Choosing a Midwife
Interviewing Midwives... Questions to Ask
Congratulations on your pregnancy! It is wonderful you are informing yourself on your options for care and guidance during your pregnancy and after. Our community is blessed with many options and excellent care providers of all types. Breath of Life Midwifery provides care that is supportive, informative, and respectful to families in Roanoke, the NRV, and surrounding areas. Our clients make decisions for their birth with support and evidence-based guidance. Because every mother, every baby, and every birth is different, there are no routine interventions or strict time limits. The strong relationships we build with families prenatally transform into lasting friendships well beyond the initial postpartum period. If this is what you are looking for, Breath of Life Midwifery may be right for you. We specialize in homebirth services for low risk families, but provide doula services, childbirth classes, breastfeeding support, well woman care, and more.
Choosing A Midwife
I encourage families to interview many midwives. A thorough interview will help decide if a midwife is both a good professional and personal match. You only get one chance to have this baby. There are many different types of midwives and various paths to becoming midwives. Certified Professional Midwives (CPM) may have received her training through apprenticeship, a school, self study, or brief internships. Certified Nurse Midwives (CNM) have attended nursing school and completed a postgraduate program in midwifery. She may have received her training in hospitals only or a combination of hospitals, birth centers, and homebirths. Lay or uncertified direct entry midwives come to midwifery from similar backgrounds as CPMs but have chosen not to certify or license. They may not have met the certification requirements or they may have exceeded them. It is crucial to ask potential midwives about their training, experience, and background. They may vary tremendously in practice guidelines, personality, and philosophy. Technology and access to medications may be comforting to some families and for others they choose homebirth to avoid such things. In your interview process, after a midwife tells you about her protocols or routines, ask why. Take notes. Compare answers. Re-interview if you’re not 100% certain about your choice.
It is important to understand how the women she works with give birth. How are the first few hours after the birth handled? This can be demonstrated through seeing a copy of her statistics. It is important that you ask if these are HER statistics or general midwifery/homebirth statistics. Are the birth stories on her website or in her portfolio births she attended or from the general public? Although mortality rates, birth defects, and infection rates are generally similar for most midwives, transfer, cesarean section, and tear/episiotomy rates may differ dramatically among midwives. Ask for references of families that have birthed with her and be sure to ask for a couple that transferred to the hospital. If birth unfolds easily people will be happy with their care, but it speaks volumes when birth doesn't go as planned and a family is still happy with their midwife.
Is she certified or licensed?
Does she participate in continuing education? What kind?
What is her birth philosophy?
How many births has she attended?
How many births were at home/hospital/birth center?
How many births was she the primary midwife?
Where there others midwives/caregivers present? What was their role?
What are HER statistics? (transports, c-sections, complications, tears)?
What kinds of services are included in prenatal care?
Who will she bring to your birth?
How often does she travel, and who do you contact if she is away?
How many births has she missed?
How do you reach the midwife?
What equipment does she carry?
What is her transport policy?
How does she handle problems or complications at home?
What interventions is she willing to perform at home?
What kind of postpartum care does she provide?
What is her knowledge of herbs and homeopathy? Does she use them herself?
Has she ever been pregnant? How did she birth?
How committed is she to nursing? Did she nurse herself?
Is she available for nursing support beyond the first year?
How accessible is she? Does it take minutes, hours, or days for her to return phone calls?
Does she use alternative practitioners (chiropractors, acupuncturist, etc.)?
Do you have access to her other clients?
How many women is she helping in your birth month? How will a large number of clients affect your care?
Does she have knowledge about important parenting options? (vaccinations, circumcision, breastfeeding, co-sleeping, homeschooling, etc.)
What is her fee? What is/isn't included?
BUT WHAT WILL IT COST?!?!?!?!
One of the most common questions asked during the interview process is, "What is your fee?" In this area, most midwives charge about the same $3,000-$4,000. Most midwives are happy to arrange payment plans, accept barters, and bill insurance for reimbursement. A midwife's worth is not in a dollar amount. Cost does not always reflect experience, but it is typical for students and those with the less experience to charge less.
If you are focusing on price you may be missing experience and knowledge. It is one thing to read about shoulder dystocias, hemorrhages, and neonatal resuscitation and quite another actually handling these situations. You should focus on how long her training lasted and where it took place. Was it in a hospital or a birth center, where medical staff and equipment was readily available for complications? Was it at home, and what type of role did she play? Did she simply catch a baby, or was she active in being the primary midwife throughout the birth process? Did she ever handle complications, and how so?
Although certification can help establish an entry-level midwife, the number of births a midwife must serve as primary is only twenty-five. This can typically be accomplished in 1-2 years or even faster in hospitals and birth centers. Some hospital and birth center internships only last a few days or weeks. What other training has she had? If she completed a traditional apprenticeship, how long did it last? How many births did she assist with prior to becoming a primary midwife? Does she have the insight gained by being a doula prior to becoming a midwife; is she knowledgeable about labor support? Is her team properly trained?
Midwifery is a traditional art that should be passed down through apprenticeship. If you are hiring a student, it is very important to get to know her senior midwife through a thorough interview. The NARM standard and VA regulations require that the senior midwife be present for prenatals, births, and postpartum visits. More important than your desire to help the student is your compatibility with the senior midwife. After all, you will be giving birth with both of these women.
Don't forget to ask for and call references. Remember that the majority of births will be perfectly normal and uncomplicated, regardless of attendant. Many times it is the complicated or less than perfect births that highlight the differences in midwives. There is no one midwife that is the perfect fit for every family. Find the best midwife for you, even if that person is not me. Good luck and best wishes on your upcoming birth!