnancy and birth, not just the physical and practical needs.

 

The Midwives Model of Care:

  • Monitor the physical, psychological and social well-being of the mother throughout the childbearing cycle
  • Provide the mother with individualized education, counseling, and prenatal care
  • Provide continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimize technological interventions
  • Identify and refer women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean section.

Jacqueline Little
Jacqueline Little
Jacqueline Little

Licensed Midwife, Certified Professional Midwife,
Childbirth Educator, Placenta Preparation Specialist

Caroline Cusenza
Caroline Cusenza
Caroline Cusenza

Licensed Midwife, Certified Professional Midwife

Services

We offer holistic integrative care for your family.

Home Birth
Home Birth

Holistic Family-Centered Prenatal, Birth & Postpartum Care in YOUR Home!

Well-Woman Care
Well-Woman Care

Pap smear, Personalized Health Assessment, Family Planning Counseling

Childbirth Education
Childbirth Education

Mindful Birthing to Prepare for Your Home Birth.

Birth Tub Rentals & Products
Birth Tub Rentals & Products

Affordable Birthing Tub Rentals and Products

Testimonials


I had the privilege of meeting Jacqueline Little during a childbirth educations series offered at The Sanctuary Birth and Family Wellness Center in June of 2013. My husband and I felt an incredible connection with her immediately. She captured our hearts with her laugh, and we immediately knew that she was the midwife we wanted to deliver our baby. Her intelligence provided us with great trust in her capability to bring our first born into this world safely. She’s an amazingly witty and fun person to be around, yet instills a sense of calm within you and the environment around her. Who wouldn’t want that kind of energy at their birth? She’s one special human being and will always be near and dear to our hearts. She’s a phenomenal educator, midwife, and woman and anyone would be lucky to have her involved in the most special moment of their lives. { Amanda C. }


Upon meeting Jacqueline of Marigold Midwifery, my husband and I knew that there would be a great connection between us. There was something so special about her presence, something so positive and reassuring, that we knew we would want her at the birth of our son. After spending six weeks together for childbirth education classes, this feeling only increased as we witnessed her dedication to education, her eloquence, and moreover the respect and belief that she has in the power of birthing and the female body. I never felt more powerful as a woman and as a mommy to be than when she explained the process of birthing. We were so blessed as a family to have her at our birth. She was a constant source of calm in what could have been a very stressful or scary experience. The education that she gave my husband and I prior to birth and her presence in our birthing space gave us much of the courage and faith in ourselves that we needed to birth without fear and welcome our son with joy, relief, and love. We are constantly blown away by how wonderful our midwifery care was throughout the pregnancy and how perfect our son’s birth truly was in no small part do to Jacqueline. We hold her in our hearts and prayers often as we think of our beautiful birth experience. We highly recommend this wonderful healthcare professional who shines her love and positivity to everyone she meets. { Leah Y. }


Jacqueline is, in a word, awesome. In two words, super awesome. She is calm, knowledgeable and the depth of her compassion would give the Mariana Trench a run for its money. (That’s a really deep ocean trench.) She manages to balance both laser focus and warmth. She also has a loud, contagious laugh. The kind that makes everyone crack a smile. { Jason P. }


FAQ : Ask the Midwives

Is home birth really a safe option?

This is a question that can only be answered by the birthing parents.  We can tell you that we believe it is safe for a low risk, healthy pregnancy and that research supports this belief, however no birth including those in the hospital is without risk. Most people that choose to birth at home have only chosen after extensive research and feel that the small risk of a serious complication is preferable to the high rate of interventions in a hospital setting (including the 33% national caesarean section rate.)

What happens if something goes wrong?

We are well trained to deal with complications and transport as necessary.  We do not take complications lightly and safety is always the priority for mother and baby. This is definitely a subject we should discuss in detail at the free consultation.

What happens in the event of hospital transport? Do you come with us?

Yes, in the case of transport one or both of us will accompany you and facilitate the transfer of care to the hospital by bringing your medical records and giving a verbal report to the receiving care providers.  We stay with you until after the birth and take on the role of advocate and birth coach.  We know it is important to help the parents understand what is happening and help you get the information you need to make an informed decision.

Why choose home birth?

Choosing home birth is a very personal decision. It is not common (at this time, less than 1% in the US) and some people will encounter resistance from family members and friends.  People generally choose to birth at home because they feel more comfortable there, they believe they are healthy and wish to avoid routine hospital interventions or non-evidenced based practices such as continuous electronic fetal monitoring, routine IV fluids, and non-medically indicated induction and other common birth interventions.  There are many more personal reasons that are given, for example, Caroline chose to birth at home because she desired a natural birth and wanted to avoid an unnecessary caesarean section.  We have had other home birth families state that they view pregnancy and birth as a natural process not an illness and therefore felt that the hospital was not the appropriate approach to childbirth or that they wished for their older children to be present and engaged in the process. What are your reasons?

When is home birth not a good option?

Home birth is not a good option for a person with preexisting disease or condition making pregnancy and birth high-risk.  Some examples are women with pre-existing diabetes, certain types of heart conditions, uncontrolled thyroid problems or hypertension.  In some instances, a pregnancy may begin as low-risk and a complication can develop such as preeclampsia.  In those instances, the care of the woman must be transferred to an OB and home birth is no longer a good option.  We will continue to provide care, however the primary care is taken over by the OB and the birth will need to take place in the hospital.

How close do you need to be to a hospital?

There are no guidelines in place for this. It is more about what the birthing couple is comfortable with.  Some families, who live more than an hour away from a hospital, choose to rent a location closer the hospital.

How much does a home birth cost? Do you accept insurance?

Home birth costs vary by region. Here in Monterey County the range is about $5-6,000 for the entirety of your prenatal care, delivery with birthing pool, and postpartum care.  We do accept insurance and offer verification of benefits and billing service at no extra cost to you. However, there is no guarantee that insurance will cover care; it depends on your policy. Payment plans, cash and military discounts are available.

What is the difference between a CPM and a CNM? A LM?

Certified Professional Midwives (CPMs) are certified through the North American Registry of Midwives (NARM). This is a national credential and in order to be certified, they must meet many qualifications including didactic and clinical experience. The NARM requires knowledge and experience with out of hospital birth.  CPMs primarily attend OOH births in homes and birth centers. CPMs study and train to be midwives (typically a program of 3-5 years); they are not nurses. While CPM status is voluntary, in California, midwives that train through apprenticeship model are also licensed by the Medical Board. Both Caroline and Jacqueline are CPM’s and LM’s. Certified Nurse Midwives have graduated from nursing school and are then trained in midwifery. They are certified through the American College of Nurse Midwives (ACNM).  CNMs primarily work and have been trained in hospitals and doctor’s offices, however; some CNMs attend out-of-hospital births (OOH). Both a CPM & a CNM provider can manage a low risk pregnancy, labor, birth, postpartum and newborn transitino. Both can carry IVs, anti-hemorrhage medication, oxygen, supplies for a newborn resuscitation and suture a laceration (tear) after the birth.

Who all attends the birth at a home birth?

Most midwives choose to work in teams. We are partners, and typically both present at your prenatal visits and birth. However, if one of us is unavailable, we will bring another licensed midwife in the community to your birth and in some circumstances a student. It is important to have two well-trained skilled providers at every birth. Additional attendants are chosen by the birthing mother or couple.

Where did you get your training?

Caroline and Jacqueline are both California Licensed Midwives/Certified Professional Midwives who received clinical training through an apprenticeship model and didactic training from the National Midwifery Institute.  Caroline received her clinical training right here in Monterey County serving families like you. She is passionate about nutrition and has extensive knowledge in vitamin supplementation and natural family care including essential oils. Jacqueline trained and later worked at a busy group practice with free-standing birth center in Los Angeles. Over a 7-year span she had opportunity to work collaboratively with many different types of health care providers including Obstetricians, CNM’s, CPM’s, Naturopathic Doctors, Pediatricians and Acupuncturist. She loves providing well woman care and family planning counseling.

How long do you stay at my house during the birth?

We generally arrive around the onset of active labor or sooner if you wish.  We stay until mother and baby are stable, between 2 to 4 hours after the birth.  We stay longer if there is a complication or the mother or baby requires more attention.

Do you come to my home for prenatal and postpartum visits?

Prenatal appointments are done in your home or our office.  If the appointments are conducted in the office there will be at least one home visit.  The postpartum visits are generally done at home.  For example, we would do the first 3 postpartum visits at home (24 hour, 3 day, 7-10 day) and usually the 6 week check up is in the office. What emergency procedures can you perform? What are you qualified or not qualified to do? We are trained in CPR and Neonatal Resuscitation. We are also trained to deal with complications such as cord prolapse, breech, shoulder dystocia, hemorrhage, placental abruption, and many others. We cannot use forceps, vacuum extractors, perform surgical birth or external cephalic version (ECV is used to turn a baby from breech to a cephalic (head down) presentation). Midwives are qualified to attend the birth of a normal, low risk pregnancy and manage complications if they arise. If complications arise that necessitate hospital care, we stabilize and initiate transport to the hospital.

How does prenatal and postpartum care differ from care with an OB/GYN?

The typical OB/GYN appointment is approximately 30 minutes of waiting for your appointment and 7 minutes spent with the physician. We spend at least one hour with you at each prenatal appointment with no waiting time. Like your OB appointment, we test your urine, take your blood pressure, listen to the baby’s heart, screen for abnormal symptoms, and measure the fundal height. Later in the pregnancy, we also feel your uterus to determine the position of the baby. Many families love this process and we often help partners, grandparents, children and the pregnant person feel the baby’s back, knees, head, etc. Most of the hour is spent discussing general health, diet, exercise, pregnancy, including psycho-social issues, and answering any questions you or your family have. Any upcoming testing or screenings are discussed prior. With every decision, we offer a full informed consent. We trust that you will make the best decision for your family and your baby. Postpartum care is a minimum of 4 visits, 3 home visits (1 day, 3 days and 7-10 days postpartum) and a 6 week office visit.  Additional visits are available upon request and encouraged, including visits just for breastfeeding support.

What happens if I want pain medication at a home birth?

We will offer natural, non-drug alternatives along with love and encouragement. If these are not effective and the mother wishes to have medication, we will transport to the hospital (though of more than 500 births, only 1-2 women have transported for pain relief). We will accompany the mother and make sure she is settled and receives care as soon as possible.

Can I still have a doula attend my birth?

Yes, a doula is a wonderful addition to a home birth. We usually arrive when the mother moves into active labor.  Some families hire a doula for support in early labor and for the consistent physical and emotional support. While we will often massage and offer emotional support, we are also listening to the baby, charting, monitoring your vital signs, or preparing for the birth. There are doulas in the area that sometimes offer discounts to home birth parents. Please ask us if you would like a doula and need more information!

What happens if two clients are in labor at the same time?

If two clients go into labor at the same time, we split up and call two other midwives to assist us. We strive to ensure each birthing mother is attended by at least one midwife she knows. In addition, we limit the number of clients we care for each month (typically 4-6 families per month).

Do I still need to see an OB/GYN at all during my pregnancy?

It is not necessary to see an OB during your pregnancy, as we are the primary care provider for your low-risk pregnancy. If a serious complication arises during prenatal care, we will consult and/or refer you to an OB.  Most clients do not continue or seek care with an OB once they have hired a midwife.

What do you bring to labor? What do I have to provide?

We bring all the medical and emergency equipment such as a Doppler to monitor the baby’s heart rate, oxygen, neonatal resucitation equipment, anti-hemmhorage drugs, antibiotics, sutures and anesthetic to repair a tear, newborn supplies, and IV, and much more. We also two birth stools, a rebozo, essential oils, and other ways to support the birthing person.

We specialize in water birth and provide you with a full-size, two person professional birthing pool. You will have to provide some basic supplies, often referred to as a “birth kit”.  Some examples of what you might find in a “birth kit” are: under-pads, peri-bottles, gloves, maternity pads, sitz bath suplies, a liner for the birthing pool, and a hose.

There are multiple midwives in the area. How do I go about choosing which one to use?

You should interview each and see with whom you feel most comfortable. A home birth is a very intimate event and you will be spending many hours with your midwife during prenatal visits, the birth, and postpartum visits.  Many midwives offer similar services and have similar philosophies but we do differ.  Ask lots of questions and choose someone you think you can work well with as a team.  Ultimately, you should really like your midwife; it’s a very different relationship than you may be used to having with other healthcare providers.

Contact

Please call, text or email us for a complimentary interview!
Call: 410.908.6778

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410.908.6778 (p)
831.269.3710 (f)

Carmel Valley Village, CA

marigoldmidwifery@gmail.com