How to choose a midwife?

[SouthernStormy]

I 'm sure there is a topic on this somewhere but I did a search and couldn't come up with much.

How do you choose a midwife?id youIs there any online questionnaire to use? Luckily I heard back from several midwifes and the birthing center, so I have a few to choose from. I thought I was a little late in the game and wasn't going to have many options. I guess it would help to know what kind of midwife I want, but with this being my first birth, I'm not really sure. Right now I think i will probably want to be left alone to do my thing, for the most part. I don't really like anyone fussing over me. But on the other hand, I've never given birth, so when the time comes I may prefer someone who is more hands on. Any advice on how to choose would greatly be appreciated?

[womenswisdom]

I would ask:

questions about training, experiences, credentials/licensing

check with your state licensing board about any disciplinary actions

verify they are current on their neonatal resuscitation training (NRP)

whether they practice alone or w/ another mw or assistant and what backup arrangements they have in place

when someone might be risked-out of care

what tests are recommended during pregnancy and how would the results affect your care

ask about protocols for monitoring baby during 1st and 2nd stage

what drugs/herbs they carry for managing pp hemorrhage

whether and under what circumstances they've ever lost a mother or baby

when and where they would transport if needed

whether they have a backup arrangement with an OB or hospital in the event of transport

how do they help you to prevent a tear

how third stage is managed

whether they are able to suture tears and what degree they feel comfortable suturing at home/birth center

post on your tribal area to find out others' experiences and opinions about the mws you are considering

you can also ask for references so that you can get an idea of how that midwife practices

There are actually a bunch of other questions I would probably ask and I have a document from the mw I work with, but don't have permission to repost here so if you'd like a copy, pm me and I should be able to email it to you.

[goldenwillow]

Originally Posted by womenswisdom 

I would ask:

questions about training, experiences, credentials/licensing

check with your state licensing board about any disciplinary actions

verify they are current on their neonatal resuscitation training (NRP)

whether they practice alone or w/ another mw or assistant and what backup arrangements they have in place

when someone might be risked-out of care

what tests are recommended during pregnancy and how would the results affect your care

ask about protocols for monitoring baby during 1st and 2nd stage

what drugs/herbs they carry for managing pp hemorrhage

whether and under what circumstances they've ever lost a mother or baby

when and where they would transport if needed

whether they have a backup arrangement with an OB or hospital in the event of transport

how do they help you to prevent a tear

how third stage is managed

whether they are able to suture tears and what degree they feel comfortable suturing at home/birth center

post on your tribal area to find out others' experiences and opinions about the mws you are considering

you can also ask for references so that you can get an idea of how that midwife practices

There are actually a bunch of other questions I would probably ask and I have a document from the mw I work with, but don't have permission to repost here so if you'd like a copy, pm me and I should be able to email it to you.

  Excellent questions.

I also relied on my inner vibe of the MW's we checked out.  Gotta dig who is helping you, KWIM?
 

[CookAMH]

I have a doc of LOTS of questions that I gathered from a couple posts here, just a couple weeks ago as we were searching for a homebirth midwife. I organized them too :) That could help, pm me with your email if you would like it. It's pretty exhaustive.

I think the more you talk to, the more you will get an idea of the kind of midwife you want. I don't mean interview ten, that is a lot of time, but a few. Take as many notes as you can because you'll forget details. There will be some you don't click with at all, and you can keep that meeting shorter if you are confident you wouldn't want to hire them. 

Thought I'd just post the questions here in case someone else searches in the future.

____

PRENATAL

What is your definition of "high-risk"?

Do you allow the mother to go past 42 weeks and still have a homebirth?
What are your standards for preeclampsia?
What is your back-up system during pregnancy and labor—when you go on vacation, are sick or with another mother?
Are you available 24 hours a day at all times?

What is your approach to taking on a client at the beginning of her third trimester?

Do you have guidelines or restrictions about who can give birth at home?

What is your fee?
What happens with your fee if I have to transfer out of your care?

What tests do you require?

STATS/EXPERIENCE

What is your hospital transfer rate?
What experience do you have with VBAC?

How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?

Have you ever missed a birth? If so, what were the circumstances?

If you are sick or otherwise unavailable during my labor, who will attend to me?
How many assistants do you normally bring to the birth?
Who are your normal assistants?

Do you file with insurance?

What is included in the fees? What will I need to provide?

How many births have you attended? How many VBACs?

What were your own births like?

How do you describe childbirth?

How, when and where did you receive your education in midwifery? Are you also a nurse? Are you certified or licensed and by whom?
How long have you practiced? Approximately how many births have you attended? Would you give me the name of a few mothers as references?
Do you maintain statistics from your practice? May I see them? Do you participate in regular peer review?

How do you advise clients in speaking with worrisome family members?

EMERGENCIES/TRANSFERRING

How would you handle a hemorrhage?

What situations do you consult the Obstetrician for?
What problems or complications in pregnancy would mean that a physician would become my primary maternity caregiver?
Under what circumstances do you transfer to hospital?

To what hospital do you transport if this becomes necessary?
What is your percentage of hospital transfers?
What is your Cesarean rate? What are the most common reasons?
What would be the plan of action if a transfer to hospital were necessary?
What care would you give me if I need to transfer?
Would you stay with me in the hospital? In the operating room? For how long after the birth?

How do you handle emergencies?

What emergency equipment will you have on hand

What physician collaboration or backup do you have? What percentage of the time is he/she called in? How long will it take for the doctor to get to me? At what point is the back up doctor typically called in? Will I have a say in the decision? Will I have a chance to meet the backup doctor ahead of time? Who covers for the doctor if he or she is busy with another delivery? Is the doctor’s fee included in the fee I pay you?

LABOR

Eating drinking, moving, blood tests,

Do you offer IVs?I felt that it helped my energy with ezra’s labor

How many internal checks do you normally perform?

When do I call you?

At what point in my labor will you or your assistant come to my home?

How many people are you comfortable with being present at the labor and birth?
How do you feel about having a doula at a homebirth?
How much time do you allow for the delivery of the placenta?

What happens if my perineum needs stitching/suturing?
What supplies do I need for the birth? Where can I purchase those supplies?
Do you help with cleanup?
How long do you stay after the birth?

Do you come to my home any time before I go into labor?

meconium in your water breakage.

What percentage of your clients tear?
What is your protocol to prevent tearing?

How many 3rd or 4th degree tears have you had? Up to what degree do you suture?

How do you think the pushing stage should be managed?

How long are you willing to let a client push, or do you base it solely on the baby's stress level?

Do you have a problem waiting for a while after the placenta is delivered to cut the cord?
What protocol do you use to stop excessive bleeding after delivery?
Have you had experience breaking the clavicle if it ever becomes necessary during a dystocia incident?
Have you had experience with cord prolapse?
Do you have any special things you do after a birth such as an herbal bath?

During labor, how active are you in checking the client, etc?

What do you perceive your role to be during my labor?
What are your expectations of clients during birth?
What equipment and supplies do you bring to a birth?  (stool, ball, etc)
What natural comfort techniques do you provide?
What pharmaceutical drugs, homeopathics and/or herbs do you use at births?
What is your usual approach to a labor that is progressing slowly?
How often do you listen to baby during labor?
How long for placenta to come out. What happens if it does not come out during that time

What equipment do you normally bring to the birth (birthing stool? blow-up pool? oxygen? ambu-bag? pitocin shot?)

What is your cut-off for considering a baby to be premature and requiring a hospital birth?

SCENARIOS

What if my water breaks and contractions do not start
What if I am in labor for days
What if my labor is just progressing slowly (not for days, but just slow)
How do you handle postpartum bleeding
How do you handle breech baby
How do you resolve shoulder dystocia handling

Under what conditions would you artificially rupture the amniotic sac?

Have you had any bad outcomes for the baby or the mother? Please explain them.

How long are you willing to wait for a baby in a bad position to change positions before labeling the pregnancy high risk?

[redpajama]

I think this is a very exhaustive list of excellent questions to ask your midwife.  However.  As an apprentice midwife I've sat through enough consults to know that, if you brought this list of questions to my preceptor and asked them one-by-one, we'd be looking at about a five-hour consult.  

My opinion--ESPECIALLY if you're interviewing multiple midwives (so it's not just a "pass-fail" sort of situation for the midwife, but a "choose the best midwife for you" scenario)--is that you could pare this down to the issues that are most important to you, the "make or break" issues, and ask those of every midwife.  Then, when you've chosen a midwife, take your time going through the other questions with her.

It's not that you're not entitled to all this information before you make a decision, it's just that I think this could be a pretty overwhelming interview for a midwife, and a REALLY overwhelming process for you, if you interviewed several midwives like this.  And, my guess is, when it came down to it, other than a few big factors, you're going to have a pretty good "feel" for who is the best midwife for you--and I say that as a relatively objective, totally non-touchy-feely kind of person.  I just think that a lot of your satisfaction with a midwife's care will come down to how well you "click" with her--it affects how you understand/interpret her actions, it affects your ability to communicate your needs and desires to her, and I think it has enormous implications for how you experience your labor/birth.  Like I said, it's not *everything,* but it's big, in my opinion.
 

Originally Posted by CookAMH 

I have a doc of LOTS of questions that I gathered from a couple posts here, just a couple weeks ago as we were searching for a homebirth midwife. I organized them too :) That could help, pm me with your email if you would like it. It's pretty exhaustive.

I think the more you talk to, the more you will get an idea of the kind of midwife you want. I don't mean interview ten, that is a lot of time, but a few. Take as many notes as you can because you'll forget details. There will be some you don't click with at all, and you can keep that meeting shorter if you are confident you wouldn't want to hire them. 

Thought I'd just post the questions here in case someone else searches in the future.

____

PRENATAL

What is your definition of "high-risk"?

Do you allow the mother to go past 42 weeks and still have a homebirth?
What are your standards for preeclampsia?
What is your back-up system during pregnancy and labor—when you go on vacation, are sick or with another mother?
Are you available 24 hours a day at all times?

What is your approach to taking on a client at the beginning of her third trimester?

Do you have guidelines or restrictions about who can give birth at home?

What is your fee?
What happens with your fee if I have to transfer out of your care?

What tests do you require?

STATS/EXPERIENCE

What is your hospital transfer rate?
What experience do you have with VBAC?

How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?

Have you ever missed a birth? If so, what were the circumstances?

If you are sick or otherwise unavailable during my labor, who will attend to me?
How many assistants do you normally bring to the birth?
Who are your normal assistants?

Do you file with insurance?

What is included in the fees? What will I need to provide?

How many births have you attended? How many VBACs?

What were your own births like?

How do you describe childbirth?

How, when and where did you receive your education in midwifery? Are you also a nurse? Are you certified or licensed and by whom?
How long have you practiced? Approximately how many births have you attended? Would you give me the name of a few mothers as references?
Do you maintain statistics from your practice? May I see them? Do you participate in regular peer review?

How do you advise clients in speaking with worrisome family members?

EMERGENCIES/TRANSFERRING

How would you handle a hemorrhage?

What situations do you consult the Obstetrician for?
What problems or complications in pregnancy would mean that a physician would become my primary maternity caregiver?
Under what circumstances do you transfer to hospital?

To what hospital do you transport if this becomes necessary?
What is your percentage of hospital transfers?
What is your Cesarean rate? What are the most common reasons?
What would be the plan of action if a transfer to hospital were necessary?
What care would you give me if I need to transfer?
Would you stay with me in the hospital? In the operating room? For how long after the birth?

How do you handle emergencies?

What emergency equipment will you have on hand

What physician collaboration or backup do you have? What percentage of the time is he/she called in? How long will it take for the doctor to get to me? At what point is the back up doctor typically called in? Will I have a say in the decision? Will I have a chance to meet the backup doctor ahead of time? Who covers for the doctor if he or she is busy with another delivery? Is the doctor’s fee included in the fee I pay you?

LABOR

Eating drinking, moving, blood tests,

Do you offer IVs?I felt that it helped my energy with ezra’s labor

How many internal checks do you normally perform?

When do I call you?

At what point in my labor will you or your assistant come to my home?

How many people are you comfortable with being present at the labor and birth?
How do you feel about having a doula at a homebirth?
How much time do you allow for the delivery of the placenta?

What happens if my perineum needs stitching/suturing?
What supplies do I need for the birth? Where can I purchase those supplies?
Do you help with cleanup?
How long do you stay after the birth?

Do you come to my home any time before I go into labor?

meconium in your water breakage.

What percentage of your clients tear?
What is your protocol to prevent tearing?

How many 3rd or 4th degree tears have you had? Up to what degree do you suture?

How do you think the pushing stage should be managed?

How long are you willing to let a client push, or do you base it solely on the baby's stress level?

Do you have a problem waiting for a while after the placenta is delivered to cut the cord?
What protocol do you use to stop excessive bleeding after delivery?
Have you had experience breaking the clavicle if it ever becomes necessary during a dystocia incident?
Have you had experience with cord prolapse?
Do you have any special things you do after a birth such as an herbal bath?

During labor, how active are you in checking the client, etc?

What do you perceive your role to be during my labor?
What are your expectations of clients during birth?
What equipment and supplies do you bring to a birth?  (stool, ball, etc)
What natural comfort techniques do you provide?
What pharmaceutical drugs, homeopathics and/or herbs do you use at births?
What is your usual approach to a labor that is progressing slowly?
How often do you listen to baby during labor?
How long for placenta to come out. What happens if it does not come out during that time

What equipment do you normally bring to the birth (birthing stool? blow-up pool? oxygen? ambu-bag? pitocin shot?)

What is your cut-off for considering a baby to be premature and requiring a hospital birth?

SCENARIOS

What if my water breaks and contractions do not start
What if I am in labor for days
What if my labor is just progressing slowly (not for days, but just slow)
How do you handle postpartum bleeding
How do you handle breech baby
How do you resolve shoulder dystocia handling

Under what conditions would you artificially rupture the amniotic sac?

Have you had any bad outcomes for the baby or the mother? Please explain them.

How long are you willing to wait for a baby in a bad position to change positions before labeling the pregnancy high risk?