Sunday, October 28, 2012

20 Questions To Ask A Home Birth Midwife Before You Hire Her

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.

They aren't.

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. 

16 comments:

gabbi haynes said...

I am a student midwife and I truly appreciate your list, it is a great tool for people selecting a home birth midwife. That being said, I just wanted to let you know that 2 of your questions would not be legal for the midwife to answer. She may answer you but she would be violating laws in doing so; the fist is "may I have a list of former clients to speak with" that is a direct violation of HIPPA, you would never ask a doctor this question and midwives are bound by the same privacy laws. Second, "have you ever lost a mother or baby and what were the circumstances" any time there is a death, that case is automatically under investigation by the state medical authorities and likely by peer review organizations so that information is strictly confidential, again, you would never ask an OB how many babies or Mama's died under their care. Just thought you would want to know so you can make your list legit.

Cathi said...

Good list of questions, but I would add one more...under the question of how many births have you attended, the client should specify under training, and as certified(if certification is recognized)... I am a new midwife, but I tell people that I have attended 80 births as student, and whatever number I am currently at as the number since certifying. I've been told that nothing before certification counts...not even doula clients( which are considerable)...

Betsy said...

Instead of asking if she has infant CPR certification, ask if they are NRP certified. Resuscitation for the first few minutes of life is different than infant CPR.

Molly said...

Whoa..thats ME!!!

Homebirthing Mommy said...

My wonderful midwife answered all of these things through just normal conversation. As for speaking with former clients, she delivered a friend of mine over 30 years ago and was the midwife when that friend was pregnant. That ended in a transfer because there was meconium at 42 weeks, and meconium is something that shouldn't be handled at home.

Gabbi, it's actually incorrect that previous cases can't be discussed. What can not be revealed is enough information to identify someone. Otherwise every time a medical professional who says "I've have a patient where this happened" would be violating laws.

It's also all right for a midwife to give references WITH CONSENT. No person in any business, industry, profession, or trade, should give personal contact into without permission, but it's not illegal to ask.

And yes, I did ask my OB (prior to my midwife) how many babies she lost. This is an extremely important part of a decision. I would immediately walk out and leave the care of anyone who wouldn't even give me a ballpark figure. If I'm going to trust my life or my child's life into someone's hands, I want to know how many lives have been lost, and I do want some idea what the circumstances were. It's one thing if the loss was because the person refused needed care, and another if it was bad judgement by the care giver.

Alanna said...

I'm meeting with a midwife on Friday, so this post has perfect timing!!! Thanks for the ideas!

Anonymous said...

Ditto what Betsy said. Very Important. I also agree with Homebirthing Mommy. Good list of questions.

Mama Birth said...

Thank you all for your suggestions-

Gabbi- I have had midwives include in their literature a list of former clients who have agreed to be available for calls from prospective clients. Thanks for all your input everybody- I hope everybody reads the comments too!

Veronica K. said...

In addition, I would add, "Where did you get your education?" (I wouldn't feel comfortable with someone who got her degree online!). Also, if a CPM has access to drugs, that would raise a red flag for me. In my state at least, they are not able to obtain cytotec, etc., legally.

And I disagree with Gabbi about asking if there have been deaths; I think that is essential. NARM is notorious, frankly, for the laxity of its peer review process, so unless your midwife is a CNM (or you live in a country other than the U.S.), then I wouldn't trust that a peer review would have dealt adequately with any concerns.

Arden said...

Veronica - This is exactly why all states should set up licensing for midwives so that CPM-LM's can carry these drugs with them, as they do in my state.

And regarding online degrees, I don't see why that would be an issue. Those midwives are still required to do their practicals, they have just as many birth attended, so who cares if they learned classroom material from a desk in a room or at a computer?

excpmstudent said...

GREAT questions.

You really cannot assume any of these things. Even if a midwife is permitted by her license to carry medications - she may not because of her personal philosophy. I've met a number of midwives who fall into this category.

Bottom line is that licensed or not, certified or not, you cannot assume anything about a midwife.

And yes, a midwife should be able to answer the question about any deaths that occurred in her practice. Absolutely.

jessy said...

I really like your blog it's really nice.

Search Engine Marketing Company in india
Search Engine Optimization Company in india
Digital Marketing Company in india
Social Media Optimization Company in india
top web design companies
website design company
best website design companies
Website Design Companies
web development company india
web design company india

jessy said...

I really like your blog it's really nice.

Deals
best deals
travel deals
Cheap Deals
laptop deals
tv deals
online deals
best buy deals
great deals
camera deals

Audrey said...

I was wondering if I could have permission to use the image at the top of the page, showing a water birth. I'm a student at the midwives college of utah and am doing a presentation on the midwifery model of care and thought that image would be good to give a visual contrast between midwife attended birth and obgyn attendted birth.

thanks,

aubrey yarper

Katy said...

Thank you for this post! I have become "crunchier" over the years and am expecting my 4th baby, our first homebirth. I am an RN, but also became a childbirth educator & doula this year. Your list was well-rounded and will help me find the balanced midwife I want: one who trusts birth as I do, but also knows when to call the shot if necessary. THANK YOU!

colleenroselle said...

I have been looking for a good list of questions to put together to take with me to my midwife interviews and I'm so glad I stumbled upon your post! Thank you for these questions ( and also the answers).

LinkWithin

Related Posts with Thumbnails