what to look for in a midwife?

[shanniesue2]

Okay, so I'm really new to all this. I don't have a whole lot of knowledge about birthing procedures and what makes a good midwife or a less-skilled midwife. I looked at the sticky and there are a lot of good questions to ask. But I'm not sure I know what the appropriate answers should be.

So, when interviewing midwives... what are some definite red-flags to look for and what are some signs of a competent midwife?

[momma2libby]

: I want to know this, too. I hope someone gives some good suggestions!

[ericswifey27]

a red flag I came across was the midwife I interviewed who swore and was just a bit too casual in our conversation. Hey I swear too but not at work!

I ended up picking a midwife who had a) lots of experience b) was not big on interventions and testing, and most importantly c) believed in ME and my abilities to birth naturally after a csection. Having that absolute confidence from her made all the difference during labor.

[mwherbs]

for me I want someone I can emotionally trust- she listens well and is calm- and is not agressive - how does she treat the people she works with? how does she treat me and my family? and I would ask her to tell me some birth stories- favorites, transports... that is what I would decide on- no matter how experienced or "good" a midwife is suppose to be from the get go I have to feel comfortable---I start there in my judgment/ decision making

[mothercat]

The list of questions is a good place to start. Just remember that some midwives, just like some doctors, know the answers you expect when you ask those questions and may tell you what you want to hear. However, that doesn't mean that is what will happen during the pregnancy and labor.

I would ask others in your community about the midwives you choose to interview or are interested in. Posting on MDC and asking people to PM you with any bad stories is a good way to get honest opinions. If the stories are good they can post them in the forum. Bad stories will earn a warning from the moderators and may be removed anyway.

You will have to use discretion with the stories that others give you. Are you hearing the same story from several different people? Are the things that happened to them, things that would make you uncomfortable?

Ask the midwife to give you the names of clients who have been really happy with her care and the names of clients who have been unhappy, including transports.
If she believes in transparency, she should have her statistics available.
She should also participate in peer review with other midwives to discuss how to improve her practice.
Look for certification by a national organization (NARM or ACNM) and that she is current in neonatal resuscitation and/or ALSO.
She should be involved in her state midwifery organization.
Be cautious when you listen to her answers about any of the above, if she has a lot of reasons why she has not or does not do these things, especially if she's too busy or if she has isolated herself because others are jealous of her and her practice.

I don't mean to be cynical, but I think midwives, and some physicians, have gotten so used to the high touch/low tech, crunchy, non-interventive Q&A, and so have the women, that we forget to ask the questions that will get us deeper into how a provider practices, and show us how they really view their clients and the pregnancies.

[cal195]

For myself, the mw and I have to click. That's important.

Just as important, though, are her answers to several questions:

How many births have you attended at? In this area? Can we have a one or
two names/numbers as references? (These are important for me to get a sense of her experience. The more, the better, though I wouldn't automatically rule out a less-experienced mw as long as I liked her other answers and we clicked.)

What is your transfer rate? What is your c/s rate? What is your episiotomy rate? (She should know her rates of these occurances and be willing to share them with you, and to talk about the circumstances behind why they occur.)

What do you do for cord prolapse? Shoulder dystocia? PPH? (Here I'm looking for specific answers. For cord prolapse, I want to hear that she shoves the baby up inside me with one hand and uses the other to call 911. Or similar. For sd, I would like to hear that she tries various positions, including Gaskin's maneuver, and that if all else fails and baby is starting to become distressed she'll counsel transport for a c/s. For PPH, I want to hear what drugs/herbs she carries and how/why she would use each.)

How long do you allow for the placenta to come out on its own? (I want to hear: lots of time. I also want to hear: I don't ever tug on the placenta.)

Have you ever missed the birth of a client? (In my mind, this should be a rare occurance, and there should be a good reason why it happened, and a backup plan in place for if it would ever happen again.)

What are your expectations for clients through pregnancy? In labor? What do you see as your role during pregnancy? In labor? (These let me get a sense of her overall philosophy and if it meshes sufficiently well with mine.)

And you can think of other questions that would be important to you. I had 3.5 pages of questions for the first meeting with my hb mw. Good thing she was patient, didn't mind answering the questions, and had plenty of time. Those are also good signs in my mind.

hope this helps...

Catherine