Homebirth and Midwives in California - Page 2

[Buzzbuzz]

"Also, do some research into transfer rates with various MWs (especially for 1st time mothers!) and c-section rates for HBs. Look into what sorts of client care your local midwives offer -- can they give IV fluids, postpartum hemorrhage meds, oxygen and etc. Look into neonatal care safety."

I agree with IdentityCrisisMama that whatever midwife you pick should have a significant transfer rate for first time mothers.  I believe the Birthplace Study out of the UK had at least a 20% transfer rate for first time homebirth mothers and that study included only the lowest of the low risk with college educated midwives attending.

I would also agree that, in addition to what IdentityCrisisMama says, you should know her:

(a) education, (b) license status, (c) malpractice insurance status, (c) length of practice, (d) number of babies delivered (this is important as a midwife may have been practicing a long time but be a "hobbyist" (for example, only taking on one birth or less a month) and this means that there are any number of complications she may not have seen in her practice despite being a midwife for a long time), (e) what emergency situations she has experienced, how recently and how she handled them (shoulder dystocia, post-partum hemorrhage, neo-natal resuscitation, etc.), (f) whether she has been charged with a crime or sued or lost her license in any other state, (g) number of stillbirths or major morbidities (like cerebral palsy) for babies and mothers under her care, (h) how many births she has missed (by being too late to arrive) and (i) birth philosophy (a "trust birther"/a "med"wife).

A friend had some luck interviewing midwives by asking each of them which midwife they would want to attend their own births.  It became pretty obvious which two local midwives were not thought well of by their peers. 

However, I would suggest that, in interviewing your midwife you need to acknowledge what you don't know.  In other words, there is no way you can meaningfully evaluate whether your midwife knows the proper technique to resuscitate your newborn, can do a complete newborn exam or properly evaluate whether your tearing needs suturing and suture it appropriately.

[IdentityCrisisMama]

ML, I did a brief look into c-section rates for planned HB and according to the source I found it is quite low - from 3.7-4%. It would be interesting to see what the rate is for first time mothers, as I'm sure it's higher. I'll see if I can find that too. 

[aumismommy]

Ok, first off surprised at where this thread has gone.  I'm going to try to answer a couple questions but not sure if it's even necessary...

We use midwives and when we first set out on the search when we were preg with our first we called several (though I had heard of the ones we ended up choosing years before and was quite thrilled to use them based on their experience and reviews).  They are a team of two women with a lot of experience and they are actually educators to midwives in our community.  I had a binder of questions for them on our first interview - literally a binder, with typed pages of questions... like what is their rate of transfer, what makes them transfer, what do they bring to a birth, what is their philosophy, etc etc... do they have priveledges at a hospital, do they have a ob they work with specifically...  I remember their direct answer to the priviledges and ob questions - if you need to transfer you need to transfer immediately and you will be going to whomever is on call at the time regardless of priveledges and ob you worked with....this is the same as if you were doing a hospital birth in most cases. 

Our midwives do SO MUCH WORK with each family I'm surprised they don't charge more and they charge a lot - $4k - this includes all prenatal, and all post natal appts - of which there are several and they come to your home several times after baby is born, they help (understatement) with breastfeeding, pp healing, family integration, etc.  They are phenomenal and worth their weight in gold. 

As for the scare of homebirth...it just depends on your approach to birth.  Can it be scary...sure if you look at the worst case scenario for everything.  I chose a home birth because I was more concerned for my baby's safety and comfort than anything else...that's what worked for us in our opinions and values.  IT was not a decision based off my comfort - though I was incredibly comfortable.  High risk mamas/pregnancies will not be a candidate for home birth...midwives just won't take them on as patients/clients.  Home births are for healthy, able bodied women and families.  Period.  So yes, they should be offered to the population and only cleared for those that can have a healthy pregnancy and labor and birth.  Unfortunately, in our time, not every pregnancy is low risk.

As for 20 week ultrasounds - our midwives prefer this done and will support you if under certain circumstances if you decline, and will support you under certain circumstances ifyou prefer more.  They came with us to our US appt - at a free standing US facility - cost us about $60 cash.  Just fyi... you don't have to see an OB to get an ultrasound.

Good luck mama! Hope you get the information you need!

[aumismommy]

Originally Posted by Buzzbuzz 

"Also, do some research into transfer rates with various MWs (especially for 1st time mothers!) and c-section rates for HBs. Look into what sorts of client care your local midwives offer -- can they give IV fluids, postpartum hemorrhage meds, oxygen and etc. Look into neonatal care safety."

I agree with IdentityCrisisMama that whatever midwife you pick should have a significant transfer rate for first time mothers.  I believe the Birthplace Study out of the UK had at least a 20% transfer rate for first time homebirth mothers and that study included only the lowest of the low risk with college educated midwives attending.

I would also agree that, in addition to what IdentityCrisisMama says, you should know her:

(a) education, (b) license status, (c) malpractice insurance status, (c) length of practice, (d) number of babies delivered (this is important as a midwife may have been practicing a long time but be a "hobbyist" (for example, only taking on one birth or less a month) and this means that there are any number of complications she may not have seen in her practice despite being a midwife for a long time), (e) what emergency situations she has experienced, how recently and how she handled them (shoulder dystocia, post-partum hemorrhage, neo-natal resuscitation, etc.), (f) whether she has been charged with a crime or sued or lost her license in any other state, (g) number of stillbirths or major morbidities (like cerebral palsy) for babies and mothers under her care, (h) how many births she has missed (by being too late to arrive) and (i) birth philosophy (a "trust birther"/a "med"wife).

A friend had some luck interviewing midwives by asking each of them which midwife they would want to attend their own births.  It became pretty obvious which two local midwives were not thought well of by their peers. 

However, I would suggest that, in interviewing your midwife you need to acknowledge what you don't know.  In other words, there is no way you can meaningfully evaluate whether your midwife knows the proper technique to resuscitate your newborn, can do a complete newborn exam or properly evaluate whether your tearing needs suturing and suture it appropriately.

This is interesting to me.  First of all, addressing the part I bolded in the quote - why?  Why would you want them to have a high transfer rate for first time mothers?  Maybe I'm reading your statement wrong.

Second - does anybody ask their OB these questions - besides the questions directed at what neonatal and hemmorage equip they have - assuming the hospital has that - what about your questions of c-i that you typed out?  I wonder if mamas/families ask their OB those questions.  This is interesting...not flaming or judgey at all... just interesting.  I asked our midwives when I interviewed them all of these and more but as for friends that have used OB's there has been none like this - just assumptions.

[Buzzbuzz]

"First of all, addressing the part I bolded in the quote - why?  Why would you want them to have a high transfer rate for first time mothers?  Maybe I'm reading your statement wrong."

I believe the UK birthplace study, while it has its limitations, is the most "reliable" study on homebirth that I have seen. 

It did find an increased risk to first time mothers in homebirth, even with an extremely low risk population and with a relatively high transfer rate. 

While the birthplace study is not directly transferable to the US (they have college educated midwives, integrated transfer etc.), I find it helpful to use it as a proxy of what a safer mode of homebirth practice looks like.  Thus I would have concerns about a midwife with a very low rate of transfer for homebirth mothers.

"Second - does anybody ask their OB these questions - besides the questions directed at what neonatal and hemmorage equip they have - assuming the hospital has that - what about your questions of c-i that you typed out?" 

I have asked my OB any  numberof those questions except for items where I know because they are licensed they are compliant (for example, my state requires malpractice insurance at certain levels). 

However, I would note that the reality is that there are many more external "check" factors for doctor than there are a midwife, so these questions while important for someone considering an OB's care are substantially more important for a midwife.  

Also, there seem to be standard points of confusion that I have seen women, including on this boards, have about their midwives -- first, whether their midwife's practice was legal and whether it was licensed. 

[JudiAU]

Prenatal care is important and I wouldn't transfer from even substandard care until I had a replacement in place. Most obs would never provide backup care for a homebirth so I don't think her reaction is particularly bad. It is just standard. Also, you have to understand how OBs are paid. Prenatal care is paid very poorly, any real payment for their services comes from delivery. So if you are asking them to provide backup or shadow care they are basically doing it for free for something they don't support. I wouldn't even take it personally.

I don't think you will have much luck finding a backup OB on your own. That's not really how it works. Find a midwife you like and find out if he or she has a backup OB. Most do in California in fact I think it may be a requirement for practice. Once you transfer care you may be asked to meet the backup or not. I chose too because in the event I needed to transfer for some reason it makes the process much easier to be an active patient. We did  a quick medical review and he said, "I hope we never meet again" with a smile.