Help me choose a midwife!

[DoulaLMT]

I had DS at home 2 years ago and have to choose a different HB midwife this time around because my midwife from last time is pregnant herself and will be taking my birth month off. I live in a state where midwives are licensed. One of the midwives I'm considering is unlicensed and I'm looking for feedback about whether or not you would consider her.

She has been a midwife since the mid-70's, has caught over 3,000 babies. Because she isn't licensed, she doesn't advertise (and is therefore significantly cheaper than other options!!) but has plenty of clients due to word-of-mouth referrals, having worked in this area for so long. Her birth team includes her daughter (also a lay midwife - trained by her) and her granddaughter who she is teaching midwifery to. Does this raise red flags for anyone?

My other choice is well-experienced. Her birth team includes a couple of apprentices, she teaches at a local midwifery school part time. She's also nearly $1,000 more expensive.

Help!

[jljeppson]

Doesn't worry me at all. I'm apprenticeship trained and it can be an excellent model of schooling.

[xixstar]

I don't worry about the license aspect, just the experience and the personal fit. So no, I see no red flags, but I also don't see anything about your personal feelings towards either midwife, perhaps you've not interviewed/met them yet?

[DoulaLMT]

They are pretty equal, as far as my comfort level with them. The lay midwife wore perfume which put me off initially, being in the first trimester.

[honeybee]

Well, since I live in a state that does not yet have licensure, that wouldn't bother me. Most likely, this midwife was practicing long before there was a licensure law. I would specifics about her training and experience. Ask her what she would do in certain situations. What are her protocols? And I would see if I gelled with her personality-wise. Bottom line... does your gut feel comfortable and trust her?

I fully believe in licensure... mostly for legal protection for midwives... but I also believe there are many very qualified midwives who have never gotten licensure or formal certification. If you've gotten to a certain point in your career, I can see how it wouldn't be worth it to jump through the hoops.

Now... a few years down the line, when certification/licensure becomes the standard, I would probably wonder why someone just starting would choose not to go the established route.

[DoulaLMT]

I guess what's been rattling around in the back of my brain is that likely midwives who are licensed get regular continuing education. How often to protocols in midwifery change, based on new information? I know doctors were routinely cutting episiotomies back in the 70s and they don't now. Obviously she doesn't do episiotomies. My point is that standards of care change over the years and I wonder if she's kept up.....or if midwifery care is basically the same now as it was then.

[sharr610]

just my thoughts. If you happen to be in Oregon, a lot of the unlicensed midwives here aren't licensed for matters of principal and the cost of the license, which, from what I understand, can be a little steep.

[DoulaLMT]

I'm not in Oregon, and from talking to her, she seems to be unlicensed because of how long ago she got training, her training being much shorter than what is required now, and the cost.

[Paige, CPM]

I think asking the canidates the specific questions that you are posing here will help you...as a doula you have a fair idea about birth issues...ask her about her protocols...GBS...like what would the plan be if you had decided not to do the testing but you had been ruptured over 24 hours? Hibicleans, IV ABX, transport, WBC bands testing? How would you be monitored and what would be indication of transport? What are their transport plans (does she give report and chart when transferring, does she stay with you?).

What does your birth community have to say about the two midwives, any controversial issues?

I have recently experienced something in my community that was quite shocking for everyone regarding a long term lay midwife...some very unprofessional stuff, so just because someone has a license or just because someone has been practicing a long time or just because someone is charismatic doesn't mean they practice professionally and safely. Although I want to believe that this is rare, it is right to ask deep questions when interviewing to see how they have handled situations and what their plan is to handle specific issues.

Good luck!

[Belle]

Originally Posted by DoulaLMT

I'm not in Oregon, and from talking to her, she seems to be unlicensed because of how long ago she got training, her training being much shorter than what is required now, and the cost.

I want to mention that if you are in WA then the cost of licensure is outrageous. There have been a couple of well-known cases where the state dept of health led an unfounded witch hunt against midwives. Particularly against midwives who attended breech births at home. They raised the cost of the licencing fees to fund their prosecution. A couple years ago there were around 120 or so licensed midwives in our state and now there's around 80 or so. (Not sure of the exact numbers there) Washington, though midiwifery friendly on paper, in actuality is not.

My own midwives are licensed in OR and are willing to cross the border to attend births in WA. Not many are willing though.

[dannic]

I agree that if they both seem like a good fit, it comes down to your level of comfort and their protocals...surely one would highlight something that will stand out to you (either way). GL! I was a lucky one who met her midwife and just.knew.

[DoulaLMT]

Thanks everyone. I am in WA, and I understand the licensing issues here. I guess something that seems like a red flag is the fact that I truly can't find ANY information about the unlicensed midwife on the internet. I realize she can't advertise, so she's obviously not going to have a website. I only know one person who has used her, and although I don't know many HB-ers IRL, my tribal area on MDC has plenty to say about midwives in my area and I've never heard her name mentioned either for good or bad. Not sure why she's so obscure if she has so much experience, etc.

Basically what it comes down to for me is that I have to pay out of pocket for a homebirth. I already have had one homebirth, so my chance of transport is very, very low. I feel like if she's at all qualified to attend births, I should go with her based on the fact that I can save $1,000+. However, the fact that I'm asking so many things about her (and the thoughts I've shared) is leading me to believe that maybe I'm not comfortable with her or something.............??? Going to have to do a little more soul searching I guess.

ETA: it just occurred to me that I should ask some more questions of the person I got the referral from. Duh! See if I can uncover any more info that way.

[DoulaLMT]

This is so silly. I was looking her number up on my caller ID and realized I was spelling her last name wrong. DUH can my pregnancy brain get any cloudier? (knock on wood) she actually does exist on the internet and for whatever reason, that makes me feel better. Even found someone's birth story who had used her.....

[mamakaryn08]

Andrea I'm glad you asked me about her. For those who are wondering, she is unlicensed because of the cost and because of the ridiculous restrictions placed on WA licensed midwives. She doesn't like being told that she can't practice a certain way when it is perfectly safe (and legal in other states!) to do so. Also Andrea, if you're interested, I can put you in touch with at least 3 or 4 other people who have birthed with her.

[MsBlack]

Oh, that is funny about misspelling her name!

I was going to say that maybe she is not on the internet for 2 reasons:

1--she's never been prosecuted or otherwise sought or been given the limelight....she has managed to stay underground!

2--because of being unlicensed, she tells her clients to be VERY careful about using her name publically. It can be very hard to stay underground if your happy clients are singing your praises a little too loudly, and in the wrong places.

anyway, now you've found her correct spelling, and found her online, yay.

Only other thing I would do is talk to more people who've used her (along with others' suggestion to ask her about particular protocols).

[isras1]

Paige had some good points to ask the midwife, I would add: does she bring oxygen and what is her protocol for hemorrhage (has pitocin?) and does she repair tears? Does she have a supportive back-up health care provider, if not, you may want to establish a relationship back-up so that you aren't provided with whomever is on-call in case of transfer. 3,000 babies is alot! That in itself sounds great. Good luck momma!