Midwifery Care 

Dr. Tracy is now in a midwifery practice partnership with Elias Kass, ND, LM, CPM at One Sky Wellness. 

Tracy McDaniel, ND, LM and Elias Kass, ND, LM, CPM offer comprehensive midwifery care at One Sky Wellness, including prenatal, intrapartum (labor and delivery) and postpartum midwifery care for pregnant women and their families. We attend births at home and in free-standing birth centers. A free standing birth center is one that is not affiliated with a hospital.

In addition to being licensed midwives, we have independent naturopathic practices at One Sky Wellness.  Dr. McDaniel provides naturopathic primary care for women and children at One Sky. Dr. Kass offers whole family primary care services.

Both Dr. McDaniel and Dr. Kass attended Bastyr University, a 5 year postgraduate program in both naturopathic medicine and midwifery. During our training, we attend over 100 births. Dr. Kass’s training included rotations at Providence Everett Hospital and Valley Medical Center. Dr. McDaniel did a rotation in Seattle’s Providence Hospital. Both Dr. McDaniel and Dr. Kass did advanced midwifery training at Vila Central Hospital in Vanuatu, where the midwifery model of care is the norm. Dr. Kass spent the last 2 years of his training working with Dr. McDaniel as a student intern and joined the practice in 2010.

Practice Volume: We attend approximately 4-6 births a month.

Scope of Practice:
Training in naturopathic medicine and midwifery enables us to follow women through an essentially normal childbearing cycle. Naturopathic therapeutics will be recommended when addressing health concerns which may arise during pregnancy. Should significant deviations from normal arise, a consultation with an obstetric physician will be obtained, and a referral for specialty obstetric care will be made when necessary.

Dr. McDaniel and Dr. Kass and their midwifery team carry the equipment, medications, and necessary supplies for normal childbirth in a home or other out-of-hospital setting. There are, however, certain specialized services and equipment which are not available in the home or birth center setting.

For example, we do not:
Carry equipment for advanced resuscitation, intubation or a ventilator. We do have oxygen available.
Perform vacuum extraction, forceps or surgical deliveries
Carry or administer blood
Administer epidurals or narcotic pain medications


Our Philosophy:
We acknowledge your fundamental right to choose how to birth your baby. It is our philosophy that the best outcomes for mothers and babies are achieved when preparation for birth is regarded as a mutual responsibility of both the client(s) and her midwives. We will work with you to help you make decisions regarding your care. Routine maternity screening tests, procedures and treatments will be explained during office visits. You are encouraged to ask questions and to ask for additional written materials or resources when you want more information regarding any topic relating to your maternity care.

Initial Consultation: Your initial visit is a consultation session which will include a discussion of the following topics:

• your reasons for chosing to birth at home or in a free-standing birth center

• an introduction to the midwiferymodel of care

• how labor and birth in a hospital differ from from out-of-hospital care

• risks of childbirth to the mother and infant, and the management of complications at home or in a birth center

•  Arrangements for medical consultation and referral

• Ample opportunity is provided for you to ask quetitons

Services Provided: Our services will include prenatal, intrapartum, and postpartum care including:

• History, physical, dietary assessment and standard labs are collected and sent for processing.  Selected lab tests are done on site

• Prenatal viits at the clinic occur monthly until 28 weeks, twice monthly until 36 weeks and then weekly until your baby is born

• One postpartum visit at home within 72 hours of the birth

• Postpartum visits for the mother at 1, 3-4 and 6-8 weeks postpartum

• Postpartum monitoring and care for you baby in the immediate postpartum period

• Ongoing pediatric care is available with either Dr. Kass or Dr. McDaniel

• Use of lending library

• Access to your midwife 24 hour a day, by means of an answering service or pager

• An integrated naturopathic approach to prenatal andpostpartum care

Screening and Risk Assessment
In the screening and care of midwifery clients, we rely on the client's report of her medical history and other information which the client provides. The client agrees that such information will be complete and accurate to the best of her knowledge. Complications may arise during prenatal or intrapartum care which your midwives diagnose as a high risk. In this case your midwives will recommend birth in a hospital. You are always encouraged to ask questions and your midwives will gladly explain the reasoning behind any medical recommendation.

Giving Birth in your Home:
Historically, about 75% of our clients plan to birth at home. Adequate heat, electricity, water and a telephone (or reliable cell service and a cell phone) are necessary for families choosing to give birth at home. Many families laboring at home have children, pets and support people present. If you plan to give birth at home, we will give you a list of supplies to buy, including a “birth kit” which contains medical supplies commonly used for the birth. When we come to your home, we will bring medical equipment, more supplies, medications and your medical record. People who would like to use a labor tub generally arrange a rental with a local company that delivers sets-up and fills the tub in labor. In order to access hospital based medical care in an emergency; it is our policy to attend home births only when the home is located within 30 minutes of the nearest hospital.

Birth in a Free-Standing Birth Center:
There are a number of birth centers in the Seattle and Eastside region. About 25% of our clients decide to give birth in one of them. When considering a birth center, consider its location, amenities for birth, family waiting rooms, and nearest hospital. Know that the medical equipment available at a birth center is virtually identical to that available at home. Many families choose birth centers because the ritual of going to another place to give birth is meaningful, or because their home is far from a hospital (e.g. on an island) or because they are more comfortable in a non-home setting.

Back up Midwifery Coverage:
We alternate being on-call for our clients’ labors. If one of us is at a birth, the other is generally available to attend your labor. In the unlikely event that you need assistance while we are both either occupied or unavailable, we have relationships with other licensed midwives who are available to care for you.

Consultation and/or Referral for Obstetric Specialty Care:
Dr. McDaniel and Dr. Kass consult with several area medical centers, obstetricians and pediatricians. If significant deviations from normal develop at any time during labor and delivery, a specialist will be consulted. During the prenatal and postpartum period, consultation or referral will be recommended when the condition is outside of our scope of practice and knowledge as a naturopathic doctor and midwife. If transfer to medical care during labor is indicated, we will arrange for your care to be transferred and admitted to an appropriate hospital.

If you need to go to the hospital during labor:
In about 20% of labors, something occurs that necessitates a transfer of care to a hospital based medical team. Generally this is not emergent. Some reasons we transport a laboring woman to a hospital include:

• Prolnged labr, often due to the baby facing the mom's front instead of her back; the baby is "OP"

• Non reassuring fetal heart rate

• Meconium in the amniotic fluid (the baby has a bowel movement before being born)

• Mom shows signs of infection or high blood pressure

About 6% of the time, transport is by ambulance. Reasons for calling 911 in our practice have included:

• Breech presentation (baby''s bottom comes out first instead of her head)

• Non reassurin fetal heart rate

• Retained placenta after delivery with bleeding

• Prolonged pushing phase, with baby to low to go by car
  

If your labor becomes complicated and requires a transfer of care to a hospital, your midwife will facilitate the transport by arranging care at a hospital, discussing your situation with the receiving provider and supplying them with a copy of your medical record. The support of a labor doula is very important for most women when the labor environment changes. If you have not hired a doula, or if you’d prefer more support, talk to your midwife about birth support services in the hospital. Once admitted to the hospital, you and/or your baby will be under the medical care of the hospital staff.

Student Midwives and Birth Assistants:
Dr. McDaniel and Dr. Kass are usually assisted in the office and at births by student midwives and/or trained birth assistants. Student midwives and/or trained birth assistants are in attendance for the added safety of both mother and baby, and in the case of students, to further their training. Student midwives are integrated into the care team and are consistently involved in your care. Dr. McDaniel and Dr. Kass are very supportive and respectful of the intimacy of birth and are committed to training students with the same philosophy. If you choose not to have a student attend your birth, we will provide you with information about hiring a professional birth assistant.

Click the links below for more information about the area's free standing birth centers: