The Importance of Birth Centers for Better Prenatal Care

Photo Credit: Monet Moutrie

When it comes to prenatal care in the United States, there is no question that the system is not equipped to offer the best care pregnant women require. In response to the growing need for better prenatal care with more respectful labor and birth options, the number of birth centers in the US is on a steady increase, and so is the size of their clientele.

With so much awareness around high maternal mortality rates in the US, there is a strong shift towards midwives and birth centers that offer prenatal education and care. “The United States is the only industrialized country where maternal mortality is consistently on the rise.”1 A recent four-part series by CNN and Every Mother Counts, Giving Birth in America, depicts the struggles of low-income, uninsured women who cannot afford prenatal care through a medical provider. The documentary covers the incredible work of midwives at The Birth Place, a local birth center in Winter Garden Florida that has an open door policy for all women seeking prenatal care. The birth center offers free prenatal care to low income women who otherwise have no access to the necessary health care that will lead to healthy births for both mother and baby.

Birth centers are also growing in popularity among women who are looking for respectful birthing options that offer a higher level of quality and personalized care. Avoiding unnecessary interventions is another strong factor backing birth centers, where the main focus is placed on healthy, natural births and interventions are only considered when medically necessary. According to a report published by the Centers for Disease Control and Prevention (CDC), 29% of the out-of-hospital births that occurred in 2012 took place in a freestanding birth center, with an increase in birth center births from 0.36% in 2011 to 0.39% in 2012. Although there is still a ways to go to improve these numbers, they are increasing steadily in comparison to the CDC’s record of 23% of birth center births in 2004.

“Women aren't getting the level of care they want. [The] reason why women are making a wide range of choices and seeking doulas and seeking home births and seeking options outside of the medical model is because they want to be treated with respect. They want to be at the center of their health care decision-making."2 - Michele Giordano, executive director of the nonprofit advisory group Choices in Childbirth

A medical model that has respect at its core prioritizes education from prenatal care through to postpartum care. Birth centers will continue to grow in popularity because they support the rights of women during every stage of maternity. They offer a great option to expectant mothers who are not interested in home birth but also want more freedom and personalized care than what is provided in most hospitals.

At Cascade we are proud to actively support the growth of birth centers and are committed to being a resource for everything midwives need to set-up new centers or refurbish existing ones. If you need assistance or are looking for a particular product that we haven’t added to our product line yet, give us a call. We want to ensure that we grow with your needs so that we can continue to offer you the best quality equipment and supplies at affordable prices. Below you will find a variety of resources and articles with more detailed information on birth centers.

Written By: Samantha Darling for Cascade HealthCare Products



1Christy Turlington Burns, 'Giving Birth in America', CNN and Every Mother Counts, 2016

2Nia Hamm, 'Out of Hospital Births on the Rise: Data Shows Fewer Health Risks', Public News Service, 2015

Kathleen Doheny, 'More US Women Delivering Babies at Home or Birth Centers', US News, 2016

Shanna Fortier, 'Back to the roots with natural childbirth', Colorado Community Media, 2016

Dr. Marian F. MacDorman, T.J. Mathews, and Dr. Eugene Declercq, 'Trends in Out-of-Hospital Births in the United States, 1990–2012', CDC, 2014

Information on Birth Centers in the US, American Association of Birth Centers

Midwifery Instruments: Where One Size Doesn't Fit All

When it comes to choosing midwifery instruments there is never a one-size-fits-all option. Quite often there is a lot of confusion around surgical instruments that are commonly referred to by different names. Let us clear up some of the most common misconceptions about instruments and provide an easy guide to choosing the right instruments for your purposes.

Instruments differ in two significant ways: quality and style. Two major things to consider when making a decision are: how frequently do you plan to use each instrument, and what is your budget? Below we have broken down the three major categories to consider when correctly choosing your next instruments.


Instructors often have personalized preferences when teaching midwives and others skill sets that require surgical instruments. From suturing and cord clamping to episiotomies and other gynecological procedures, each instructor is likely to have a specific type and size of instrument that they will recommend. In most cases these general recommendations work well, but there are exceptions.

One example of an exception to the general rule is the 6.25” Mayo-Hegar Needle Holder. This is great for the average size female hand, but women with larger hands may find the length too short for their grip. Likewise, those with smaller than average hands may find the length too long, and in both cases you may prefer going with a smaller or longer needle holder for personal comfort.

Another important option to keep in mind is for those who are left handed. Where available, we offer Quick-Release instruments that are designed specifically for left-hand users including Quick-Release Carb-N-Sert Mayo Hegar Needle Holders and Quick-Release Carb-N-Sert Crile Wood Needle Holders. Like anything, it will always be easier to perform when using an instrument designed for your prominent hand.

When it comes to size, the bottom line is that personal preferences should also be taken into account when ordering instruments. This leads us to the next category to consider when training versus practicing: Brand Quality.


Keeping it simple and affordable: Floor-Grade

Vantage is the most affordable brand we supply and although it doesn’t offer longevity and high quality, it does have many uses. Vantage instruments are a great choice for training or when trying out a new instrument style. These quality floor-grade instruments are also a good choice when purchasing seldomly used instruments or when you need a back-up set of commonly used instruments.

Vantage floor-grade quality brand of instruments are made in Pakistan, as are virtually all floor-grade surgical instruments. However, not all instruments are made equal. A lot of less expensive floor-grade instruments are made of chrome and are offer poor quality. Vantage instruments are made of Japanese stainless steel and the factory where they are made produces high quality floor-grade instruments. When properly cleaned and sterilized, Vantage instruments will provide a reasonable amount of service; however, they are not designed for long term use. It is also important to note that the blades on floor-grade scissors are not as sharp as higher quality brands and tend to dull quickly; the locking mechanisms are not as smooth; and the blades on needle holders do not hold as securely as higher-grade brands. 

Good quality at a reasonable price: Mid-Grade

When you’re ready to invest in a higher quality brand, you have two great choices that offer German-made instruments with strong German stainless steel: Konig and Miltex. Konig is our generic line of mid-grade German quality instruments and is a good brand for those looking for high-quality at a reasonable price. All Konig instruments are manufactured in Germany and made of German stainless steel. The scissor blades are sharp and the forceps’ locks are very smooth. The blade clearances – also known as the gaps between blades - are minimal, which is especially important for needle holders. With proper care, Konig instruments will last you for many years. We have sold Konig at Cascade for 20 years without any significant customer complaints.

The top brand: High-Grade

For those wanting to invest in a high-quality brand of instruments, Miltex is the top of the line for high-grade, German made stainless steel instruments. We have carried Miltex for 33 years without any negative feedback. The quality of Miltex instruments is superb and guaranteed to be free from material defects. Miltex backs all of their products with a lifetime guarantee that ensures instruments are free from manufacturing or material defects for as long as it is being used by the purchaser. Although more expensive than other brands, Miltex is the ideal choice for practitioners who will be using their instruments frequently because they are designed to withstand repetitive cleaning and sterilization. Where cost is not an issue, you can’t go wrong with Miltex.

When strength meets quality: Premium-Grade

A relatively new development in the world of surgical instruments are premium-grade Carb-N-Sert German stainless steel instruments with Tungsten Carbide blades. The Carb-N-Sert type of instrument is offered by Miltex and Konig and includes scissors, needle holders and dressing forceps.

Why are Carb-N-Sert instruments unique? Well firstly they have easily identifiable gold-plated ring handles. In terms of quality, the scissors offer precision-cutting performance and the durability of Tungsten Carbide cutting edges which maintain their sharpness much longer than standard stainless steel instruments. The needle holder and forceps have replaceable Tungsten Carbide jaw inserts in the tips to ensure optimum grip on sutures and needles, as well as long-lasting performance against wear.

As you can see, the main difference between the high-grade Miltex instruments and the Carb-N-Sert premium-grade instruments is the increased strength, durability and longevity of blades and teeth. Speaking of teeth, our next category covers some commonly made mistakes when it comes to identifying obstetrical instruments that are regularly used in midwifery.


Within the world of midwifery there are some commonly misidentified instruments. Worst of all is the instruments most often misidentified are also the most commonly used, which can be very confusing for student and seasoned midwives alike.

The ‘Correct’ Cord Clamping Forceps

Case in point, Kelly Forceps. These are very useful little forceps but because they have small blades they are not good for cord clamping. Somewhere along the line the term ‘Kelly’ has incorrectly become known as the ideal forceps used to clamp umbilical cords. There are many forceps with blades big enough for cord clamping but the one most commonly used are the Rochester Pean 6.25” Forceps.

“Tissue Forceps Without Teeth”

Another misused phrase for instruments that a lot of midwifery students have struggled with is "tissue forceps without teeth". All tissue forceps have teeth. If someone mentions ‘tissue forceps without teeth’ what they are referring to are Dressing Forceps. Dressing forceps have serrated tips and are sometimes referred to as “pick-ups”.

The most important thing to remember when confused about any aspect of instrument selection, is that we are always here to help. Having supplied instruments for over 30 years, we are well-versed on all of the instruments and brands that we carry and can assist you with every step of the selection process.

We have also assembled two bestselling Suturing Kits that contain the instruments most commonly used by midwives for perineal repair. The Basic Suturing Kit is ideal for midwives with an existing collection of instruments and the Deluxe Suturing Kit is more comprehensive for midwives, especially new midwives, who don't already have a thorough selection of instruments. See below for links to our full selection of Instruments, Instrument Care products and Sterilization products.

Written By: Samantha Darling for Cascade HealthCare Products



Surgical Instruments:

Midwifery Suturing Kits:

Autoclaves and Sterilizers:

Instrument Sterilization:

Instrument Care:

Instrument Disinfectants and Lubricants:

3 Simple Components for Setting Up an IV

This is a short, sweet and simple guide to what midwives need to set up an IV. You will find greater details on all items listed on their corresponding product pages.

What you need:

1. Solution Set

Solution sets contain the tubing required to connect the IV fluids to the catheter. The most commonly used solution set among midwives is the Baxter IV Solution Set with 1 Injection Site. These solution sets measure 76” long and include a Lever Lock Cannula, Luer Lock Adapter and one injection site. Click here for details.

2. IV Catheter and Injection Site

The IV catheter is the device that is inserted into the hand and is connected to the solution set. There are a few different options available when choosing a catheter – with lubricant for easy insertion, protective shields to reduce needle-stick injuries, or wings to conform to the body for greater comfort.

Our top 3 picks for IV catheters are:

  • Terumo Surflo Winged Infusion Sets with soft, flexible interlocking wings that conform to the body’s contour.
  • BD Insyte Autoguard shielded IV Catheters with a unique push-button shielding mechanism that releases a spring allowing the needle and flash chamber to quickly retract into the safety barrel. These are excellent for reducing needle-stick injuries in practitioners inserting the IV cathether.
  • Terumo Surflo IV Catheters that have a medical grade lubricant to allow for easier penetration and smoother travel through tissue.

Injection Sites, like the Baxter Injection Site 2N3379 and Baxter Injection Site 2N3399, are used to cap a catheter that you want to leave in place. 

3. IV Starter Kits

Above we listed the supplies you need to put together an IV. In addition to the IV set up, there are necessary supplies for prepping the skin and securing the IV as well. For those who prefer the convenience of a ready-to-use starter kit with all the necessary supplies, each kit includes the basic necessities: dressings, gauze, surgical tape, alcohol prep pad, iodine prep pad, and tourniquet.

Why use an IV Starter Kit? Less opening of packages reduces the risk of contamination. It is also extremely convenient as each kit contains all the requirements to prepare for an IV. Important note: IV Starter Kits do not include the Solution Set or the IV Catheter. They are a single-use kit for preparing and securing the IV when it is administered.

Two of our favorite IV Starter Kits are the Medi-Pak Performance IV Start Kits with Tegaderm Dressings and the Medline IV Start Kits.

Medi-Pak Performance IV Start Kits with Tegaderm Dressings include:

  • Tegaderm dressing
  • Gauze: 2" x 2", 4-ply
  • Antibacterial PVP iodophor prep pad
  • Antibacterial alcohol prep pad
  • Transpore tape
  • Tourniquet

Medline IV Start Kits include:

  • Alcohol prep pad
  • Iodine ampule
  • Gauze: 2” x 2”
  • Bioclusive dressing
  • Transpore tape
  • Tourniquet
  • Label

We also carry a full selection of IV supplies, IV bags and IV teaching aids. Just click here for the complete IV section.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'How to Choose Sutures', 'Why Do We Use Plastic Cord Clamps? and 'Entering the New Age of Midwifery'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products



Current Specials on IV Bags:

IV Supplies:

IV Bags:

IV Teaching Aids:

Entering the New Age of Midwifery


Oh how the times have changed.  During the last decade there has been a significant increase in the number of licensed midwives and birth centers in the United States. As midwifery in the United States becomes a greater part of the mainstream health care system, the scope of midwifery practice is changing and midwives are now required to follow mandated health care regulations. What does this all mean for the practice of midwifery?

Traditionally, the majority of a midwife’s interactions with her clients have focused on the health and well-being of the mother, which leads to positive birth outcomes and of course a healthy baby. Midwives screen mothers to detect any pre-existing conditions – such as high blood pressure, gestational diabetes and Strep B infections – and they provide nutritional information, childbirth education and tips for good health; all while offering emotional support. Midwives have been thoroughly trained in maternal assessment and have both the skills and tools necessary to ensure healthy mothers and babies. With limited legislation regarding the care of pregnant women in the past, it was easy for midwives to continue with their traditional ways, while still ensuring optimal care.

When it comes to newborn assessment, the scope of midwifery practice has changed over the years. Thirty years ago midwives would do a basic assessment, weigh and measure the baby, and monitor for a few hours. It was routine to then have parents take their baby to see a doctor within a few days after birth. Gradually midwives have started providing legally required eye care, Vitamin K, newborn blood screening and developed further skills for assessing newborn health. However, overtime more newborn testing has been mandated leaving midwives wondering how best to serve their clients.

With increased legalization, midwives are entering a new era of compliance with government mandated screenings - especially when it comes to the newborn. Midwives have also gradually expanded their scope of practice and now provide longer postpartum care for both mom and the baby. In addition to increased newborn screening, midwifery practices are growing to include postpartum follow-ups for infants as they grow. This additional area of care is great for parents who value the holistic approach of a midwife more than that of a medically-focused pediatrician. This expansion of practice is also a positive indicator that midwifery is becoming more widely embraced by families as a preferred approach to care.

Yet with the desire to provide midwifery-based care while also meeting newborn assessment requirements, midwives are faced with some tough decisions. Do they invest in expensive but necessary equipment so they can test newborns in the family’s home? Or do they send mothers and their babies off to a medical facility where the necessary newborn screening can be done within the required 24 hours? The cost of purchasing the equipment required for newborn assessments is at times difficult to justify based on the number of births a midwife attends. There is a statistically low probability of a home-birth baby’s screening results showing a problem. So is it worth the investment to increase the comfort of mother and baby by offering at home testing after birth, or is it more feasible for midwives to delegate the necessary screening process to a medical facility?

The decision to invest in the equipment that allows a midwife to test for CCHD (Critical Congenital Heart Defects) or Hearing Loss is one each midwife either has or will soon face. Even if the majority of births a midwife attends are uncomplicated and result in healthy babies, the cost of vital testing equipment, like a Neonatal Pulse Oximeter or a Newborn Hearing Screening Device, may be worth the investment. Why? Because it only takes one time to catch a baby’s low blood oxygen level or signs of hearing loss to realize that having the right instruments plays a vital role in the quality of that baby’s life.

With the midwife’s foray into longer postpartum care comes an additional need to be savvy when choosing equipment that will not only serve at birth, but also as infants grow. A great example is the steady move from traditional hanging scales to more reliable digital scales that are functional at birth and throughout early infancy. Being able to monitor accurate weight gain and loss in newborns is part of the expanding role midwives play through postpartum care.

So is this all a welcomed change? The sentiments are mixed. Midwifery has always been founded on a holistic approach to pregnancy and birth, where a mother’s informed consent is revered above all else. With increased regulations now encompassing out-of-hospital births, there is concern that what is most paramount to the practice of midwifery will be jeopardized: the ability to empower women to make their own informed decisions for their bodies and their babies. Midwifery has been a welcomed alternative for maintaining dignity during birth and ensuring the best of care for both mother and her baby. Increased regulations raise concerns that mothers will have less say during and after birth, especially when it comes to newborn assessments.

At Cascade, supporting midwives during this time of change and ensuring you have what you need  for whatever choice suits your practice best, is paramount to us. That is why we work hard to make sure we not only meet the regular day-to-day needs of our midwives, but also the expanding needs of your practice. You can trust that we will do the research for you to ensure we offer the best equipment required to meet mandated testing standards. We are also always focused on making sure our prices are reasonable, because if you decide to expand your practice we don’t want it to be overshadowed by the expense.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Why Do We Use Fetoscopes?', 'How to Choose the Right Doppler', and 'Why Do We Use Plastic Cord Clamps?'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products



Neonatal Pulse Oximeters:

CDC, 'Facts About Critical Congenital Heart Defects':

Newborn Hearing Screening:

HealthyChildren.Org, 'Purpose of Newborn Hearing Screening':

Newborn and Infant Digital Scales:


Measuring Up Infant Scales

When it comes to choosing the best scale for measuring newborns, it can be easy to opt for the lightest and most convenient option – the Chatillon Hanging Scale. Commonly used among midwives, the hanging scale is small enough to tuck into a midwifery bag, making it one less thing to lug around when performing home visits. But are they really effective?

The major issue we have come across in our years of feedback from midwives using scales of many shapes and sizes, is that hanging scales are not always accurate. On average they tend to be inaccurate by up to 4 oz. They are also limited in their scope of use because a hanging scale can't be used beyond the first few days and are ineffective in measuring small weight gains.

So why are they so popular? They’re affordable and small. However, there are a variety of portable digital scales that we recommend using in place of hanging scales and here’s why.


Portable scales are designed to be lightweight and compact, so you can store them in your trunk if you are a traveling practitioner, or you can store them in a small closet space if you work at a birth center or facility. Some designs like the Health O Meter 8320KL Digital Portable Pediatric Tray Scale (featured above) have built-in handles and fold in half, while others, like the Health O Meter 549KL Digital Pediatric Tray Scales, have optional carry cases.


The readings of digital scales that sit firmly on flat surfaces allow for more stability, and are calibrated to offer you more accurate readings than mechanical hanging scales. Depending on your preference, there are scales that also offer measurements in both pounds and kilograms. The Health O Meter 553KL Digital Pediatric Tray Scale for example, weighs up to 44 lbs in 1/2 oz increments in both kilograms and pounds.


No need to re-weigh a baby if you forgot to jot down the weight, digital scales offer helpful technology that holds the weight measurement for a few minutes after the baby is removed, or has an auto-recall option. It is also a lot easier and faster to place a baby on a stationary scale than it is to prepare a sling. Hanging scales also have no way of recalling a weight measurement. Recall is particularly handy after birth when there’s a time crunch for midwives wanting to do all the necessary testing quickly so that babies can be reunited with their mothers as soon as possible.


The most important feature that a scale offers is the ability to use it for neonates as well as infants up to a few years old. Since many midwives do follow-ups with families, having a scale to weigh babies as they grow is crucial. The same applies to birth centers or midwifery offices where families attend follow-up appointments. Having a portable scale that can be tucked away until needed is a great space saver.

So when considering which scale is best for your practice, take a minute to think of how it will serve you over the long term. If you plan on using it beyond birth, consider the variety of quality scales available to you that are now designed to be convenient too.

For our full selection of Scales from Digital Scales to Hanging Scales, just click here.

If you enjoyed this post, the topics covered in the following blog posts may also be of interest to you: 'Entering the New Age of Midwifery', 'How to Choose Sutures', and 'Iron Duck Bags: American Made Strength'. Click the post title to view the full article, or scroll through our complete archive of posts by clicking here.

Written By: Samantha Darling for Cascade HealthCare Products