interviewing homebirth midwife, HELP! - Mothering Forums

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#1 of 11 Old 08-24-2006, 01:28 PM - Thread Starter
 
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i'm interviewing a midwife today for my HBAC and i haven't given much thought to what i should ask. i'm totally unfamiliar with the standard questions or things i need to know about her practice. does anyone have any suggestions? so far i've come up with:

1. what is included in the fees? what will i need to provide?
2. at what point in my labor will you or your assistant come to my home?
3. what is your hospital transfer rate?
4. what experience do you have with VBAC?

... after that, my mind draws a blank. i know there are other things i should ask about but it's too early to think and i've got morning sickness to boot!
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#2 of 11 Old 08-24-2006, 01:30 PM
 
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"How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?"
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#3 of 11 Old 08-24-2006, 01:33 PM - Thread Starter
 
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AHH. of course! thank you! i really am out of it today.
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#4 of 11 Old 08-24-2006, 01:35 PM
 
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Do you have guidelines or restrictions about who can give birth at home?
What is your definition of "high-risk"?
When do I call you?
How would you handle a hemorrhage?

eating drinking, moving, blood tests,

What is your back-up system during pregnancy and labor—when you go on vacation, are sick or with another mother?
Have you ever missed a birth? If so, what were the circumstances?
Are you available 24 hours a day at all times?

Prenatal Care

What are your expectations of clients during pregnancy?
Can you recommend or will you loan to us appropriate books , videos, internet sites, etc. to help us prepare for homebirth?
Do you require or recommend that my husband and I take a childbirth education class or attend pregnancy discussion groups?
What do your checkups consist of?
Do you allow the mother to go past 42 weeks and still have a homebirth?
What are your standards for preeclampsia?
Do you come to my home any time before I go into labor?


Hospital and Obstetrician

What situations do you consult the Obstetrician for?
What problems or complications in pregnancy would mean that a physician would become my primary maternity caregiver?
Under what circumstances do you transfer to hospital?
What is your percentage of hospital transfers?
What is your Cesarean rate? What are the most common reasons?
What would be the plan of action if a transfer to hospital were necessary?
What care would you give me if I need to transfer?
Would you stay with me in the hospital? In the operating room? For how long after the birth?


General Labor

What do you perceive your role to be during my labor?
What are your expectations of clients during birth?
What equipment and supplies do you bring to a birth?
How do you handle emergencies?
What natural comfort techniques do you provide?
What pharmaceutical drugs, homeopathics and/or herbs do you use at births?
What is your usual approach to a labor that is progressing slowly?
How often do you listen to baby during labor?
How many people are you comfortable with being present at the labor and birth?
How do you feel about having a doula at a homebirth?
How much time do you allow for the delivery of the placenta?
What is done with the placenta once its delivered?
Do you allow the placenta to be delivered underwater?
What is you episiotomy rate?
What happens if my perineum needs stitching/suturing?
What supplies do I need for the birth? Where can I purchase those supplies?
Do you help with cleanup?
How long do you stay after the birth?

How do I obtain the baby’s birth certificate?
How often do you come to see me after I give birth?
What do these visits include?
How often will I visit you after the birth?
What do these visits include?
Why are they important?
Do you examine the baby at any or all of your visits?
What does the examination include?
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#5 of 11 Old 08-24-2006, 01:48 PM - Thread Starter
 
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oh, you are fabsulous! thank you SO much for that list. i'm printing those questions off right now.
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#6 of 11 Old 08-24-2006, 02:20 PM
 
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I asked a lot of "situation" questions. like what would you do if ...
that gave me good ideas about their philosophy and approaches.

here's my topic from way back http://www.mothering.com/discussions...d.php?t=222838

Valeria
dd 05.17.2005
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#7 of 11 Old 08-24-2006, 11:17 PM
 
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what a lot of great ideas! thank you all!

here are my scribbled notes i've jotted down with some of my biggest concerns. i'm interviewing a couple practices soon, and i'll definitely be adding some more q's based on this thread!!

due date determination? transfer of care?
AROM, s&s?
VE during pg and l&d?
under what circumstances would an induction be in order
how often do you like to check heartbeat during labor
how do you think the pushing stage should be managed?
what prenatal tests do you recommend?
transfer rate? episiotomy rate?
back up?
cord clamping and cutting?
GBS?

Rosemary & Gary :
James 12/04 & Cecelia 4/07
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#8 of 11 Old 10-12-2006, 12:59 PM
 
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I thought some of you might find my list of questions to ask midwives when you are deciding on which one will be your care provider useful. It has some questions I didn't find on any other list I came across. Here it goes, hope it's of some use to someone:

How many births have you attended?
How many internal checks do you normally perform?
Do you have a problem using a fetalscope instead of Doppler most of the time?
If you are sick or otherwise unavailable during my labor, who will attend to me?
How many assistants do you normally bring to the birth?
Who are your normal assistants?
What is your hospital transfer rate (or, how many times have you had to go if it's low)?
Does your rate include transfers that occur during labor, or all transfers, including conditions that develop before labor? If it includes all of them, do you know a breakdown of before labor/during labor transfers (just trying to get a feel for how many moms transfer during labor)?
What is your typical transfer, one that requires intervention, or one where the mom desires it?
What is your c-section rate?
What hospitals have you transferred to? (The closest to us is South Austin Hospital)
What is your favorite hospital to transfer to?
Do you stay with me after the transfer and offer support for my decisions the best you can?
If I develop a condition that makes me high risk, do you have a doctor you normally use to transfer my care to? Do you also try to use this doctor for transfers during labor?
What is your cut-off for considering a baby to be premature and requiring a hospital birth?
What happens if I go past 42 weeks?
What conditions make me high risk (GD, etc)? Do you have herbal protocols to try to follow for these conditions before labeling a client as high risk (GD, preeclampsia, etc)? At what point would placenta previa make me high risk?
What are your normal guidelines for weight gain, or do you just stress good nutrition?
Do you deliver breech babies?
What do you try to turn a breech baby?
How long are you willing to wait for a baby in a bad position to change positions before labelling the pregnancy high risk?
What percentage of your clients tear?
What is your protocol to prevent tearing? Would you mind incorporating some of the stuff from my last midwife if I get exact details?
How many 3rd or 4th degree tears have you had? Up to what degree do you suture? How many episiotomies have you performed?
How long are you willing to let a client push, or do you base it solely on the baby's stress level?
Are you willing to use alternative protocols for Strep B such as grapefruit seed extract?
Do you have a protocol to help prevent me from being positive for Strep B?
Do you have a problem waiting for a while after the placenta is delivered to cut the cord?
What protocol do you use to stop excessive bleeding after delivery?
Have you had experience breaking the clavicle if it ever becomes necessary during a dystocia incident?
Have you had experience with cord prolapse?
Do you have any special things you do after a birth such as an herbal bath?
During labor, how active are you in checking the client, etc? During the last labor, for most of the time, my husband and I preferred to labor alone in a separate room for the most part (until pushing), I suspect it might work out the same this time, is that okay?
If my water breaks early again, and the baby's head is not high, then I don't desire anything but gentle herbal labor stimulation (NO castor oil). Am I an automatic hospital transfer after 24 hours, or can I sign something that allows me to go longer?
What equipment do you normally bring to the birth (birthing stool? blow-up pool? oxygen? ambu-bag? pitocin shot?)
Under what conditions would you artificially rupture the amniotic sac?
Do you do the required newborn screening bloodtests, or will I need to see a doctor for this?
What is your fee?
What happens with your fee if I have to transfer out of your care?
Do you file with insurance? Have you had any experience filing with Aetna PPO?
Do you require that I take a childbirth education class?
Have you had any bad outcomes for the baby or the mother? Please explain them.
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#9 of 11 Old 12-05-2006, 07:45 PM
 
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EDUCATION/EXPERIENCE/STATISTICS
How, when and where did you receive your education in midwifery? Are you also a nurse? Are you certified or licensed and by whom?

How long have you practiced? Approximately how many births have you attended? Would you give me the name of a few mothers as references?

Do you maintain statistics from your practice? May I see them? Do you participate in regular peer review?

BACKUP CARE/HOSPITAL TRANSFER
What physician collaboration or backup do you have? What percentage of the time is he/she called in? How long will it take for the doctor to get to me? At what point is the back up doctor typically called in? Will I have a say in the decision? Will I have a chance to meet the backup doctor ahead of time? Who covers for the doctor if he or she is busy with another delivery? Is the doctor’s fee included in the fee I pay you? Are you allowed to stay with me if we have to call the doctor? May you stay if I have a cesarean?

What is your transfer rate? What is the number one reason a mother has to transfer in your practice? What are some other reasons we would transfer to the hospital?

What arrangements do you have to transfer a home birthing mother or baby to the hospital if needed? To what hospital do you transport if this becomes necessary? Who will go with me? Do you have an arrangement with the hospital that allows you to attend or co-manage my birth in the hospital?

Who covers for you if you are on vacation or are occupied with another mother in labor? Are your backup midwives also certified and licensed, and what is their experience? Do you work with a partner? If so, what are her qualifications?

POLICIES
At what point in my labor will you come to me? How long will it take for you to get to me? Will you stay with me during my whole labor if I want you to?

How many women are due within a month of my due date? What is your plan if someone else is in labor when I am?

Do you use pharmaceutical products to induce labor?

What prenatal tests do you require/recommend? If I am found to be high risk, can you and a specialist co-manage my care? What kinds of conditions would risk me out of your practice and eliminate the possibility of a homebirth? Will you deliver my baby if he/she is early or overdue? By how many weeks?

Do you provide childbirth education or work with someone who does? Do you recommend a particular method?

What are your recommendations about my diet during pregnancy? (You should be wary of anyone who recommends a weight gain of less than 25 or 30 pounds. If you are overweight, you should not be encouraged to lose weight or to avoid gaining beyond a certain number of pounds. Watch out for practitioners who recommend salt restriction.)

What is the schedule of prenatal/postpartum appointments? What postpartum services do you provide?

What are your fees? If I need an ultrasound or other testing, how is that handled?

Do you have training or experience in alternative medicine? What sorts of things do you recommend to deal with the discomforts of pregnancy (morning sickness, headaches)? Will you recommend alternative therapies before pharmaceutical ones? Do you have contacts in the area who perform things like acupressure/puncture or massage?

EMERGENCY SITUATION
Do you carry an oxygen tank to births? What other resuscitation equipment do you bring to the delivery? Is your certification in neonatal resuscitation up to date? What pharmaceutical products/herbs to you bring in case of hemorrhage or other complications?

mama to 3 girls: Abigail 2.12.05, Eliana 8.26.06, Willa 1.9.09
RN-BSN 5/11, CBE, former doula
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#10 of 11 Old 01-10-2007, 11:33 AM
 
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Wow this is a lot of questions. I wouldn't think to ask most of them until the prenatal visits...

Non Practicing Midwife, going back to school! Mamma to my 3 loves, living each day to the fullest.
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#11 of 11 Old 01-20-2007, 09:43 PM
 
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And then ask yourself, even she has all of the "right" answers, "Do I want this person at my most intimate moment?" Your intuition will shout out Yes! or No!
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