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Questions To Ask About Homebirth




 



 


Homebirth is safe and on the increase. You’ve probably all heard about the January report from the Centers for Disease Control and Prevention (CDC) that shows that homebirth increased 29% between 2004 and 2009. Homebirths increased 36% during this same time period among non-Hispanic white women: 1 in every 90 non-Hispanic white women has a homebirth, according to the CDC.


The percentage of homebirths was higher in the northwest than the southeast and more common among older married women with several children. Most homebirths are attended by midwives. Homebirths have a lower risk profile than hospital births suggesting that midwives are selecting low-risk women as candidates


The increase in homebirths is certainly fueled by the soaring rate of medical interventions at hospital births, particularly cesarean surgery, and the success of Ricki Lake’s film, The Business of Being Born. While the American College of Obstetricians and Gynecologists (ACOG) and other naysayers challenge the safety of homebirth, in fact, its safety is well documented. Critics lump unplanned homebirths together with planned homebirths, but planned homebirths by low-risk, well nourished women who receive good prenatal care have always been found to be safe. In fact, birth is safe in any setting.


For most of us, it’s getting comfortable with the fact that birth is safe that is our most important preparation for birth. What helps us get comfortable with this fact is being around others who already believe it. If you are interested in a homebirth, find the homebirth community and get involved. Read the literature on the safety of homebirth and understand the politics. Find a birth attendant who you really like and in whom you can put your trust. Don’t expect yourself to know everything, but find someone who does.


QUESTIONS TO ASK YOUR MIDWIFE


Here are some questions to ask your prospective birth attendant. Add your own.


What is your midwifery education and experience? What certifications or licenses do you have?


How long have you been practicing? How many births have you attended?


Who is your midwifery back-up? Who is your medical back-up?


How often will I see you during my pregnancy? How long will prenatal visits last?


How will my partner (and children) be involved in prenatal visits, during labor and at the birth?


Will you provide me with nutritional guidelines?


What is your philosophy about prenatal testing?


Do you offer childbirth education classes?


Will you suggest non-drug soothers, and different positions during labor?


How long after birth is the umbilical cord cut?


How long will you stay at my home after the birth?


What emergency equipment do you carry?


What back-up hospital do you use? Under what circumstances do you transport? What is your rate of hospital transport?


SURROUND YOURSELF WITH THE POSITIVE


In addition to asking the right questions, surround yourself with positive images of and stories about birth. Look at cross-cultural art that depicts the classic image of Madonna and Child. Read homebirth stories. You can find these stories in Ina May Gaskin’s books, Spiritual Midwifery, Birth Matters and Ina May’s Guide to Childbirth.


Watch The Business of Being Born.


Read the 2200 threads of birth stories in the Mothering community.


Read more birth stories on Mothering.com.


Birth is normal. Trust yourself. Trust the process. Trust the outcome.


 


 


 


 


Peggy O'Mara  (101 Posts)

Peggy O’Mara founded Mothering.com in 1995 and is currently its editor-in chief. She was the editor and publisher of Mothering Magazine from 1980 to 2011. The author of Having a Baby Naturally; Natural Family Living; The Way Back Home; and A Quiet Place, Peggy has lectured and conducted workshops at Omega Institute, Esalen, La Leche League International, and Bioneers. She is the mother of four.

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Tags: ACOG, Birth Matters, CDC, Homebirth, Ina May Gaskin, Ina May's Guide to Childbirth, Madonna and Child, Midwife, Ricki Lake, Spiritual Midwifery, The Business of Being Born





Comments (6)

Peggy ~ Thanks for sharing the fact that birth is normal, homebirth is a safe option,and that choosing a qualified Midwife is important. Questions to ask your Midwife, is a great tool for women & their families to use no matter where they want to give birth. The benefits of being well informed, positive, active, well nourished & rested while pregnant, during labor & birth impact not only good outcomes, but have profound, genuine effects on the baby in the womb! Sincerely, Sarah Ann Baldwin LM Licensed Midwife
I think that women should be encouraged to ask questions of their birth care provider and absolutely, should ask many of the questions on the list. But it does read like a cross-examination of the midwife. I wonder if there's a place for more touchy-feely questions, like asking about the midwife's personal approach and core beliefs about birth.
Having had two homebirths with an outstanding midwife, I would add questions about postpartum support including breastfeeding, to this list. In my case this support continued for 6-8 weeks after my babies were born and was almost more valuable than the birth itself. Mindy
Questions to ask your Midwife It can be a good idea to interview more than one midwife, if that is available to you. Some midwives charge you for this interview time, some will answer some questions over the phone, and some will come to your home free of charge. The following are a series of questions. You may want to use some of them in interviewing midwives. You may want to ask more questions of the midwife as your pregnancy progresses. Read through them and decide which ones are important for you to ask and when to ask. General Questions 1. How long have you been a midwife? Where did you train and when? What about refresher courses and extra skills courses? . Have you had any long periods away from practice? If so, what did you do to update your skills and knowledge? 2. Why did you become a midwife? 3. What do you perceive your role to be - during my pregnancy, during my labour, after the baby is born? How does your practice vary for different women? 4. How many mothers have you assisted with the birth of their baby? 5. How many of these were at hospital? In a birth centre? At home? 6. Do you work with other midwives? If you work alone, what happens if two women go into labour at the same time? What is your back-up system? If you work with other midwives, when can I meet them? 7. Do you work closely with any doctors? Why? If you do - who are they? When can I meet them during the pregnancy? Practical Matters 8. How many mothers do you have due around the same time as me? 9. Are you allowed to practice at a hospital in the same way as a GP? If so, if I need to be transferred, is this the hospital we would go to? IF it is a private hospital will they accept me if I have no private health insurance? Should I book in beforehand? As a public or private patient? 10. What are your fees for a home-birth? What does this include: how many prenatal visits' postnatal visits? How is it paid: Installments; before or after the birth? Do you accept alternative methods of payment? Is there someone else I can see? What if, for some reason, you are not available to attend my labour? What if I need to transfer to someone else for care? What can I get back form a private health fund? 11. What commitment can you give me that you will be the person attending my birth? Are you going on holidays during my pregnancy; who will be my caregiver during this period? 12. Can you give me the contact numbers for any local homebirth support groups? Care During Pregnancy 13. Routine pregnancy testing- is there an extra charge for routine blood tests etc ,throughout the pregnancy? 14. How regular are the prenatal visits with you? 15. Where will my prenatal visits be held? 16. Do you offer childbirth classes or pregnancy discussion groups? If not, what classes are available? 17. Can you recommend appropriate books , videos, internet sites etc for my pregnancy? Who else can I speak to? Care During Delivery 18. What do you carry with you in terms of equipment and supplies to the birth? 19. Are you comfortable with waterbirths, should I decide to labour or birth in water? How many waterbirths have you done at home? At hospital? 20. What is your policy regarding episiotomies? What is you episiotomy rate? What is you rate of tears or intact perineums? What happens if my perineum needs stitching? After the Birth 21. How often do you visit me at my home after the birth? What do these visits entail? Why are they important. 22. Do you do the New Born Screening Test? 23. Do you have information on the pros and cons of giving Vit K andimmunisation? Transfer to Hospital 24. Under what circumstances do you transfer to hospital? What is yourpercentage of hospital transfers? What would be the plan of action if atransfer to hospital were necessary? What care would you give me if I need totransfer? Special Needs Pregnancies 26. What is your policy regarding high risk pregnancies: breech or transverse lie babies, twins, high blood pressure, diabetes, fetal distress, toxaemia? If you do attend these at home, what is your experience with each of these? What extra back up is provided? 27. If I have Rh negative blood, can I still birth at home? Do I need to have Anti-D? Do you arrange to get the Anti-D? When do I have my blood tests? How are the blood tests organised? What is your training and how many births have you attended? · How do I contact you between visits if I have any concerns? · How do I contact you when I am in labour? · How much time do you normally spend with a labouring woman? · If a woman is in labour and you are not there, who provides her care? · Do you have a working relationship with another doctor/midwife if needed? Who and where? What happens in the event that you are unavailable? · Do you do prenatal checkups? How often? Do you do postpartum checkups? · Do you offer prenatal classes? Where are they held? · How will you assist me in preparing for labour? · What percentage of women receive episiotomies in your practice? How do you prevent the need for episiotomies? · What percentage of women receive cesarean sections in your practice? · What do you do in emergency situations? · Do you encourage family-centered maternity care? How do you see this working in practical terms? · Are medications available? · How do your services differ from that of other birth attendants? · Do you offer water births? · What is your policy on informed decision making by the parents? The first question you want to ask a potential midwife is whether you can interview her for free. Other questions you may want to ask include:- What is your fee? - What does your fee cover? How many visits / hours? Are childbirth classes included or extra? - Are you familiar with my doctor / hospital ? Are your feelings negative or positive? - What are your beliefs about the birth process? (For instance, if you know an unmedicated birth is not your goal, you would not want to choose amidwife who was adamantly against medications in birth. Or if you definitely do not want an epidural, then you shouldn't choose a midwife who believesall women should have epidurals!) - Why are you a midwife? - How many births have you attended? - Are you certified? Details or see the certification certificate. - Do you have anyone else due when I am due? (Most midwifes limit the number of clients they accept to two to four per month, though some take more.) - Do you have a back-up arrangement with another midwife?If you meet someone who has all the qualifications you seek, stop for a moment and ask yourself: "Do I feel comfortable with this person?" and "Do Iwant her with me at my delivery?" Good luck!1. Ask, "Who can be with me during labor and birth?"2. Ask, "What happens during a normal labor and birth in your setting?"3. Ask, "How do you allow for differences in culture and beliefs?"4. Ask, "Can I walk and move around during labor? What position do you suggest for birth?"5. Ask, "How do you make sure everything goes smoothly when my nurse, doctor, midwife, or agency need to work with each other?"6. Ask, "What things do you normally do to a woman in labor?"7. Ask, "How do you help mothers stay as comfortable as they can be? Besides drugs, how do you help mothers relieve the pain of labor?"8. Ask, "What if my baby is born early or has special problems?"9. Ask, "Do you circumcise baby boys?"10. Ask, "How do you help mothers who want to breastfeed?"==================1. Do you attend your patient’s births or are you on rotation? If you are on a rotation, how many other doctors/midwives do you rotate with? Is itpossible for me to see these other doctors/midwives as well?2. Do you have limits on the number of support persons I can have with me?3. What is your personal cesarean rate (not the hospitals)?4. What is your episiotomy rate?5. What do you do to prevent a tear of the perineum?6. How often do you deliver babies with the mother in positions other than lying or semi-sitting? For instance will you allow me to give birth on abirth stool?7. How often do your patients give birth without the use of pain medication and epidurals? Do you support women giving birth in this manner?8. Under what circumstances would you consider labour to be too slow and what type of intervention would you suggest to speed it up?9. How long do you feel pregnancy should be allowed to continue if monitoring of the mother and baby shows no problems?10. What suggestions would you have for me if my baby was breech at 35 weeks gestation?11. What is your opinion on fetal monitoring?12. For how long do you feel a woman should be allowed to push? The best questions to ask your doctor are things along the lines of what they're protocol is for different procedures. Like: tests-what ones are required and can you refuse to have any test by signing an informed consent/denial of test letter? (this CAN be done legally!!). What is the protocol for ultrasound? How many are required and can you refuse all of them? What is their c-section rate? How often do they do episiotomy? Will they let you labour in any position? Can you breastfeed right after birth? Can you have your baby by your side right after birth-not to be taken away? What are the routine shots given to your newborn and how can you avoid them? Will they attend your birth even if they aren't the ob on call when you go into labour? How do they feel about natural childbirth? Will they honour your wishes to NOT push drugs? How long are you required to stay in the hospital after birth? Will they honour your wishes to NOT give your baby formula or glucose water after birth? What about the routine use of Pitocin after birth-do they do this and can you refuse it? What is there protocol for length of pregnancy- will they let you go until you start labour or will they start pushing induction and c-sections before your edd date has even come?
In Ontario, midwifery is fully integrated into the health care system with a four year baccalaureate in midwifery. Most of the questions being asked appear to apply in settings where education standards and registration / licencing are variable. I used to be a midwife (now I teach prenatal classes and work full time as a Consulting Hypnotist) and was used to answering questions - I welcomed them, in fact. Earthmamagypsy's questions , however, would take hours to answer and the volume and tone of questions imply that the midwife is inadequate. Would anybody even consider asking such questions of a physician? If I were a midwife today, I would very hesitant to take on a client who grilled me in the way that Earthmamagypsy suggests, because it feels quite adversarial. You are building a relationship, not assessing a stock fund. The questions in the Mothering article are very good and are a good start in the first meeting. In fact, most midwives routinely have answers to these types of questions on their websites. More information on Ontario midwives is at: www.ontariomidwives.ca
I had a midwife attend me in a wonderful hospital with excellent, compassionate nursing staff and a jacussi! I thoroughly recommend this approach as a best of both worlds option. After 17hrs of often intense pain I was relieved to have the option of an epidural so I was ready to push when fully dilated.
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