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Use the form on the right to contact Karen Ruby Brown directly! If you have a special case or prefer to speak over the phone, please don't hesitate to contact us by calling  (858) 707-5765

San Diego and Riverside Counties

(858) 707-5765

Aerie Midwifery provides full-scope, out-of-hospital midwifery care in the greater San Diego area. We offer a personable, competent, and commonsensical approach to your care before, during, and after your birth, as well as well-woman care throughout the lifespan.
You can expect clinical excellence meeting the highest, evidence-based standards, grounded in solid experience, and inclusive of the fully informed consent of women and their families.
Contact us today for more information, or to schedule a complimentary consultation!

FAQ Blog

Why out-of-hospital birth?

Tanya Moushi

I’ve been practicing in a hospital setting for thirteen years. I’ve attended thousands of labors and hundreds and hundreds of births. For better and for worse, I’ve witnessed and managed many complications, including the most common obstetric emergencies. I have seen the most normal of normal compromised by unnecessary medical intervention, and I have witnessed the slightly abnormal only recognized as such too late and, thus, allowed to progress into full-blown complications. All of this experience has only bolstered my belief that institutional protocols used routinely without due regard to particular circumstance can not only get in the way of the normal process of labor and birth, but also, in the case of a labor subtly veering off-track, it can obfuscate nuance and thus prevent the early recognition of a problem in which simple course-correction could make or break a desired outcome. What is that desired outcome? The safest, healthiest and happiest possible mothers and babies, of course!

When is best to make a decision?

Tanya Moushi

It is best to start care in early pregnancy. There is so much that goes on in the first trimester, and a lot to talk about. Prenatal visits, which can last up to an hour depending on your needs, are monthly until your 3rd trimester, then every 2 weeks and, in your last month, every week. By the time you go into labor we will know each other well, and have that foundation of trust so essential to optimal childbirth.

That said, many women decide upon home birth after starting care elsewhere, and I am happy to meet with you at any time during your pregnancy and to facilitate transfer of care.

How much does it cost?

Tanya Moushi

I am not contracted directly with insurance companies, but am able to provide clients with what's called a superbill during the postpartum period. Clients may elect to submit this superbill to their insurances to seek reimbursement. CNM services are often reimbursable by some insurances. 

Having your baby at home or in a birth center costs but a fraction of what it would in a hospital. Nevertheless, it is a significant out-of-pocket investment for many people. I do not want cost to be the one thing limiting your options, so if finances alone prohibit you from participating in the type of care I provide, talk to me about it.

What does "Aerie" mean?

Tanya Moushi

Aerie means “eagle’s nest.”
Let's ignore for a moment the whole “bird of prey” thing; you’ve got to make the following concessions: 
Eagles are majestic. They inspire reverence, and symbolize authority, strength and power.
At the same time, they are exceedingly private, and vulnerable to the effects of observation.
Eagles are protective of their nests, which they build with large, sturdy sticks, and line with soft, warm materials for their nestlings.
The eagle is the only bird that will fly directly into a thunderstorm.

Like birthing mothers. Like you.
Fearless, feisty and fiercely protective

What if you have two women in labor at once?

Tanya Moushi

Life being what it is, this may sometimes happen for any and all midwives, indeed for any birth attendant regardless of where they're catching babies (it even happens in the hospital!). I keep my client load low to minimize the chances of having to clone myself. And, fortunately, the greater San Diego area has a robust and supportive community of midwives. I have relationships with several other midwives whom I trust and respect to back me up on those rare occasions when I am at another birth, just as I am available to back them up in the same situation. Sustainable home and birth center birth practice depends upon the proverbial village! 

How often are clients transferred to the hospital?

Tanya Moushi

From the largest contemporary prospective study of home births in the US and Canada, involving 5418 women, 12.1 percent of patients were transferred to a hospital intrapartally or postpartally. Five out of every six women transferred (83.4 percent) were transferred before delivery; half of these transfers were for failure to progress, pain relief or exhaustion. After delivery, 1.3 percent of mothers and 0.7 percent of newborns were transferred to a hospital, usually because of maternal hemorrhage (0.6 percent of births), retained placenta (0.5 percent of births), or newborn respiratory problems (0.6 percent of births).  (BMJ. Jun 18, 2005; 330(7505): 1416).

What does this mean for you? Approximately one in ten of you will require transfer to the hospital. It is more common for mothers giving birth for the first time to require transfer.

How do you address complications?

Tanya Moushi

It depends, of course, on the complication. It is important to note that there are complications, and there are emergencies. Most problems with childbirth are not true emergencies and, if recognized early in the process, can be corrected using a variety of simple measures. Should these fail to work, we will together consider transfer to the hospital.

In actuality, the most common obstetric emergencies, such as hemorrhage, shoulder dystocia and neonatal resuscitation are managed essentially the same regardless of birth setting. Nonetheless, it is true that there are some extreme and acute emergencies that cannot be optimally managed outside of a medical facility. Such emergencies are rare. Part of being an informed home birth consumer is accepting that very small–though not absent–risk. Part of working with me is trusting my clinical acumen should I initiate an emergent transfer to the hospital.

What equipment do you bring?

Tanya Moushi

  • Doppler to hear fetal heart.
  • Stethoscope and blood pressure cuff.
  • IV supplies.
  • Antibiotics for women who are GBS-positive.
  • Medications to stop excessive bleeding.
  • Oxygen and neonatal resuscitation equipment.
  • Newborn medications.
  • Suturing supplies and equipment, including lidocaine.
  • A baby scale.

In addition, home birth clients are responsible for providing some low-cost items. A list and instructions will be made available during the course of prenatal care.

Who is involved?

Tanya Moushi

Karen Ruby Brown CNM, MSN

There will always be at least two people at your birth-- myself and an assistant. All of my assistants are birth professionals (midwives or nurses) and hold current certification in neonatal resuscitation. I teach midwifery students, and may also have one or more students with me. We will discuss all of this in advance. You, of course, may have any support people, friends and family–including children–with you. It's your birth!

How do we get started?

Tanya Moushi

It's easy! You make an appointment to meet with me. This initial consultation is complimentary. We decide together if home or birth center birth is right for you, and if we are a good fit. Once we agree to work with one another, I will see you regularly throughout your pregnancy.

You may call me, email me, or send a message here.