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Choosing A Midwife

post #1 of 26
Thread Starter 
Dh & I are TTC. Dd was born CS. (all these abbreviations!!!) I want to have a HBAC with a midwife who will let things take their course naturally. Can anyone offer any advice on how to select such a midwife? What questions should I ask? What warning signs should I look for in order to avoid someone too medically minded? I feel so empowered by the idea of birthing totally independantly, but I also want someone experienced on hand to assist since I am considered higher risk.
post #2 of 26
Lila,
I found a book written by Elizabeth Davis called "Heart and Hands - A Midwifes Guide to Pregnancy and Birth". There is some good info in there, and a list of questions for parents to consider when choosing a midwife. It really helped me, even though there were only a handful to choose from.
Is she licensed? What is her experience? What do services include? Does she work with assistants and will you meet them before the birth?
How many births does she attend each month. Our midwives (we had two who always attended births together) scheduled 3-4 women a month, tops.
What happens if two births are occuring simultaneously?
What kinds of complications does she have experience with?
What equipment does she bring?
What are her basic beliefs about birth? Will she encourage your husband to participate?
If there is anything you feel strongly about, that you want to happen or don't want to happen, ask about that.
I think it's important that you feel comfortable, this woman will be in your home, interacting with your family during a very intense time and you want to be able to trust her completely.
I'm sure theres more, but many mamas here to add to this list!
post #3 of 26
Hi there, I am 13 weeks now but I interviewed 4 midwives before choosing. However I talked to another 4 on the phone and eliminated them before meeting with them. If they sounded too medical or didn't ask me any questions I didn't even meet with them. When I met with the ones I chose I asked very specific questions...
Will you do twins at home?
Will you do breech at home?'
What testing do I HAVE to have done?
How do you induce?
Who's decision is it to induce?
How about Vit K and Eye ointment?
You need to ask if she will do VBAC

I didn't want to choose a midwife and then have to change at the end of my pregnancy if my baby happened to be breech. It was important to me that I am in charge of my pregnancy and that I make all of the decisions. Many midwives have many things they will not do - you need to interview a few to find the one closest to your beliefs.
Good Luck!
Keri
post #4 of 26
I found some great lists of questions to ask your midwife on the www.gentlebirth.org archives (can't remember the exact link) and also on the Midwifery Today Web page. Do a search on google, I think it is www.midwiferytoday.com, can't remember exactly.

I asked some open-ended questions and specific ones such as:

What is your general philosophy on pregnancy and birth?
How do you handle complications, what kind of complications have you handled in the past?
How many years experience do you have? Certifications?
What is your c-section rate?
What is your episiotomy rate?
Under what circumstances would I not be able to birth at home?
Have you delivered twins?
Have you delivered breech?
What is considered overdue? Do you induce, if so, how?
What kind of tests do you require?
How frequently would I see you?
How do I get in touch with you in case of an emergency?
How much does it cost?
Will you assist with nursing?
Am I allowed to eat, drink, move around freely?
Have you had a homebirth?
Under what conditions would I be reffered to an OB?

I would add to these, quesitons such as do you do HBAC? How many have you done? How many had to transfer to the hospital? What were the reasons?

Also wanted to add that in terms of finding a midwife, I looked for midwives in the phone book that were not associated with a hospital. Also looked in a Natural Health catalog we have here in NJ. Also asked a Bradley instructor in my area if she knew anyone. I also searched on the Internet under www.birthpartners.com you can do national searches for midwives, doulas, and childbirth educators there.

Best of luck TTC and having the HBAC of your dreams!
post #5 of 26
Lila, my first homebirth was attended by a very hands-on midwife, and like you I found that I was much more interested in doing it by myself as much as possible.

Some of the questions I asked when I started interviewing midwives for my second birth:

During pregnancy, which testing do you make mandatory? Which do you personally feel is important? Under what circumstances do you feel not testing is better than testing? How do you feel about ultrasound and doppler? Do you feel vaginal exams are necessary? What do you think about CPD? Will you attend a breech birth at home? How about twins? How long are you comfortable letting the pregnancy go? Under what circumstances would you feel an induction was in order?

During the labor, how much a part of the process do you feel it's necessary for you to be? Under what conditions will you feel the need to augment labor, and with what method? How long do you feel it's safe to let a woman labor before transport is necessary? Do you strip membranes, AROM, or episiotomies? How often do you feel you *need* to check baby's heart rate? What is your philosophy on why women feel pain, and do you think there's a best way to deal with pain (and what is that)? Do you feel it's important to check dilation, and if so, why? How do you think the pushing stage should be managed?

Answers to these questions were VERY revealing. I went through several midwives before I found the one with the answers I wanted to hear, but it was sure worth it.
post #6 of 26
Wow! I just stumbled upon this thread and thanks for the information. I also had a hospital birth and hated the place... I want to select a great midwife next time and didn't know what to ask during an interview.
post #7 of 26

Choosing A Midwife

During my first pregnancy, I did a poor job of interviewing midwives. My questions would lead them to the answers I wanted to hear. Consequently, I made a bad decision and ended up in the hospital with cascading interventions leading to health problems and never being able to breastfeed my son. What sorts of questions would you ask to have a truely natural childbirth, a supportive and reassuring midwife, a midwife that would not lead you to interventions? Certifications and degrees no longer reassure me in my search.
post #8 of 26
I too did a poor character judgement on my midwife...Like I have said in other threads she was very pleasant in our prenatal visits but during the actual birth she was rather bossy and highstrung.

Next time round I am planning on having an unassisted birth but Ihere are some suggestions for you...

1. Do you believe that a woman instinctively knows how to birth her baby? If the answer was 'yes' the I would ask What role do you place yourself in during a woman's labor then? (personally I would want her their to supervise and not dictate) If the answer was 'no' then I would say Thank you for your time. Have a good day.

2. Have you attended any homebirths where there has been an emergency that required you to take needed action if so what action did you take? (You need to decide if that kind of response to an emergency would make you feel threatened or not. The reason why I would ask for a specific example would be to get an idea of how she would work under stress.)

3. What made you decide to become a midwife?

4. I would tell her my specific desires e.g low/natural light, soft music, my husband being present, etc and ask her if she had any objections.

5. Do you use any homeopathic or herbal remedies?

6. If you are wanting a water birth you would obviously need to find out if she is comfortable with it and how much experience she has.

7. Ask her if during the labor she would bring another midwife to assist her. My midwife did this and never told me....fortunatley her assistent and I clicked. You will obviously need to decide for yourself if you are comfortable with having someone else there.

Anyway...hope I have been of service.....
Good luck...
post #9 of 26
Have you tried word of mouth? I have friends who had birthed with midwives and a large part of my decision was based on their recommendations and birth stories. I chose to work with the midwives who were recommended by the friend who is most like me in terms of emotional needs. It was the right choice for me.Can you ask around in your community through birthing classes, La Leche League, etc.?

Best wishes for your search.
post #10 of 26
Well dang it, I could swear I posted to this thread already. Weird.

Anyway, gemsmom, I did the same with my first pregnancy.

When I was interviewing midwives the second time around, I was totally on the offensive. I went in there, "I want to do this birth alone, it's fine if you sit on the sidelines and observe, but I don't want the typical monitoring, and I don't want coaching or help! How do you feel about that?" I got a lot of nervous looks, and the attitude that "we take the mother's wishes INTO ACCOUNT" communicated to me in various ways.

Then one day I was sitting in a midwife's living room, and I said, "when I'm in labor, I might be making a lot of noise and faces, I might be raging through it." That's great, she said, different things work for different people. (My first midwife disapproved when I'd grimace or yell, according to her that hindered the labor.) "It might be very painful, and I don't want anyone trying to convince me that I'm a whiner or that I'm imagining it!" I understand, she said, my own labors were very painful. (My first midwife acted like I was making too much of the pain, and felt that I could control it if I really wanted to.) "I don't want perineal massage and I'm not going to push til I can't help but do it! No coaching, no timing of contractions or dilation checks, because it psychs me out!" She said her role in my birth would be up to me. She would be whatever I wanted her to be. It was my show.

I felt the fire start to go out of me, and I knew I'd found my midwife.
post #11 of 26
I have always felt that as a midwife my role is to be lifeguard and facilitator - nothing more. I guess one way to ask that question is something like (bluntly) "can you leave your ego at the door? (or at home!)"

All the above questions are really good ones, along with "what happens to you (the midwife) if we have to transport to the hospital? Do you come with me?"

Barbara
post #12 of 26

Interview questions

Hi all, I'm Joy. Just found out I'm pg with #2 and very excited about the prospect of a hb this time around! Bad hospital experience with #1.

My dh is very apprehensive. We've been reading Gentle Birth Choices and The Thinking Woman's Guide to a Better Birth to get more informed about our decision. He seems to be warming to the idea.

I've spoken with two local mws who do hbs. I plan to interview one in about a week. What sorts of things should I be looking for and asking about? She has a good deal more experience than the other, altho the other was much more personable. I'm torn. I think we'll first interview the one with the most experience, she was much easier to talk to the second time we talked.

I'd just like to know some key information I should be seeking from her to evaluate her credentials! Thanks so much, gosh I just can't wait to birth at home!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
post #13 of 26
Okay, here is what I can think of that we have asked...

Do you carry pitocin (for hemoraging)?
Do you carry oxygen?
Transfer rate?
Episiotemy rate?
What do you use to induce, if I go late?
What is the prenatal care schedule?
Do you have hospital rights if I transfer?
Will you stay with me either way?
Do you have a back-up midwife?
If so, will I have a chance to meet with her?
What prenatal tests do you recommend?
How do you do the diabetic screening? (I refuse to ever drink that glucose junk again)
What kind of post natal care do you provide?
Do you check the baby at one and two days, or do I need to arrange for a peditrician?
What kind of childbirth classes?
Do you offer a sibling prep class?
Can I continue with you for Gyn. care after pregnancy?
Will we notify local EMT of planned homebirth before hand in case of emergency?

That is all I can think of for now. My husband was also very apprehensive about home birth before speaking to the midwife (even though he saw all the problems they caused at the hospital the first time). After we met with her, he felt a lot better about it all. The most important thing is that you feel comfortable, a homebirth is so intimate, you'll want someone you like and trust.

Good luck - Chelsea
post #14 of 26
I agree with all the above questions. Other things I spoke to my midwife about were:

**waterbirths (I wanted one and wanted to make sure she was experienced and comfortable with this)
**routine med. procedures performed on baby after birth (I didn't want any of them done and wanted to make sure she was ok with this. She was, but I had to sign wavers - this was for eye drops and vit. K injections)
**medicated deliveries (I wanted no pain killers and no pitocin injection before hand)
**due dates (what did they consider "over due" and what was their procedure for addressing that situation)

I think in the end, I ended up being a lot more "crunchy" than many of her patients and while some people I know found her very liberal, I felt she took more of a medical view of birth than I would have liked. Still, I love her and she respected all my choices and beliefs.

She definately agreed that a homebirth was a much safer option for a woman and baby in good condition. Familiar germs in the house, relaxing atmosphere, etc. My dh was scared by his father who said, "But what about hemorrhaging?! So much can go wrong!" So, each midwife visit was me and all my hippy dolphin love vision stuff, and dh asking about all the blood and guts and emergency stuff. LOL

In the end, the most important thing was that she made us *both* feel comfortable because my body took care of the rest. We had a 2 1/2 hour labour and delivery, in water, with absolutely no problems. I was up and around the next morning.

Best wishes to you, and have fun!
post #15 of 26
Some other questions that I feel are important:
*what does she consider "overdue"
*consequently - can you still birth at home no matter how overdue you go (I am not sure, but I think CNMs cannot doa home birth after 42 weeks)
*how would she induce if need arises
*under which conditions would she recommend transfer
*which complications had she encountered before, how many of each and how did she handle them (things like shoulder dystocia (spelling?) etc)
you could ask her how she would handle different situations:
like ROM and no labor fo x hours, not dialating more then x cm for x hours etc
post #16 of 26
I would suggest also asking how she typically manages labor, because this is as or more important than her experience dealing with complications. For instance:

- when will she want to arrive
- how she feels about the necessity and timing and frequency of vaginal exams, dilation checks, and timing of contractions
- what is her philosophy concerning labor coaching
- how (or whether) she feels second stage should be managed, i.e., her thoughts on AROM, birthing positions, breathing, pushing, perineal massage, episiotomy, and who can or should catch the baby
- how she feels third stage should be managed, i.e., her thoughts on how and when the placenta must be born, when the cord should be cut, suctioning, cleaning, etc.

You should make sure you are on the same page not only in terms of which interventions are acceptable or necessary, but also in terms of what you and she expect her role to be in the birth (will she be there only to watch for possible complications, or will she be actively guiding you through the birth?)
post #17 of 26

What type of questions do you suggest in searching for a midwife?

I am not pregnant now but plan to be in the next 18 months. I was very dissatisfied by my last birthing experience and my dh and I want to have our next baby at home. For those of you that have been there, what questions did you find to be the most helpful when interviewing midwives and what are some red flags you have encountered? We want to have a homebirth where things are allowed to progress naturally on my bodies schedule without intervention (unless in a life threatening emergency for mom or baby of course) and with out the comands to push or change positions. I want someone there who will encourage me to believe in my own ability to give birth and who knowledgable if something wrong does happen.
post #18 of 26
this topic was recently discussed - take a look at the link: http://mothering.com/discussions/sho...&threadid=4855

maybe someone else will offer even more ideas.
post #19 of 26
hi, i have read all the excellent questions and thought I would add my own .02.
i personally think choosing a midwife is a highly intuitive thing. YOu are talking about someone who will be there during one of your most personal and private moments. What I learned from my experience w/midwives w/dd, baby one. ...they do whatever they usually do and really, though, they may say they will do antying...do whatever their norm is--meaning whatever they feel comfotable w/. (For example, w/dd they said they would do whatever aside from things harmful for the baby but chose my positions for me late labor--lying on my side for high BP--which was incredibly hard to push her out. IMO, had I been able to squat, she wouldn't have had such a hard time right after birth w/breathing etc. HOwever, *I* chose to listen to them!! )
maybe the best way would be to hear from former clients...though preferably not the ones they suggest..cuz they're more likely to be the ones who had the best experiences.
also, i think some other questions that may help you get a feel for the midwife are things like....
"What were your own births like?"
"What do you believe to be necessary for a successful homebirth?"
These questions may reveal whether they themselves have faith or not in birth.
all in all, you need to just go with your gut and realize no matter what, YOU are in charge and in control of your own birth and that may give you confidence needed no matter what happenrs. Maybe this will be an encouraging thought. (I know people that have fired their midwife very late preg. because they knew it wouldn't work) ultimately, you create your birth experience and that is the most important thing.....good luck
post #20 of 26
bumping for myself
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