Finding a midwife for twin delivery

[dsb76]

Hi,  I recently found out that I am pregnant with twins (I'm due 12/7).  Unfortunately the birth center where I delivered my daughter (she's 20 mo now) doesn't deliver twins so I am looking for a new midwife.  I am setting up interviews with midwives over the next few weeks and I want to make sure I remember to ask all the important questions.  It seems that most of the midwives in my local area deliver twins at the same hospital but they all seem to work independently of each other.  Are there any questions you wished you asked when you picked your midwife or OB?  Did those of you that planned a vaginal delivery with a midwife but ended up with a c-section meet the OB prior to the delivery time or did you end up with the OB on call?

Any other pointers/helpful hints you can send my way for this pregnancy/delivery and the future is greatly appreciated.  I am really appreciating this forum and all the great information and support of these threads.  Thanks!

[star8kitten]

I had both my older boys at a birthing center and was planning on having a home birth with what we thought was #3.  We found out it was twins at 19 weeks and suddenly I had a lot researching and questions.  After reading about the birth attitudes of most doctors in my area about twins (c-sec at 37 weeks) I felt like my only option for a natural birth was to continue using my midwife and try for a home birth.  So, I talked it over with my midwife, she had never been the primary midwife on twins but she said that they would have three midwives at the birth, the other two being midwives that had delivered twins several times.  I was okay with decision for a long time but something kept nagging me about the HB decision and my midwife brought up the fact that she has worked with an OB in town that let he be there for most of the labor and only came in to catch the babies.  She suggested we meet with him and see if he would be willing to do the same for me.  We met and I liked him and he is really supportive of natural labor so as foreign as it is to us, we are going to have our babies in the hospital.

The thing that kept getting my husband and I is having to transfer to the hospital for the birth of baby B.  The one scenario I could not come to peace with was the one where you have baby A naturally and everything is beautiful and then baby B turns transverse and you have to transfer to the hospital to have baby B by c-section.  So when my midwife mentioned the OB to me, it sounded like the best of both worlds.  I really do not like hospitals, or Dr.s for the most part but when I dug down deep I will feel the most comfortable at the hospital and really that is the most important thing for a birth mother.  However, there are a lot of great HB stories on here and would encourage you to read them for support either way.

The midwives in your area will know who does twins.  Talk to them and get the names of those midwives.  You might also search the local tribe forums to see if there are any twin friendly OB's in the area too. 

Advice on the pregnancy - start eating!  Seriously, most all the experts on twins suggest over 150 grams of protein a day and over 3,000 calories.  You will feel better the more you eat and your babies will grow.  I felt horrible the first half of my pregnancy (I did not know it was twins) until I started eating enough to feed the babies and me.

Good luck!

[dsb76]

Thank you so much for the response, I have an appointment with a solo midwife who delivers twins tomorrow and depending on how that goes I have 2 others I can interview.

After reading your post on protein I did some additional forum searching and saw recommendations up to 176g protein daily ! wow ! No wonder I am so fatigued - I know I haven't been eating any where near that amt.  I guess I will be grilling steaks for dinner.

[pezbez]

congratulations!! there are surely homebirth midwives that will support you in a twin birth.  i'd check for red flags:  providers that seem fearful, controlling...  birth is a natural, normal event.  twins were born at home before the creation of obstetrics, and traditional midwifery cared for women prior to that too.  remember that YOU are birthing, regardless of who is assisting you.  who YOU choose to have the honor to assist at your birth is really up to YOU, and no one else.  no one has a right to decide with whom or where you should birth.  

good luck finding a birth trusting midwife.  not sure where you are in PA...?  

blessings

[Gena 22]

Glad you've got a couple of leads.  My midwife is based in south-central PA and I can't recommend her highly enough.  She deals with the Amish and has loads of experience.  We had a wonderful birth, thanks to her skill.

If you'd like another name, PM me and I'll send you her contact info!

[Jane93]

Questions I would ask:

(1) List of degrees and certifications.  For example, is the practitioner certified in NPR?  Not only is she currently certified, but how many times has she actually performed the neonatal res. in an urgent situation?  Experience being, of course, different than book learning alone.

(2) Status of licensure.  Is she legal or illegal in her state?  Don't let her escape into some sort of alegal claim (alegal is illegal).  Has she had her license removed or suspended at any time by any state (including her current state)?  This has been an issue, for example, where a practitioner who had her license removed in Minnesota was able to obtain a license without difficulty in Oregon.   What were the circumstances of any license removal or suspension?  Has she had to appear before the applicable State Medical Board or State Board of Midwifery?  What were the circumstances and outcome of such appearance?  I would search the records of the applicable State Board to verify license status and history.

(3)  Has she been charged and/or convicted of any crime (beyond simple traffic violations)? 

(4)  Has she been sued in connection with her practice?  What were the circumstances of the suit?  I would also make a search for her name in local court records to verify. 

(5)  How many babies has she delivered over what period of time?  How many sets of twins?  How recent is her twin experience?  What was the birth positioning of the twins she has cared for?   What sort of positioning would risk you out of homebirth (breech-breech, for example)?  What is her outcome over the life of her career -- in terms of babies with morbidities (NICU stays) and mortalities (death of baby or mother)?

(6)  What sort of testing will be performed?  GD, GBS, all standard tests, etc.?  How frequently will the twins be checked by ultrasound (to confirm that they are growing concordantly, etc.)?   Who will be performing the tests (if your practioner is a midwife and unable to provide these services)?   What test results will risk you out of a homebirth?

(7)  What sort of drugs and equipment is the midwife bringing with her to the birth?  Is her possession of those drugs legal or illegal?  Twin moms have a higher risk of post-partum hemmorhage, so I would be especially concerned about her ability to carry the drugs that are used to treat PPH.

(8)  What is her experience with emergency scenarios?  Does she have actual experience treating PPH or has she just been lucky so far?  Has she handled SD?  Has she ever cut an epis?  What is her experience with reviving flat/blue infants?   What were the outcomes of her handling of those emergencies?

(9)  I would try and see if I could get any info about her from the L&D department where she usually transfers.  I have a L&D nurse friend and she says that some midwives can reliably be counted upon to wait until the mother reaches trainwreck status before transfering while others transfer in a timely manner before the trainwreck happens.

(10)  Does she carry malpractice insurance?  If not why not? 

[philomom]

Originally Posted by Jane93 

Questions I would ask:

(1) List of degrees and certifications.  For example, is the practitioner certified in NPR?  Not only is she currently certified, but how many times has she actually performed the neonatal res. in an urgent situation?  Experience being, of course, different than book learning alone.

(2) Status of licensure.  Is she legal or illegal in her state?  Don't let her escape into some sort of alegal claim (alegal is illegal).  Has she had her license removed or suspended at any time by any state (including her current state)?  This has been an issue, for example, where a practitioner who had her license removed in Minnesota was able to obtain a license without difficulty in Oregon.   What were the circumstances of any license removal or suspension?  Has she had to appear before the applicable State Medical Board or State Board of Midwifery?  What were the circumstances and outcome of such appearance?  I would search the records of the applicable State Board to verify license status and history.

(3)  Has she been charged and/or convicted of any crime (beyond simple traffic violations)? 

(4)  Has she been sued in connection with her practice?  What were the circumstances of the suit?  I would also make a search for her name in local court records to verify. 

(5)  How many babies has she delivered over what period of time?  How many sets of twins?  How recent is her twin experience?  What was the birth positioning of the twins she has cared for?   What sort of positioning would risk you out of homebirth (breech-breech, for example)?  What is her outcome over the life of her career -- in terms of babies with morbidities (NICU stays) and mortalities (death of baby or mother)?

(6)  What sort of testing will be performed?  GD, GBS, all standard tests, etc.?  How frequently will the twins be checked by ultrasound (to confirm that they are growing concordantly, etc.)?   Who will be performing the tests (if your practioner is a midwife and unable to provide these services)?   What test results will risk you out of a homebirth?

(7)  What sort of drugs and equipment is the midwife bringing with her to the birth?  Is her possession of those drugs legal or illegal?  Twin moms have a higher risk of post-partum hemmorhage, so I would be especially concerned about her ability to carry the drugs that are used to treat PPH.

(8)  What is her experience with emergency scenarios?  Does she have actual experience treating PPH or has she just been lucky so far?  Has she handled SD?  Has she ever cut an epis?  What is her experience with reviving flat/blue infants?   What were the outcomes of her handling of those emergencies?

(9)  I would try and see if I could get any info about her from the L&D department where she usually transfers.  I have a L&D nurse friend and she says that some midwives can reliably be counted upon to wait until the mother reaches trainwreck status before transfering while others transfer in a timely manner before the trainwreck happens.

(10)  Does she carry malpractice insurance?  If not why not? 

Great questions!

[dsb76]

These are all great questions.

I had planned to use a midwife and deliver in a hospital (not comfortable enough with homebirth and no birth center option for twins) however there seemed to be a high likelihood that I would end up either with a section or being delivered by the Ob on call with midwife acting as support unless everything was Perfect.  Rather than hoping for the perfect birth I decided prepare for possible complications.  I picked an Ob who is comfortable with and delivers twins vaginally, delivers 80% of his own pts, and delivers at a hospital with a level III NICU.  By no means is this a perfect arrangement but as the things I hated the most about having a hospital birth (constant monitoring limiting mobility being the main thing) were things I wasn't going to be able to avoid anyway I figure this is the plan I'm most comfortable with.

[Jane93]

Thought of one more:

(11)  Is she able to suture?  Seems like a number of the homebirth moms on the birth boards here have had post-partum issues with tears not being appropriately repaired.

I would also suggest you read the recent guest post on the Navel Gazing Midwife's Blog -- the guest poster outlines an important issue with selecting midwifery care.  The issue is to what extent are certain services not offered (like antibiotics for GBS or suturing for tears) not because they are not medicially advisable or necessary but because they are simply outside the ability set of the midwife in question? 

I think it is important to give consideration as to what sort of choices the midwife can offer to you.  Can she only offer herbal tinctures for PPH or can she offer both medication and tinctures depending on the client's need?