How to Hire a Home Birth Midwife

Congratulations. You've done your research and decided that a home birth is the right birthing method for you. Now that your decision is made, you just have to choose the right midwife to attend your blessed event. There are certain questions that you should ask a midwife to make sure that she is the best one for your birth. Like obstetricians, midwives also differ in their training, values and protocols. It's best not to choose a midwife soley based on the recommendation of a friend, but only after an interview process in which you feel comfortable.

Difficulty: Moderate

Instructions

Things You'll Need:

• One to two hours of uninterrupted time
• A list of questions to ask

How to Set Up the Interview

1. Look up available midwives in your area. Some midwives, especially Certified Professional Midwives, are not always found in the phone book. You may have to look online or ask friends and women in your community about the midwives in your area.

2. After you've found a list of midwives, call and check their availability for your due date. Each midwife has her own schedule and usually has a protocol set for how many clients she will take a month. If she has availability for your due date, set up a consultation meeting. Plan to set aside at least one to two hours of uninterrupted time so you may ask lots of questions.

3. Brainstorm a list of questions to ask. The following steps have many initial questions you should ask, but they should also encourage you to think of your own questions. Midwives are generally busy people, so make the hour or two you have with them really count.

How to Conduct the Interview

4. Once the midwife arrives, offer her something to drink and a small snack if possible. This will set up a comfortable setting for both of you.

5. Introduce yourself and your partner, if he is available to meet. Start by discussing the reason you chose to have a home birth and explain that you have some questions you'd like to ask.

6. Ask the midwife about her philosophy of birth and her model of care. Ideally, you want her philosophy about birth to be very similar to yours. Generally, home birth midwives practice the Midwifery Model of Care, but you should ask just to make sure.

7. You should ask about her certifications. Is she licensed through the state? Is she a Certified Professional Midwife or a Certified Nurse Midwife? (The two are very different.) Perhaps she doesn't hold any certifications at all, but has been practicing for 30 years. It isn't that one way is better than the other, but at this point, you should know which type of provider you will feel most comfortable with.

8. Ask about her home birth practice. How many births does she do a month? Can she safely fit you into her birth schedule if she has other clients? Do you feel comfortable if she has someone else close to your delivery date?

9. Ask her about a backup midwife. Does she have a backup midwife who is willing and able to attend your birth if she cannot come? What is the backup midwife's certifications and experience? Can you meet with her also before the birth?

10. Find out if she has any assistants and what their role is during your birth. Many times, midwives take on apprentices, which are midwives in training. To gain their experience, they also have to complete clinical tasks and deliveries. Ask if her apprentice, if she has one, will be doing hands on with you during your birth and if she is available to meet.

11. Ask her about her protocols at births. How many hours will she let you labor at home in a normal labor pattern? What is her protocol for delivery (time wise) after your amniotic sac ruptures? Does she attend water births?

12. Ask her about her transport rate. How does she typically transport a mom to a hospital if needed? Is it by family car or ambulance? What are her protocols for necessary transport? All midwives follow their own protocols in addition to the state rules and regulations regarding transport to a medical center. Does she stay with you?

13. You should ask if she is able to administer IV fluids if necessary. How does she treat minor things that come up during labor, birth and postpartum? Does she use herbs and homeopathy?

14. Does she do routine episiotomies during delivery? Is she able to do repairs for labial or perineum tears? Does she use a local anesthetic to help make you comfortable during the process?

15. Ask her about her protocols for mandatory testing. Does she require an initial panel of blood work or ultrasounds? What about gestational diabetes testing and Group B Streptoccocus? If she requires tests, how will you get them as her client? Can she order them?

16. Find out about prenatal meetings. When does she see you and where? Does she come to your home or does she have an office? What things will she check for at the prenatal visits to ensure the well-being of you and your baby? Does she have a backup obstetrician that you also have to see during your pregnancy? Or is she your only practitioner? This varies by state due to midwifery laws.

17. Ask about the postpartum period. How long will she stay with you after the baby is born? Does she do any routine testing to the baby? How many postpartum visits will she do?

18. After the birth, does she do a thorough newborn exam? Does she carry eye ointment and Vitamin K, if you choose to have it administered?

19. Ask about her referrals. Can she give you good referrals to pediatricians and other healthcare members?

20. Ask about the prices for her services. Many midwives offer much lower rates than typical hospital births. What amount is refundable if you were to become high risk and couldn't have a home birth? Or if you opted out of a home birth, will your insurance cover any of the expenses?

21. How does she feel about letting your partner or children help deliver the baby? Does she encourage participation from the family?

22. Ask for client referrals. The one sure way to check out the midwife is talk to other people whom she has provided services for. Were they happy with her services? Would they birth with her again?

23. Take a few days to make a decision and interview more than one midwife. They all have different personalities and philosophies about birth. One may be more family care-centered and the other may like to make all the decisions. Be selective. She is going to work for you and it is your birth. Make sure what you truly desire in your experience will be what she is able to provide.

Tips & Warnings

• Do your interview in a comfortable environment for both of you.
• Bring a notebook and a pen to the interview. You will want to take good notes.
• Ask lots of questions. The questions I've listed are great starter questions, but they should make you think of more to ask.
• Voice your opinion about your ideal birth.
• Take some time to make your decision. A hasty decision can lead to regret later.