Interviewing a midwife?

[dharmama]

Is there such a thing as interviewing or having a consultation with a midwife or doctor?

My background:

I’m finishing up what appears to be an anovulatory cycle (my 5th TTC) and I’m really wanting to talk to someone. I am currently seeing an OB/GYN and he is a great person, but the more I read and the more time I spend at MDC, I realize that he is just not the right match for me.

I’d like to switch to a midwife but I don’t want to go through the trouble of switching my records etc. until I know if I’ve found the right person.

Have any of you had this type of “get to know you” meeting with a midwife?

Thanks!

~Erin

[Dodo]

When I first met with my midwives, they wanted me to ask them questions, but, frankly, I didn't know what to ask because I didn't know yet what was important to me. This is probably not the case with you. You already hang out here so I'm assuming that you have a nascent birthing/parenting philosophy.

Now I would ask about their own births. I would ask what they think about women birthing unassisted. I would ask if we could skip the monthly weigh-ins and peeing in a cup. I would ask what they see as their role. I would ask if they feel that they are only there for the worst case scenario and if so, what are they legally entitled to do to help out. I would ask about their reasons for hospital transfer. I would ask about their transfer rates, as well as their epi and c/s rates. I would ask about their views on u/s, vitamin K and eye gel. I would ask how they felt about no internal exams, especially not before or during labour.

[dharmama]

Ooo...thank you Dodo!

I'm so focused on talking with someone about how to GET pregnant, I haven't given a lot of thought to the questions I want to ask about how she views pregnancy and birth.

I have an apt. with a midwife (who some of my friends have birthed with and liked) in three weeks. I was bummed that it's far off (I know not really) but now I'm glad I have some time so I can make a list of my questions!!!

Anyone else have any experience consulting with a midwife???

~Erin

[Laurel]

What about a naturopath? I've gone to a naturopath who is also a midwife. I was able to get the benefit of her expertise in therapeutic massage and herbs. She was able to ascertain what problems I'm having with infertility and what things are actually going right with my body.

Before I went to her, I read the book "Healthy Parents, Better Babies" by Francesca Naish, which is a holistic approach to preconception healthcare. Then I just asked her questions about the things I read in that book. You could also ask questions about the diagnostic techniques she uses.

[rubelin]

I also recommend asking about their rates of transfer, episiotomy, etc. I really wished I'd asked my horrid OB this. What they say their views are and what the truth is can be very different.

[dharmama]

Laurel ~ Thanks! I do have a naturopath that I see occasionally (she is not able to accept insurance in Rhode Island so I have to pay out of pocket and DH is out of work right now, so that's not really an option). Thanks for the book suggestion. I will check it out!

rubelin ~ Great suggestion! Thanks!

So this is what I've come up with so far. No questions yet, but I thought I'd jot down some things to help the midwife get a sense of who I am and what kind of relationship I'm hoping to have with her. Kind of use this as a conversation starter. (I'm thinking she's either going to look at my lists and say YES, YES, YES...you've found the right place or Oh my...I don't think you'd fit in here. I think you might want to talk to _____.)

What I’ve read (or am currently reading)
Taking Charge of Your Fertility
Birthing From Within
Wise Woman Herbal for the Childbearing Year
Spiritual Midwifery
Ina Mae’s Guide to Childbirth
Mothering Magazine

What I’m interested in
Yoga (I teach vinyasa and prenatal yoga)
Reiki
Reflexology
Herbal Medicine
Energetic Healing/Chakra/Aura work
Massage

What scares me about pregnancy?
Being forced to have tests I don’t want
Being told about all the things that can go wrong during pregnancy, labor and birth
Being rushed in office visits
Not feeling comfortable enough to ask questions
Feeling like I’m being a “difficult” patient because I ask a lot of questions

What I’d like to experience during pregnancy?
Spiritual growth/deeper introspection
Celebration of carrying life (Blessingway, belly casting, pregnancy photography or other rituals)
Massage
Yoga
Support for natural childbirth
A midwife who I am comfortable talking to
Not feeling rushed during office visits
Support for a vegetarian diet
Information about using medicinal herbs

What scares me about birth?
Pitocin/Epidurals/Forceps/Episiotomy/C-section
Having pain medications pushed on me when I am most vulnerable (I attended my nephew’s birth and witnessed this)
Feeling out of control like I’m a passive participant in my birth
Being undermined by medical professionals
Monitors and machines that go “ping”
Being told when to push and having people yell 1-2-3-4-5
Being told not to push because the doctor/midwife/nurse isn’t ready (Saw this happen to my sister-in-law)

What I’d like to experience during labor and birth?
Homebirth (or the most home-like environment I can have)
Waterbirth
Doula care
Prayer/Meditation
Freedom to move into any position I want
Freedom to go outside if I need fresh air
Freedom to eat whatever/whenever I want
Time and space alone (or with just my husband)
Music, Incense, Massage
Support for breastfeeding, skin-to-skin contact, no mother-child separation (maybe family bed)
Delayed cord clamping
No immediate vaccinations
No Vitamin K/ no eyedrops/ointment
Definitely no circumcision


This was fun and I think it should give any of the midwives I talk to a pretty good idea of what I'm looking for, don't ya think?!

~Erin

[LisaG]

Erin,

What a great list! Seems very thorough and I think it will give them a good idea of who you are and whether or not you guys are compatible. I like the idea too that it's presenting who you are rather than potentially putting them on the defensive with a bunch of questions.

If you are having anovulatory cycles (are you temping?), a reproductive endocrinologist is the type of doc to see who can help you figure out what is/isn't working. I'm not sure how helpful a midwife will be in solving that puzzle - but I could be wrong! I think of them as more pregnancy and birth experts than fertility experts. I've had to see an RE for other issues (weird uterine architecture : ) but use their tests and diagnosis to help my more natural health care providers with my treatment. That helps me integrate the best of both worlds for my fertility issues.

Good luck!

Lisa

[dharmama]

Thanks Lisa,

Good point about the RE. I guess I'm not sure if I'm there just yet. : I came off the pill in December (after 12 years ) I believe my body is trying to recover. I just charted my first cycle this month.

I am thinking I'd like to work with a midwife because generally they are more open to natural remedies, which is where I want to start. I'm hopeful that mainly through diet and herbs I can get things going in the right direction.

It's been five cycles for me so far. My MD said that the average number of cycles to conceive is six so I guess technically, I should just relax and enjoy the process. But that is SOOOO HARD.

Thanks for all your replies. I really appreciate it!

~Erin


Here's my wacky chart if anyone's interested.

[dancinggirl]

Hi Erin, Good luck with finding a midwife. I believe there are a few good groups in RI. I also believe they have doulas at Women and Infants Hospital maybe you could give them a call and they can give you some refrences.

[bloodrayne]

Absolutely!

We planned to interview 3 or 4 midwives, but when we interviewed the first one, we totally fell in love with her and knew she was the right one! After I asked her about her ideas on the things that were most important to me, we sat and chatted a bit. I would never hire someone without knowing exactly what their philosophies were and how they fit in with mine.

I have a gigantic list of things you might want to ask them about, if you're interested. I can PM it to you.

[Abylite]

Hi Erin,

Knew I'd find you here!!

I think your list is a great idea. I'll be in the same boat as you as far as interviewing midwives. Maybe we can help each other out since we will be "neighbors"...

I was also on the BCP for 14 years or so...and purposely "waited" about 6 months before really TTC, knowing it can mess things up for a little while. I understand how hard it is to be patient. I've learned that my timing is not always the "universe's" timing.

I've done extensive research on boosting your fertility...took vitex, EPO, etc. And luckily...it didn't take us too long to conceive with both our pregnancies. We need to have these pregnancies be "sticky!!"

[Xander's Mama]

The MW can come later

After 12 years on the pill, I'm not surprised that you've had 5-6 anovulatory cycles. Think about the adjustments your body has to learn. I wouldn't even start counting the "6 months" until you've seen at least one ovulation. I know its frustrating, but you really do want a healthy uterus and hormone system before you get going.

I'd keep charting and watch for trends. I looked at your last chart and it does look wacky, but I'm not sure you didn't ovulate (but just had a short progresterone period). It would be interesting to see all the charts together to see what pattern you do have.

I had many years on the pill, waited almost a year after quitting with the hopes that my wild cycles would calm down (they ranged in length from 27 days to 120 days). The first month I said we could give it a try, it worked.

Also, ask your naturopath to recommended a gyn (whom insurance will accept) so that you can get a few hormone tests done. Then the naturopath will know what to work with.

After all of this, I'm sure within a few cycles, you'll really need to know what to ask your midwife!!

Best wishes,
Xander's Mama

[dharmama]

I think your list is a great idea. I'll be in the same boat as you as far as interviewing midwives. Maybe we can help each other out since we will be "neighbors"...

Can't wait for you to get here Abylite!!!!!

dancinggirl, bloodrayne, Xander's Mama ~ Thanks! Many good points!

Here's a little update...

I contacted my naturopath earlier this week and I also have an appointment in two weeks with an herbalist (who I really like and who REALLY knows her stuff -- 20+ years focusing on herbs for women's health). I talked to her briefly and she recommended that I eat only organic dairy (the BGH in dairy can supress our own natural hormones) and organic meat (but I don't eat meat so I don't have to worry about that). I will follow up on the blood tests and I'm also going to get my thyroid checked (just in case...my mom has a hpyoactive thyroid).

DH and I had a nice long talk last night about taking a break from actively TTC for a while so I can just relax, observe my cycles, focus on eating healthy, drink lots of herbal tea etc. I'm feeling really okay with that. (I mean we're not going to stop BD-ing....but I'm just going to ease up on the obsessiveness about timing and counting down to AF etc.)

Very interesting. I'm learning SO much.

I'll tell ya one thing....I wish I hadn't been on the pill so long and that I had come off much sooner.

Live and learn.

Thanks again you guys! Glad you are here.

~Erin

[Spark]

2 cents -- Hey, just for reference, here's a nice list of questions to ask. I starred the most important ones in my opinion. I think it would be odd asking all these questions, but very important to find out. You are wise to do an interview.

About You and Your Pregnancy:
*What is my due date? If you're not 100% when your last period was go for the latest possible date to avoid being induced too early.
What is the size of my uterus?
Is the placement of the sac where it should be?
*Are the symptoms I'm experiencing normal?
*Are the lack of symptoms I'm not experiencing anything to be concerned about?
*Does s/he have specific recommendations concerning weight gain, exercise and diet?
What things should I avoid?
What kinds of exercise are ok and which are possibly dangerous?
Is sleeping on my back as bad as some books say?
What are his/her thoughts on sex during pregnancy?
How often will s/he see me during pregnancy?
*What does a typical prenatal office visit consist of? (urine sample, weighing in, listening to heartbeat, etc)
How often does s/he do vaginal exams?
What is his/her recommendation/practice for the use of ultrasound?*
Does s/he offer alternatives to ultrasound? (e.g. fetoscope)*
How often will an ultrasound be performed?
Does s/he recommend certain pre-natal classes? Which ones?
*Is s/he open/supportive of me attending Bradley, HypnoBirthing, Birthing from Within &/or others?
Will s/he be in town around my due date?


About the Careprovider:
How long has the doctor/midwife been in practice?
When and where did s/he receive training?
Does s/he have references?
What sources of information does s/he recommend?
***What is his/her general philosophy concerning pregnancy and birth?
Why did s/he decide to become a doctor/midwife?
Does s/he have any children? How were they born?
How many babies does s/he deliver per week/month/year?
*What percentage of his/her patients does s/he deliver him/herself?*
*What percentage of his/her patients start labor spontaneously?
Which hospitals/birth centers does s/he have privledges at?
Does s/he do homebirths?
*If a physicain, does s/he use a nurse practitioner for visits?
*Who does s/he share on-call duties with? What is the rotation schedule?
*How long have the others been in practice?
*Will I be seen by every practitioner with whom s/he rotates?
*Do I have a choice about who I see?
*Will other practitioners respect the agreements that are made between me and the dr/midwife?
What are his/her guidelines for a "normal" vs. "high-risk" pregnancy?
*What is his/her definition of a high-risk pregnancy?
Does s/he return calls personally, or ask a nurse/receptionist to call me back?
*How does s/he feel about partners being involved at prenatal exams and during labor and birth?
*Is s/he open to me hiring a doula or monitrice (personal private duty nurse)?
*How does s/he regard written Birthing Plans? Are they respected?
*What is his/her policy on induction if I go beyond my due date?
*How long beyond term, for what reasons and what percentage of women does s/he induce?


About Testing:
What routine tests does s/he require?
What tests does s/he usually perform on a woman with my background (age, history, etc.)?
*Ask him/her to explain fully each test that will be performed (CVS, Alpha Fetal Protein, hCG, etc.).


About the Hospital/Birthing Center:
Is there a facility you prefer? Why?
*When can I take a tour of the facility? (Doing so may answer most of these questions for you).
When a mother arrives in labor what standard procedures are done?
*Is there a one-room option in which I can labor, give birth and recover?
*Is this room always staffed?*
*What are the features of the birthing room? (dim lights, tape player, tv, etc.)
*What is the nurse to patient ratio? (according to ACOG, one nurse for two women in early labor, and then one to one for those in the pushing stage is ideal)*
*Does the hospital have a policy on required use of Electronic Fetal Monitoring during labor?
*If so, what is the required length of time?
*Can this be waived or reduced?
*Do you have a squat bar or birthing chair?
Do the beds break down?
*Are water births done at the facility?
*Is there access to a whirlpool/tub for those in labor?
*What percentage of mothers go without chemical pain relief?
What is the hospital's cesarean rate?*
What is the epidural rate?*
Can my partner and/or doula be with me at all times, including in the operating room, if I have a c-section?*
*How many other people can I have with me at all times? (a doula, friend, relative, etc).*
***Will my baby be with me at all times while I'm in the facility?
Is video taping allowed?
***Is there a place for my partner to lay down or sleep somewhere during labor?
***Can my partner spend the night in my room if he wishes to (after the birth)?
*Is there a lactation consultant on staff?
*Is she accredited?
*Is she full time or part time?
*Is she on call to be available for me, when I need her?
*Will I automatically get to meet with her? When?
When can family and guests visit me?*
Is there an age limit on visitors? Does that apply to my own children?
Is there free parking?
*How soon after birth can/must I leave the facility?
*What is the average cost or vaginal birth? Cesarean birth?*


About Labor & Delivery:
*At what point in labor does s/he recommend coming to the birth center?
*Do you have different recommendations for women who want less interventions and fewer medications?
*How long does s/he allow women to labor before starting interventions?
*How soon after I start labor will the doctor/midwife come to see me?
*How much time will s/he spend with me when I'm in labor?
***What is the dr's c-section rate? (suggested that dr's not limited to high risk pregnancies should not exceed 15%)
***What is the c-section rate of his/her colleagues with whom he/she shares on-call responsibilities?
*For what reasons does s/he perform cesarean sections?
*Does s/he do vaginal breech births? (This has been deemed safe)
Will s/he encourage and attempt external version (turning a breech before birth)?
Does s/he encourage VBAC (vaginal birth after cesarean)? (N/A for you)
***Does s/he require IVs during labor?
***What is his/her recommendation for the use of the EFM (fetal monitor)? Continuous? Can doppler be used instead?*
*How often does s/he do vaginal exams during labor?
***Does s/he do episiotomies?
***When, why and on what percentage of women?
*****How often do your clients give birth with intact perimeums?
***Does s/he ever use warm compresses or perineal massage instead of/prior to episiotomies?
*What does s/he recommend to help me avoid an episiotomy?
***What percentage of mothers go without chemical pain relief?
*What percentage of his/her patients have epidurals?
Can my partner/doula be present during the amdinistration of epidural anesthesia?
Other drugs?
***What is his/her standard IV medication?
***What is his/her policy for chemical augmenting of labor including Pitocin?
***When, why and on what percentage of women do you use it?
***In what percentage of mothers is pitocin used to help expell the placenta?
*What percentage of mothers have manual help delivering the placenta?
***Does s/he use pictocin routinely after birth?
*How does s/he handle a long labor?
***What is your policy when labor 'stalls', are there time limits?
*What does s/he do when dilation is slow?
*Does s/he use vacuum extraction or forceps? Under what conditions?
***On what percentage?
*How does s/he handle premature rupture of the membranes at term? (PROM)
***What is his/her policy concerning artificially rupturing or stripping membranes?
*How often is stripping of membranes used to help start labor?
***And is it done with the mother's knowledge and consent?
***What percentage of mothers have their water broken artifically?
*What is his/her policy concerning interventions after my water breaks?
***Do you encourage the mother to push whether or not the urge is felt?
*Am I allowed to touch my perinial area during birth?
***Does s/he allow showering and/or bathing during labor?
*Can I use a warm bath for pain relief in labor, even if my water has broken?
*How do you feel about water births?
Is video taping allowed?
***Can my partner and/or doula be with me at all times, including in the operating room, if I have a c-section?
*How many other people can I have with me at all times? (a doula, friend, relative, etc).
Can I have my well prepared and attended children with me during birth?
***Does s/he allow food and drink during labor?
***Does s/he encourage women in labor to walk, squat or be in positions they find helpful during labor?
*Does s/he have a set position they want me to birth my baby in?
***Do I have a choice of positions? What laboring positions are recommended?
*Is the partner allowed to catch the baby? (This is so amazing to do. I hope Dan can catch your baby.)
***What happens to the baby immediately after birth? How long does s/he wait to cut the cord and deliver the placenta?
***Can I breastfeed immediately after birth?
***If the baby needs the immediate care of a pediatrician, how is this handled?
*How soon after birth can/must I leave the facility?


About Baby After the Birth:
***What percentage of babies have suction used to clear airways?
*How often are warmers used?
*Do you allow the vernix to be rubbed in rather than washed off?
*****Can the family be allowed some bonding time before routine exams are given?
*****Can examination of baby be done while still held by parents?
*Is weighing done in the room?
***What is used and when is eye care done, can it be delayed?
*****What is his/her view of breastfeeding?
*****Does s/he encourage women to breastfeed?
*What is his/her view of circumcision? (This is a personal decision. You guys have plenty of time to research & decide)
When, why and on what percentage of boys does s/he do circumcision?
*****Does s/he use anesthesia for circumcision?
Will s/he participate in religious rituals regarding circumcision?
*****How soon after going home, and how often thereafter, does the dr. see the mother and baby?