what ???'s do I ask the mw during interview?

mom2baldie emailed me some great midwife questions just a few days ago. Here they are:

How many babies does she catch per month?
What happens if you have 2 clients laboring at 1 time?
Have you ever missed a birth?
Do you work with a partner or assistant? Who are a few of the midwives you work with? Can I meet/talk with them before my birth?
What kind of complications would cause me to be transfered out of you care prenatally?
What is your (prenatal) transfer rate? As an example - Dinahs was aout 7-8%.
What routine tests does she require? (GD, AFP, GBS, sonos...)
Are there any sort of birth scenarios that you would be uncomfortable attending at home?
What happens if I go past my due date? What hapens if I get close to 42 weeks gestation?
How often do you listen to baby during labor? During pushing?
How soon after I start labor will she come to my house?
Will she help me during labor - as opposed to doing paperwork...?
Does she do vag. breech births? Will she recommend/attempt an ECV?
How does s/he handle premature rupture of the membranes at term?
How does she handle a long labor?
What is your policy when labor 'stalls', are there time limits?
What is her policy concerning AROM?
How often does she do vaginal exams during labor?
Does she ever do episiotomies? How often?
What % of your clients give birth intact?
What medical complications require transport to the hospital?
Will she be able to continue labor support should I need to go to the hospital?
What is her c-section rate? Dinahs was 2.5%
How long does s/he wait to cut the cord and deliver the placenta?
What does she do if there is a PPH?

Some of these are probably a repeat of the last poster, but here's my list from when I interviewed some mw's. I got them off this website: http://birthfind.homestead.com/interview.html

I added a few to the list but can't find the original one I wrote down. I'll edit if I find it soon.

1. What type of training have you
received? How long have you been
practicing?

2. How many babies have you helped deliver?

3. Do you have physician backup? Whom?

4. What type of medical equipment do you bring? What is your monitoring protocol?

5. What type of complications have you handled?

7. Under what circumstances would you transfer care to an OB in pregnancy or call for a hospital transport in labor?

8. What is included in your prenatal and postnatal care?

9. What are your fees and what do they include?

10. If applicable, what kind of insurance to you accept?

11. In case of emergency transport, would you come with me to the hospital?

12. Do you carry and are you allowed to use drugs for emergencies?

13. Do you perform suturing if required?

14. What is your position on vaginal exams late in pregnancy?

15. What is your position on episiotomies?

16. Are you experienced in waterbirth?

17. Under what circumstances (health or otherwise) would you not accept a client? What about multiples, breech, VBAC, etc.?

18. What kind of midwife are you? CPM, DEM, CNM, Lay?

19. What is your usual recommendation if pregnancy goes beyond 42 weeks? Is it different for first time moms? What is your pro tocol if I choose not to follow your recommendation?

20. What is your protocol for managing a posterior birth? Do you have experience manually turning a posterior baby?

HTH

Shannon

I guess I am an Ina May groupie, because I am always referring to her! Page 305 of Ina May's Guide to Childbirth starts a chapter titled "choosing a caregiver." In that chapter she has 15 or so questions for home-birth midwives. Just cuz I'm that kinda gal, I would be willing to type them up, but posting them all online may be a no-no for copyright reasons. They are similar to the questions the pps mentioned. A couple that jumped out at me are:

-Do you maintain statistics for you practice? May I see them?

-How many women are due within a month of my due date?
[this is ZeldasMom talking--Ina May has several questions related to this--my midwife takes no more than 4 by the way]

-What are your recommendations about 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 avoid gaining beyond a certain number of pounds. Watch out for practitioners who recommend salt restriction.)

-Is your certification for neonatal resuscitation up to date?

-Do you participate in regular peer review?

So that gives you a flavor. When I interviewed the midwife I chose I was much less methodical about it. I didn't have a list of questions. I shared my approach to birth and asked if she would be comfortable with that (i.e. I want to labor on my own as long as possible w/o her there). I asked her about some of the issues the pp mentioned just to get a sense of her approach to birth, but I didn't feel that I had to hit everything that might come up.

I think interviewing a midwife is a personal thing because different things are important to different people. I wanted a person who read medical literature and took an individualized/evidence-based approach. I also wanted someone who got the mindset of it's my birth, I'm in charge. My midwife gives me info, then I make the decision about things like testing for gestational diabetes, group beta strep, etc. I wouldn't want someone who took the approach of "I have all my clients do X."

So far I have only phone interviewed 2 midwives (1 CPM, 1 lay, both same practice). I wasn't expecting a call from the lay (who is my favorite and will probably either by my primary MW or my doula if I choose a birth center). She called and we talked for four hours. We talked about everything from birth, to vaccinations, to child raising, etc. I pretty much explained what happened in my first birth and why it happened (ie 'needed' vaccumn assistance, major tearing, etc). I then told her how I wanted to labor and she went on to tell me how she usually gives the woman options, then they decided together, but she never goes against the mothers wishes. She also explained why they would transfer during labor / prenatal.

After I got off the phone with her I felt like I had known her all my life, like she was a sister. I also spoke with the CPM today, and we spoke in the same monor, very relaxed, I voiced my concerns and she told me her philosiphies. However, I only spoke with these midwives, but I have no desire to seek out anyone else. I just feel like we clicked and our views are right on. So if I choose a hb then I will go with them, if I choose a BC birth, then I will use the lay midwife as a doula.

I didn't really know what people ment when they said "When you find 'the one' you will know." but now I do.

Some of these questions are more of a test as to what the type of philosophy the midwife really has, as you can't just ask "Hey, what's your philosphy on the pregnancy, birth thing"...lol. I think I had a few more questions but I can't find them right now. But this is a pretty good list of questions that usually don't get asked.

Do you deliver in the water, or just let me labor in the tub?
What are the top 3 reasons for transfer?
Who will be present (assistants)?
How many births have you attended/assisted?
Have you dealt with hemorraging before?
How would you handle lowered infant heartrate during delivery?
How do you feel about dad catching?
Would you stip the membranes, or break the waters to speed up labor?
What type of things do you bring with you to assist the woman in laboring?
Do you allow food and drink during and after labor/delivery?
What do you require having done before leaving?
How long do most pre-natal visits last?
What is done on most typical visits?
Are children allowed at pre-natal visits, and at the delivery?
How do you handle a transfer?
Is it necessary to attend any classes during the pregnancy?
Do you offer breastfeeding support? For how long?
How many post-partum visits do I get?
Do you have a home visit after the delivery (can you come out to Lowell)?
What would make you transfer me to a doctors care?
Under what circumstances would you induce?
How would you go about it?
Does it have to be done at a hospital?
Can you name a few unusual things you've dealt with?
Would a breech delivery always be dealt with at the hospital?
If you discover a breech delivery during labor, would you transfer?
At what point during labor do you like to be present?
How long would it take you to get there?
How long do you usually stay after the delivery?
Do you require the vitamin K shot, and eye ointment?
What is done without question, or will you ask before doing ANYTHING??
How long do you wait to cut the umbilical cord?
How flexible are you on payment options, as long as the total is paid up when due?
How do you feel about me staying mobile through the entire labor?
What positions are ok for me to be in when pushing?
How often do you check me during labor? Do I have a choice?
When I am at 10cm do I have to push or can I wait until I feel an urge?
How long can I labor, before I am transferred assuming there are no real complications?
What reasons would you recommend a C-section?
How far overdue do you feel is reasonable?
If my water breaks first, how long can I labor before home/birthcenter is out of the question?
Can I do my own urine strip test and weighing at each visit, or are they even necessary?
Do you post the birth in the paper or online?
Do you have a limit for how many people can be present (not that I really want an audience but&#8230?
Do you check the cervix at each visit, or just near the end of the pregnancy?
How often during the pregnancy do you do breast exams?
If something comes up and I do become a high risk, will you still be working with me?
If I am high risk can a midwife still be present and do most of the work at the hospital?
Can you work in conjuction with a doctor?

This is my list I came up with after gathering questions from all sorts of sources (seen end of list). In my phone interviews, I only asked a few questions:

1) How much homebirth and emergency experiences have you had?
2) Are you available around October 14?
3) Do you consider yourself to be hands-off during labor and birth?
4) Do you have any protocols which might affect my ability to give birth at home (such as no births past 42 weeks, no breach babies, etc.)?
5) Do you have water birth experience?

The phone interviews were to get a feel for the personality of the midwife, and to see if their voice wasn't annoying (seriously, must be mature, lower, calming voice--no valley girls please.).

I ended up only interviewing one midwife in person. I requested references as this particular midwife isn't well-known in my community (but has been a doula for a long time, which is a plus to me); I am still in the process of talking to all the references (3) before I officially hire the midwife.

The list below is really anal, I guess. But it helped *me* get a grasp on the details of homebirth, what to consider, etc. And, yes, in my discussion with my midwife, most of these questions were answered without my asking; or some of the questions didn't matter to me or didn't apply (I didn't want a licensed midwife, and didn't care if she went to peer group meetings, etc.)

Please let me know if you notice any typos or if I missed anything. Thanks.

Here are the five most important things my family is looking for in our homebirth:
1.
2 -
3 -
4 -
5 -

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What should I ask myself about the experience of meeting with a maternity caregiver?

+ When you go to interview a caregiver and during your prenatal visits, ask yourself how you feel about the experience:

+ Is this person listening to me and respectful of my wish to make careful decisions?

+ Is the person willing to take the time to answer my questions to my satisfaction?

+ Does this person share my vision for my maternity care and birth?

+ Do I think that I can feel comfortable with and trust this person?

+ Can I get what I want from this person?

+ Does this feel right for me?

This person will be working intimately with you and your family through one of the most important times of your life. Follow your instincts. Only you can make the decision that is right for you. If you have concerns, even if you are well into your pregnancy and prenatal care, it may be important to explore other options
================================================== ========

QUESTIONS

My due date is around ___. Are you available?

Experience

1. What is your general philosophy of care; what are your basic beliefs about pregnancy and birth?
2 a) Are you a mother yourself? How old are your children now?
b) How were your babies born?
3. Why did you become a midwife?
4 a) How long have you been involved in birth?
b) How many years have you been practicing as a midwife?
5 a) How many births have you attended as the primary caregiver?
b) How many of these births were in the hospital? In a birth center? At home?
7. How many births do you attend in a year?
8 a) What is your education and training as a midwife?
b) Where did you train and when (in a home or hospital setting)?
c) Are you licensed or certified? By what organization? Why or why not? What are the pros and cons of being and not being licensed?
d) Do you take refresher courses and extra skills courses?
e) Have you had any long periods away from practice? If so, what did you do to update your skills and knowledge?
9. Do you participate in a local midwife peer review group? What is the purpose of these meetings? How many meetings have you attended in the past year?
10. How does your practice vary for different women?
11. Do you have guidelines or restrictions about who can give birth at home?
12 a) What is your definition of "high-risk"?
b) What is your policy regarding high-risk pregnancies: breech or transverse lie babies, twins, mother over age 35, high blood pressure, diabetes, fetal distress, toxemia, VBAC?
c) If you do attend births with these types of situations at home, what is your experience with each of these?
d) How would you handle a hemorrhage?
e) What extra back up is provided for these high-risk situations?
13 a) Do you work alone or with a partner or assistant?
b) If you work with someone else, how would I get to know everyone who may attend my birth?
c) If you work with several, what happens if I don't want one of them, or prefer one of them at my birth?
d) How often will I see this assistant during pregnancy?
e) What exactly is the assistant's role?
14 a) How many mothers do you have due around the same time as me?
b) Do you have a maximum number of mothers you will work with at a time/in a month?
c) How do you manage to avoid too many commitments?
d) What do you do if two women go into labor at the same time?
e) What is your back-up system during pregnancy and labor-when you go on vacation, are sick or with another mother?
f) Have you ever missed a birth? If so, what were the circumstances?
15 a) What is your communications system like?
b) Do you have a beeper or cell phone? If not, how do I reach you?
c) Are you available 24 hours a day at all times?
16. Will you give me the contact numbers for some of your recent clients?
17. Will you give me the contact numbers for any other midwives to interview?

Prenatal Care

1. What do you perceive your role to be during my pregnancy; and what are your goals for prenatal care?
2. What are your expectations of clients during pregnancy?
3. Can you recommend or will you loan to us appropriate books , videos, internet sites, etc. to help us prepare for homebirth?
4. Do you require or recommend that my husband and I take a childbirth education class or attend pregnancy discussion groups? Do you lead such a class or group; or can you refer me to one?
5 a) How soon will I be able to start my prenatal checkups?
b) Where will my prenatal visits be held?
c) How often will I see you?
d) How long are the checkup appointments?
e) What do your checkups consist of?
f) Do you do internal exams?
g) How many women do you see at prenatals daily?
6. What pharmaceutical drugs, homeopathics and/or herbs do you use prenatally?
7. Do you recommend "routine" blood tests or other types of tests? If so, do you provide these tests?
8. Do you require that I see a physician during my pregnancy even if everything is all right?
9 a) What are your expectations of me regarding self-care in pregnancy?
b) What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise?
10. What are your guidelines concerning the length of pregnancy? Do you allow the mother to go past 42 weeks and still have a homebirth?
11. What are your standards for preeclampsia?
12. Do you come to my home any time before I go into labor?

Hospital and Obstetrician

1. Do you attend births in a birthing center or hospital?
2 a) Do you refer to or work closely with any doctors?
b) Why?
c) If you do, who are they?
d) Do I need to see him/her prenatally?
e) What situations do you consult him/her for?
3 a) Do you have a particular backup physician/hospital?
b) Is this covered by my insurance?
c) If not, can you work with a physician/hospital under my insurance plan?
d) Do you have pediatric backup?
4 a) What problems or complications in pregnancy would mean that a physician would become my primary maternity caregiver?
b) What arrangements would you have for my care should I develop one of these complications or problems?
c) Would you continue to have a role in my care?
5 a) What hospital would my baby be taken to, in the case of an unforeseen complication?
b) What is the procedure for transfer?
6 a) Under what circumstances do you transfer to hospital?
b) What is your percentage of hospital transfers?
c) What is your Cesarean rate? What are the most common reasons?
e) What would be the plan of action if a transfer to hospital were necessary?
f) Which hospital would we go to if I needed to be transferred?
g) What care would you give me if I need to transfer?
h) What are your privileges in this hospital setting?
i) Would you stay with me in the hospital? In the operating room? For how long after the birth?

General Labor

1. What do you perceive your role to be during my labor?
2. What are your expectations of clients during birth?
3. How early into the labor do you come to my house? When should I call you to come?
4. What equipment and supplies do you bring to a birth? Do you bring oxygen, IV fluids, ambu-bag for baby (what is this?), resuscitation equipment, medications for hemorrhage (pitocin or methergine), suturing materials?
5. How do you handle emergencies?
6. What natural comfort techniques do you provide?
7. What pharmaceutical drugs, homeopathics and/or herbs do you use at births?
8. What is your usual approach to a labor that is progressing slowly?
9. Do you let us do whatever we want during labor? (drink water, eat food, choose positions, etc.)
10. Do you do internal exams during labor?
11 a) What sort of monitoring of the baby do you use during labor?
b) How often do you listen to baby during labor?
c) I want the use of a fetoscope, but not a Doppler. How do you feel about this?
12 a) How many people are you comfortable with being present at the labor and birth?
b) Do you encourage family participation? How? Will you allow my partner to be as active at the birth as he desires?
c) Do I get to decide who catches my baby (myself, my husband, my child)?
d) What suggestions do you have regarding siblings being present?
e) How do you feel about having a doula at a homebirth?
13. Do you wait until the cord has stopped pulsating before it gets cut?
14. How much time do you allow for the delivery of the placenta? What is done with the placenta once its delivered?
15 a) Are you comfortable with water birth?
b) How many home water births have you attended?
c) Do you allow the placenta to be delivered underwater?
d) Do you have a tub the clients can use?
16 a) What is your policy regarding episiotomies?
b) What is you episiotomy rate?
c) What is you rate of tears or intact perineum?
d) What happens if my perineum needs stitching/suturing?
17. What supplies do I need for the birth? Where can I purchase those supplies?
18. Do you help with cleanup?
19. How long do you stay after the birth?

Financial Matters

1. What are your fees and what do they include? How many prenatal visits, how many postnatal visits, how many home visits, sibling preparation, lab work, prepared childbirth classes?
2 a) What is NOT included in your fee?
b) What other costs might I incur? Lab work, prenatal testing, birth classes, extra supplies and birth kits, suturing?
3. Can you submit your charges to my insurance company?
4 a) What payment arrangements do you make?
b) Installments; before or after the birth?
c) When is payment expected?
d) Do you accept alternative methods of payment, such as sliding scale, time payments, or barter?
5. What if, for some reason, you are not available to attend my birth?
6 a) What if I need to transfer to someone else for care?
b) How much does your backup physician charge?
c) What are basic hospital charges?

The Baby

1 a) Have you ever had to resuscitate a baby?
b) Have you ever lost a baby under your care? What were the circumstances?
2 a) Do you examine the baby after birth?
b) What does this examination include?
c) Does it include Apgar assessment, evaluating my baby's heart rate, breathing, muscle tone, reflex response, and color?
3. Do you give antibiotic ointment eye drops to the baby?
4. Do you recommend giving oral Vitamin K to help baby's blood clot; if so, do you carry it yourself?
5. Do you recommend newborn hearing tests? Is this done only in a hospital?
6. Do you recommend a PKA blood test? Is this done only in a hospital? [Heel is pricked and a small amount of blood taken to test for phenylketonuria (PKU), hypothyroidism, and other disorders.]
7. Will you help me with breastfeeding?
8. How do you feel about circumcision and immunizations?
9. Do I need to bring my baby in to meet a pediatrician?
10. Do you have a pediatrician you work with or recommend?
11. How do I obtain the baby's birth certificate?

Postnatal Care

1. What do you perceive your role to be after the baby is born?
2. How often do you come to see me after I give birth?
3. Do you provide or know of anyone who will help new mothers after birth?
4 a) How often will you visit me at my home after the birth?
b) What do these visits include?
c) Why are they important?
5 a) How often will I visit you after the birth?
b) What do these visits include?
c) Why are they important?
6. Do you examine the baby at any or all of your visits? What does the examination include?

Sources:
Heart and Hands : a Midwife's Guide to Pregnancy and Birth
http://www.maternitywise.org/mw/top...giver/tips.html
http://www.socalbirth.org/resource/question.htm
http://www.gentlebirth.org/archives/intrvu.html
http://www.midwifemama.com/interview_midwife.html

: :

Thanks a lot!

Thanks, I'm very anal.

undunesorte:

I have not heard of this question until this thread:
How often during the pregnancy do you do breast exams?

I've not heard of hb midwives doing breast exams. Can you give me more info?

Any other questions I missed on my list?

Thanks again for all the good information. We compiled a list of questions from the ones given and had everything ready for our interview this morning. It went great! We have 2 more interviews next week before we decide on a midwife, but dh is already feeling much better about homebirth!

Melissa