|Photo used with permission from a Mama Birth reader.|
What should you ask a home birth midwife before hiring her?
Making the leap to a home birth is usually a pretty big choice for people. In the US, less than 1% of women make that choice so it is by any standard somewhat "fringe". Then choosing an actual midwife can be difficult too. Everybody has ideas about what is important and what isn't. People come out of the woodwork to tell you how dangerous the home birth choice is and how incompetent midwives are and next thing you know, you are feeling a little shaken up.
I have chosen home birth twice and a birth center once and a hospital once before that. No matter where you choose to birth it is imperative that you and your care provider are on the same page. This list is some questions you may want to ask your home birth midwife in particular. Licensing and even legality vary from one state to the next and competence of midwives as well as philosophy varies widely also. We must not let our belief in the midwifery model of care convince us that all midwives are created equal.
This list isn't exhaustive, but it is a good start. You need to find out for yourself what kind of answers you are looking for. Some people won't like this list. These are things I want to know when I am looking for a midwife. And, as I teach birth classes, these are things I HOPE my students will ask their midwife. (The stuff in bold or underlined are things that I personally care about when looking for a midwife.)
1) What is your transfer rate?
2) Under what circumstances would you transfer to the hospital?
3) Under what less than ideal circumstances would you stay at home?
4) Describe to me (without violating HIPPA) a transfer you had and why it happened that way.
5) If I change my mind about home birth and ASK to be taken to the hospital, how will you respond? (This is an important question because it isn't unusual for women to give up on this whole natural birth thing when they are in transition. It is also not unheard of for women to genuinely know that something is wrong and have their midwife kind of blow them off as just in transition. You deserve to know if your midwife will take this seriously. You also need to know how you want her to respond and read the situation.)
6) How far overdue can I go and still birth at home? Are there any laws requiring ultrasound or testing if I do go overdue in my pregnancy?
7) How many births have you attended? (I personally prefer a very experienced midwife, though some don't. I feel that the more births they have attended, the more crazy shite they have seen. Eventually something will go wrong and I want a midwife who can handle it and recognize it when it happens. If one of the midwives is newer, maybe her partner is more experienced. I consider over 500 births experienced but that is an arbitrary number. You may want to know how many births they attended prior to being licensed AND after.)
8) On how many of those births were you the primary midwife?
9) Who comes with you to the birth? If that person is another midwife, how experienced is she? If that person is NOT another midwife, what qualifies her as a birth attendant? (I prefer the other person to be another midwife.)
10) Do you carry anti-hemorrhage drugs with you to all births? Which ones to you bring? In order, what do you use in case of hemorrhage? (You should know, that it makes me very nervous if a home birth midwife has no DRUGS for hemorrhage -Cytotec, Pitocin or Methergrine- Though some common hospital interventions CAN increase the chance of hemorrhage in birth, it can also happen at home in a natural birth and it can happen quickly. I would not personally feel confident with a midwife whose only options were herbal or involved raw placenta consumption. People disagree with my opinion on this.)
11) What is your training? Are you certified through a certifying organization? If so, which one? If not, why not?
12) May I have a list of former clients to speak with?
13) Can you resuscitate an infant? Are you NRP certified? (Met some midwives who aren't. An important question.)
14) Do you carry oxygen?
15) Have you ever lost a baby or mother? If so, what were the circumstances?
16) Do you feel confident in your ability to suture? How much experience do you have suturing? How bad would a tear need to be for you to feel it required a hospital transfer? (Lots of people in the natural birth community feel like being stitched up is kind of lame and better left alone. I respectfully disagree and highly value a midwife who has excellent skills in this area. It is an art and I want somebody who can do it well. I am a busy mom and can't sit around with my knees locked for two weeks. Frankly it also makes me a little nervous if a midwife "never" stitches anybody. It also makes me nervous if a midwife has lots of women with bad -third degree or worse- tears.)
17) How many births do you attend each month? (A midwife who attends a lot of births may have a harder time making it to every birth. A midwife who attends very few may be less experienced.)
18) What things would make me "high risk" and necessitate transfer of care either during pregnancy or labor? (I think this is an important question for a few reasons. One, some midwives are only comfortable with very low risk and very healthy women. That is perfectly fine. It does however limit how often they see things go wrong and may impact if they will or won't recognize it. Another reason this question is important is because you deserve to know what your midwife is or isn't comfortable with before the eleventh hour. For example, if you know you always carry your babies post-date you need to know if your midwife is comfortable with that or not and adjust accordingly.)
19) What is your personal philosophy of birth? (The answer you want to this question will vary a lot from one woman to the next. Some women want a midwife who just "trusts birth". Personally I trust birth, but I want a midwife who knows when to make the "call" - the decision to transfer or change things or interfere. I don't have a midwife at my birth to touch me or brush my hair. I labor fine all by myself. I have a midwife there if something goes wrong. Otherwise, I prefer she sit on the couch. But women want VERY different things from their midwife. Some want a friend, others a confidant, others a mother. What do YOU want and is this midwife going to give it to you?)
20) Do you monitor the baby? With what tools do you monitor and how often? What do you consider a non-reassuring heart rate? (I think this is an important question too. Very important.)
I highly suggest talking to other birth professionals about your prospective midwife. The birth community is often small and gossipy (it's true). Talk to your birth teacher, your doula, your friends, and other midwives about them. You will be amazed what you will learn.
Can things go wrong with a birth even if you ask all the right questions? The answer is a resounding yes. Birth is not something that man or technology can control. It involves risk. In the end you simply need to feel comfortable and safe with the choice you make no matter where or with whom you are birthing.