Most important ?s to ask potential midwife?

[kel]

We need to start looking for a midwife soon and I was wondering what others think are say, the 4 or 5 most important questions to ask a midwife when you're deciding who to choose for your care? Where we live most of the midwives are CNMs and do hospital/"birthing room" birthes, but there is also one lay midwife around here that I know of. Most of the midwives are women, but one that I've also heard good things about is a man. Since I have 3 kids in tow, and we only have one vehicle, I'll probably email a number of different midwives initially with a few choice questions, and go from there.

In the past I've had one planned birth center birth that ended up at the hospital (and was a pretty horrible experience), one great birth center birth, and one satisfactory :) home birth (it was at my in-laws as we were between homes, so what can I say!) I am generally pretty hospital phobic, but I don't want that to be the only reason I choose the lay midwife if one of the CNMs is better suited for us. I generally prefer women doctors, but again I don't want to be totally closed off to a male CNM if he's great. With all of those factors, what do you think should be my top questions?

THANKS!!!

[Apricot]

When would you expect to see me?
(Pre and Post Natal visits, when in labor, etc.)

[safe womb]

I would ask
Where did you get your education from?
How many births have you done?
What do you do in an emergency?
What do you call an emergency?
do you do episeotomies?
DO you suction on the perineum?
what do you carry with you?
what are your bounderies? 24 hour after ROM, 2 week post dates? is she firm on these?
have you lost a baby or mom?
does she coach you in labor?
can dad catch baby?
can kids be there?
does she have back up?
does she work with another midwife?
does she have an apprentice?
what will she do for you if you are in pain in labor, what are her tricks?

[KeysMama]

I did/would ask:

~What is your basic philosophy of birth?
you can tell lots by the answer - woman centered, Midwife centered, baby centered....you can tell by the answers....

~May I meet all backup MW and Asst's?

if it is no, then DOINK!

~Do you have a direct OB/Hospital Backup or do we just go if we need to?
not a big deal either way, just nice to know....

~Are you comfortable with my refusal of certain tests/procedures?
ya better be!

~What are some of your more interesting/unusal birth experiences?
just neat to hear what they consider unusual

[And although I don't come out and ask, I may fish for it because it is important to me]:

~Are you Pro- Choice?

[XM]

I would ask how many babies she has lost in how many years of practice, and doublecheck with the state to make sure she is not being investigated for malpractice. A good midwife should not think twice about you asking how many babies she's lost... if she gets her guard up I would move on. Not as fun as asking if Dad gets to catch, but your baby needs for you to know this information.

There is a MW in our area who is currently being investigated by the state for losing 3 babies in less then two years, two of whom I know were healthy term babies (compared to my midwife friend who has lost 2 in 16 years, one was born at 25 weeks and one had placental problems)... she is a favorite of some of the Bradley teachers in the area, who continue to refer students to her despite this. So if you did'nt ask about babies lost, and did'nt follow up with the state, you'd think she was fantastic...

XM

[KeysMama]

Originally posted by XM
I would ask how many babies she has lost in how many years of practice, and doublecheck with the state to make sure she is not being investigated for malpractice. A good midwife should not think twice about you asking how many babies she's lost... if she gets her guard up I would move on.

If you ask Doctors the same question you get real vague answers...recently a client of mine asked the Doctor for his c/s and mortality rates and he 'declined to make it personal' but then cited "national' averages....:rolleyes:

[XM]

Good point, KeysMama, but we're talking about midwives :) and I have never had a midwife try to dance around that question, I have always been answered in a straightforward manner. I would expect that of a doctor, though :rolleyes:

[mamaduck]

I would ask for a sheet with all their stats. including,
# of births for the past year,
% or episiotomies
% of transfers to hosptal
% ended with C-section
any deaths
The birth center I used had this information on hand, and it was only a matter of making a photocopy for me.

I would also want to know who the back-up practioners are and when I could meet them.

Who will be in the room at the birth (students? nurses?) and when could you meet them? And could you refuse to have them at the birth, if you wanted to?

Could you bring whoever you wanted to the birth? Limits on how many people?

I would want to know what reasons they would have to transfer you to the hospital.

That is all I can think of right now.

[mamaduck]

Oh yeah -- of course --

I would ask if she is comfortable with me making sounds, noises, yells, screams or whatever I feel I need to do.

And is she comfortable with me walking around a lot and choosing my birthing position.

[kel]

Lots of good points - thanks!!!
-Kelly

[captain optimism]

We picked our midwifery practice based on the way they answered our questions. Let me be a little more accurate about that: I couldn't make the phone calls to the practioners from work because i didn't want to tell people I was expecting until I finished the first trimester. So I typed up a list of questions for my dh to ask the midwives. They were similar questions to the ones already posted in the thread, but there were a LOT of them! The midwife my dh spoke with stayed on the phone with him, really relaxed and kind as she answered the whole barrage. That by itself let me know that the CNM practice was committed to patient-centered care.

The most important question to me was who attends the birth and how much of the birth does she attend. This was a major reason why I didn't go with the nice and smart OB-GYN I saw first, because i had no way to guarantee she would attend my birth, and why I wasn't crazy about a practice with only one midwife. Our midwives share the practice, whoever is on duty attends the birth, so every patient meets every midwife for prenatal appointments beforehand. And each midwife stays with each patient through the whole labor and birth. I'll let you know how it goes after the labor, but I've been very happy with the prenatal care.

[Mallory]

I really like
What books should I read?
If they say What to Expect When You are Expecting and Girlfriends Guide to Pregnancy, you can just say thanks. But if they say spirtual midwifery and sear's birth book you can set up an appointment! (those were the responses of my ob-gyn and then the cnm I switched to at 6 months pregnant)

[gurumama]

If it's a CNM, one of the most important questions is: What hospital policies are you forced to comply with? (i.e. 20 minutes on the fetal monitor) and Have you and the OB back-up ever disagreed on how to proceed with a laboring mother, and how do you handle that?

[Helix]

Are there any women you do not accept as patients?

Do you ever induce labor? If so, for what reasons? At how many weeks gestation? What induction agents do you use?

How much weight should a pregnant woman gain? What do you believe is an unsafe amount (too much or too little)?

How do you monitor labor - electronically? Fetoscope or stethoscope? How often?

What do you consider abnormal labor?

How do you confirm fetal distress?

What do you see your role as during birth? The mother's role? The father's?

Which people do you allow to be present for the birth? Do you allow children?

How long a labor is too long? How long spent during the second stage is too long?

How long do you allow to expel the placenta? Do you use abdominal pressure or drugs for this?

Are you willing to let the baby go without shots and eye ointment?

Do you have children? How were they born?

What is your philosophy of birth?

How do you calculate a due date?

Do you believe it is dangerous for a baby to be born in any certain position (breech, posterior, etc.)?

(If at a facility) How long do you expect the mother to stay after delivery? Is the father allowed to stay as well? Suppose the mother wants to stay for longer or shorter than you recommend?

What is your opinion of unassisted childbirth?

How much noise do you permit laboring women to make?

Do you mind answering so many questions?

[Greaseball]

I like to make sure that whomever I am thinking of going with does not have a view of birth as this negative, dangerous process. For example, I'll ask "What do you think is the main cause of death during childbirth?" If she answers "Hospital infections, doctors not washing their hands, and poor living conditions" then she sounds about right, but I wouldn't think so if she said something like "It's because of women's defective bodies and also the lack of episiotomies."

[Hippie_Mama]

As of last Friday th question that comes to my mind is:

Will you catch twins? [I phrased it this way because I agree that doctor's deliver babies.Whereas midwives allow the mother to deliver her baby and the midwife is simply there to support the mother and be a babycatcher.]

Even if you *think* you won't be havig twins...you may get a suprise. I found out at the end of my 28th week(last Friday) that I have been blessed with twins. Three days later,I found out that my CNM(whose care I've been under since the moment I found out I was pregnant at 8 weeks) will not catch twins.In aditon,she currently does not have priviledges at any hospitals.She will be giving me referrals(hopefully to a midwife that will catch twins). Such a shame to because she is a competent caring person. I was REALLY looking forward to her and I welcoming my new baby(now babies) together.

Linda
EDD 4/6/03 with Twins!

[Hippie_Mama]

P.S. sorry about all of the typos. I should have proof read my post.

[fourlittlebirds]

My weeder questions:

1) What is the level of involvement in the labor and birth that you are personally most comfortable with? And, what is the level of involvement that you are required to have? (Give specifics.)

2) How do you typically manage second and third stages of labor?

3) What is your strategy for a long labor?

4) What are your statistics? (Mortality, episiotomy, etc.)

5) What do you feel is the ideal way for a woman to behave in labor?

[Greaseball]

Yes, good question about what is the ideal way to behave. I want to be able to scream and cry and swear and make a giant mess and strip of all my clothes. I don't want someone there who expects me to act "ladylike."

I also try to get the definition of "natural childbirth." The ACOG says it's "any delivery where the mother remains awake and delivers vaginally." I would want a midwife to know there are several situations that meet the ACOG definition that most certainly are not natural!

I want someone who thinks it is a privilege to be there, not an entitlement. Someone who fully believes in unassisted childbirth, someone who knows that women have been delivering their own babies since the beginning of time without complications. Someone who believes in the mother's ability to do it without her, but who is there anyway just because the mother wants her to be there. (I know, that might not make sense.)

[mischievium]

As a future CNM (I am supposed to hear back from the nursing schools I applied to next week-- where's an emoticon of praying hands when you need one?), I found this thread really interesting. Stuff to keep in mind for when I'm being interviewed by potential clients.

[jkwatkins]

Questions from Sheila Kitzinger's book, Homebirth.

How long has she been a midwife?
Why did she become a midwife?
What was her training?
How many mothers has she delivered, and of these how many were homebirths or not in a large hospital?
Does she work with other midwives?
If she works alone, what happens if two women she has booked are in labor at the same time?
If she works with other midwives, will you be able to meet them?
What is her backup system? Does she work closely with any doctors?
What does she carry with her in terms of equipment and supplies? Does she carry drugs, for example, for pain relief and to stimulate the uterus?
What resuscitation equipment for the baby does she carry?
What prenatal care does she provide? Are there any homevisits?
Does she offer childbirth classes or pregnancy disscussion groups? If not what classes does she reccommend?
What postpartum care does she provide?
What does she do if a woman has a very long labor?
What is the plan of action if transfer to a hospital should be neccesary?
Under what conditions does she tranfer, What are her tranfer rates?
If she works in a birth center, are there any standard procedures that must be followed regarding admission and when you are in labor, such as compulsory fetal monitioring, birth positions and so on?
What are her views on routine episiotomy? What is her episiotomy rate?
How often do mothers have an intact perineum?
What happens if your perineum requires suturing? will she do this herself or call a doctor?
When are her vacations? If she plans to go on vacation toward the end of your pregnancy or within three weeks after you are due, and you go into labor, whom should you call?

[Greaseball]

I'm just wondering, with all the questions about if they have ever lost a baby...

Would anyone ask that same question of an obstetrician, especially since ob's are more likely than midwives to lose a mom and/or baby? Also, ob's have been sued more often than midwives - according to Birth as an American Rite of Passage, 70% of ob's have been sued.

Also, would anyone dare to ask an ob why they are an ob? Many say things like "Because I love to operate." Their profession has nothing to do with a love of women and babies.

Of course, I realize many people considering a midwife would never see an ob in the first place.