Many times, I get asked about how to find a good midwife, as in - what questions to ask when "interviewing" prospective midwives.
There is no easy answer to this. Many midwives could "pass" the typical questions that might come to mind, but that does not automatically mean that they are a skilled midwife.
Also, personality plays a huge part in this very personal choice, and unless a lady has had a natural, midwife-supported birth, she might not even know what type of support she is looking for during pregnancy and birth.
I have been very happy with all the midwives that have attended my various pregnancies, but I feel that each time I had to chose a new one, I knew a little bit better what I was looking for, and made a little better of a choice (although again, I felt very blessed by each and every one of them). Part of that is probably also me changing in regard to how I cope with pregnancy and labor over the years, and what may at one time have been a perfect fit no longer would be quite so perfect.
Across the board, generally speaking, I have found every midwife I have ever met or talked to to be more knowledgable than the majority of OBs, with only one exception of a lady who I considered a danger to both moms and babies. That being said, all midwives are most certainly NOT created equal, and there are questions one could ask to get a feel for the prospective midwife's philosophy on childbearing.
The thing that makes it hard to separate the "wheat" from the "chaff" is the fact that birth, by design, turns out fine the vast majority of the time whether or not a midwife is present, if mom is allowed to labor in her own timing and without interventions. The midwife is a "lifeguard" - ready to jump in if there is an emergency, but most often not needed.
Thus, even a midwife who has very little skill and/or confidence of how to handle emergencies that might arise, might have rates of wonderful births 90% or even 99% of the time. The only reason why I want a midwife to attend my birth (other than to offer emotional support and comfort) is for the 1% of the time, when her skill could mean the difference between transporting to the hospital or being able to stabilize the situation at home. It's not that some midwives don't want to learn and improve their expertise - it's just that so much of their knowledge (that has been passed down for centuries) has been lost and buried because of the choke hold that the medical establishment has had on the midwifery community. For example, in the state of Arizona, midwives are not allowed to attend women having a VBAC, twins, breech babies, and a whole list of other things. I'm not saying they don't do it, but you can see why such an environment would make it difficult to obtain the necessary training to attend these births.
Trying to extract information from a midwife about the percentage of her births that transferred to the hospital (most often for a Cesarean) and why they did it, or trying to figure out if these transfers could have been prevented, without coming across as rude, prying, offensive, or a know-it-all can be a bit of a tightrope walk. It really more comes down to reading between the lines, and judging by what a midwife isn't saying.
So yes, while there are some questions that can help in the decision making process, in the end you will just have to pray about it and rely on your gut instincts. If you are undecided between a couple of seemingly equal choices, have your husband be the tiebreaker - it is amazing how they sometimes see things and pick up on them that we might have overlooked.
Here, in no particular order, are some questions to get you thinking:
- What is your background, training, and experience?
- How many births have you attended as the primary caregiver since the completion of your training?
- Why did you become a midwife?
- What are your expectations of me regarding self-care in pregnancy? What are your views on nutrition, weight gain, etc.?
- How long do your appointments typically last? What is a typical appointment like? Where do appointments take place?
- What prenatal tests do you require? Which do you recommend? Can I opt out of any, or all?
- What are your views on pregnancy, labor, and birth?
- If you are planning on having a large family, what are her views on that? Is she comfortable with and knowledgable about caring for a "grand multipara"?
- How do I reach you? Are you on call 24 hours a day?
- Do you have a limit on the number of births you attend per month? What would happen if you had 2 births occur at once? Have you ever missed a birth? Do you work with a partner or assistants? (Note: A good midwife tries to work with a partner and/or assistants so that a double emergency where both the mother and baby need special care is not a problem).
- What is your definition of "high risk"? What conditions would you transfer me out to obstetrical care for during pregnancy ("risk me out")?
- Do you provide postpartum visits in the early days after birth? How many? How long do you provide postpartum care?
- What equipment do you normally use at births? How many times have you actually used them? What medications and equipment do you have for emergencies? What is your training in those? Are you certified in CPR?
- What complications have you seen and handled? How would you handle complications such as hemorrhage, cord around the baby's neck, baby not breathing spontaneously, shoulder dystocia, meconium, etc?
- What if I need stitches?
- How do you feel about circumcision/immunizations/etc?
- Do you have adequate medical backup? Do you rely on a particular doctor or hospital? Can I choose my own physician? (If you do not wish to be seen by male doctors, it is important to let the midwife know right away.)
- What medical complications require transport to the hospital? Will you be able to continue labor support should I need to go to the hospital?
- Do you do VBACs at home? If so, what is your outcome ratio? What are the risks of doing so? (Note: In states where midwives are not allowed to attend VBACs, twins, etc. they may not be forthcoming with this information for fear of being "turned in" and losing their license.)
- What is your fee and what services does it include? Which fees are separate (ask about prenatal care, lab work, newborn assessment, breastfeeding support, postpartum care, water tub rental, birth kit, etc.)? What about payment plans? Do you accept reimbursements from insurance companies? Which ones? (As a general rule, HMOs will not cover any part of a the midwife's fees, whereas most PPOs will reimburse her for up to 50% as an "out of network" provider.) What other costs might I encounter? (Note: In the case of transport to the hospital, physician and hospital fees will be additional.)
- Who will you bring to the birth? How long will you stay after the delivery? Do you do the clean-up?
- How do you handle PROM (premature rupture of membranes), going post-dates (approaching/exceeding 42 weeks), etc?
- What is your rate of transfers/C-sections/assisted delivery/episiotomies?
- What are complications rates? How many women end up with an obstetrician? How many for pain, exhaustion and failure to progress, how many for medical complications? What are the rates among first time home birth moms vs. repeat home birth moms?
- Have you ever lost a baby/mother? What were the circumstances? (IMPORTANT: Moms and babies have always died in labor, and will always continue to do so. It's part of life and death. Babies die at hospitals every single week, but we never hear about those cases. Any hospital in a large city like ours typically has one to two such cases every single week.)
Truth be told, I have asked very few midwives even just a couple of these questions. I prefer to get them talking without me prodding them, while I just listen and read between the lines.
If you have anything to add, please do so in the comments below.