Questions to ask a potential midwife/birth center

[LillianB]

Hi all,

I am trying to find a midwife and/or birth center and need help figuring out what questions I should ask. I know I'm going to need to assure my husband and parents that giving birth outside of a hospital is safe. I assume I should ask about hospital access and transfer rates (and, while I'm at it, what is a considered a low transfer rate?), but what else should I ask? Should I ask about post-birth infections? Lawsuits/complaints? I really have no idea and would greatly appreciate any help with language.

Many thanks,
Lillian in NH

[jecombs]

Here is a list of interview questions I came up with when I was looking into homebirth this past summer. (Unfortunately it proved to be cost-prohibitive for us). I think many of them would also apply to a birth center. It's a bit lengthy...

1. What is your background, training, certification and experience?


2. How many births have you attended as the primary caregiver since the completion of your training?


3. What is your philosophy on birth? Are you “hands-on” or “hands-off”?


4. How many births do you attend per month?


5. What would happen if you had two births occur at once? How many times have you missed a birth? Do you work with a partner or assistants?


6. How and when can I reach you?



7. What will prenatal care consist of? What tests will I get, or do you usually perform on a woman of my background? Do you perform ultrasounds?



8. What are your expectations of me regarding self-care in pregnancy? What kind of counseling do you provide?


9. What is your fee and what services does it include? Which fees are separate (prenatal care, lab work, newborn assessment, breastfeeding support, postpartum care)? Do you accept reimbursements from insurance companies? Which ones? What other costs might I encounter?


10. Do you provide postpartum visits in the early days after birth? How many? How long do you provide postpartum care?


During birth:

11. What happens during a normal labor and birth?


12. When should I come in during labor?


13. What equipment do you normally use at births? What medications and equipment do you have for emergencies?


14. What are your guidelines for a "normal" vs. "high-risk" pregnancy?


15. What complications have you seen and handled? How would you handle complications such as hemorrhage, cord around the baby’s neck, baby not breathing spontaneously?


16. Which hospitals do you have privileges at? What situations do you transport for?


17. Will you be able to continue labor support should I need to go to the hospital?


18. What is your policy if I go beyond my due date? Under what circumstances would you recommend that I be induced?


19. What pain relief/comfort techniques do you offer or suggest? Do you support waterbirths?


20. How often do your clients give birth without needing stitches?


22. How do you handle a long or stalled labor?


23. What happens immediately after birth?


24. Under what conditions or how often, if ever, do you:
-- break the mother’s water artificially?

-- use the following: pitocin , oxygen, IVs?


25. What would you do if my water broke and labor did not start immediately?


26. How would you handle a positive GBS test? A 1hr GTT?


27. What does your 3rd stage management look like? What happens if I start to bleed too much?

[MegBoz]

Great list already, jecombs!
I'd just add:
-water birth. Do you support birthing in water? (Some FSBC may ban it, some HB MWs may just not like it, etc.)
-Under what circumstances would I not be allowed to labor in water? Birth in water? (some don't allow to get into water with PROM, etc.)
- How do you handle continuing education? (Keeping UP TO DATE with the latest scientific research is crucial!)

Originally Posted by LillianB

I know I'm going to need to assure my husband and parents that giving birth outside of a hospital is safe.

Just a thought, but I'd try not to worry about this too much. As I posted yesterday on the HB forum, I'm a big believer that you can't use logic & reason to sway people's emotions! People react emotionally to birth - and I can't say I fully blame them! Grandkids should raise strong emotions in people. So often the facts just can't sway them & get them to be comfortable with the idea & get them to drop their preconceived notion that it's dangerous, reckless & crazy.
So I think it's important to let people know, once you decide, this is not up for debate!

I even think it makes a lot of sense to LIE in many cases - otherwise people are just going to stress you. & you don't need that - you especially don't need "I told you so!" if you transfer. (Which I KNOW I'd get from my MIL & probably Mom. So whenever I TTC #2, I plan to lie about HB plans to them both.)

Obviously that applies to your parents & others, your DH you probably want on-board! Since this parenthood thing is a "joint-venture!" I would just ask him to keep an open mind and, hard as it may be, make decisions based on science, reason, & logic! (After all, shouldn't all our healthcare & medical decisions be made based on science?) Don't let ignorance & fear force you to "go along with the crowd" & birth in a hospital just from fear!

[*MamaJen*]

Hi and welcome! There's a good thread on homebirth resources here, and it's also very helpful for preparing for birth center births. It includes things like interviewing midwives. You could also post in the New Hampshire forum asking for recommendations for specific midwives or centers.
As far as safety goes, have you seen "The Business of Being Born?" That's a great introduction to the topic. Also, "A Thinking Woman's Guide to a Better Birth" is a good overview. I also really liked looking at professional studies that examined the safety of homebirth. One of the biggest and most recent was Outcomes of planned home births with certified professional midwives: large prospective study in North America . That shows that for low risk pregnancies attended by a trained midwife and with procedures in place in case of transfer, planned homebirth is typically as safe as a hospital birth and with much lower rates of harmful interventions. A Canadian study that came out just a couple months ago saw similar outcomes.
That's a great interview list that Jecombs has.
As far as your questions go, hospital transfer is mainly going to depend on how close your home or the birthing center is to the hospital. Very few transfers happen in ambulances with sirens going -- it's more frequently getting in your own car and driving there at a leisurely pace.
Post birth infections isn't going to be on the top of the list of concerns, but that sort of falls under the general banner of post-partum care. You'll want to know what the schedule is for seeing mothers after the birth -- it's typically at one day, three days, one week, two weeks and six weeks.
You would want to ask tough questions -- have they ever lost a baby or a mother, and under what circumstances; have they ever had a bad birth outcome; have they ever had a lawsuit; what do they do in the case of emergency transfers.
The one thing about the really long list of questions is that you have to know what they mean for the answers to be significant to you. That's where just getting really educated about the birthing process is helpful.
Good luck -- it's a big learning curve, but it's so worth it. A lot of women spend dozens of hours researching strollers and cribs -- I think it's so much more important to do that research about your own body and birth.

ETA
Two more things: Like Meg said, it's really ideal to be able to labor and birth in the water. Some places will let you labor in the tub until your water breaks, but if your water breaks at the start of labor, you're SOL.
Also, I know you said you're interested in a birthing center. And free standing birthing centers can be a great choice for a lot of reasons. But in terms of safety, unless your home is very far from the hospital, there tends to be very little difference birthing in a home or birth center. I've actually heard birth center births described as "homebirths you have to drive to." Midwives typically carry all the same medical equipment (pitocin, oxygen, etc) to a homebirth that they would have at the birth center.