When choosing to have an attended birth (i.e., not unassisted), finding a provider is very important. You want to find the location that supports your birth situation in the best way, and in many situations this is at home. Though evidence-based studies may indicate safety in one direction or another, you still need to look within yourself and determine what your priorities are and what your comfort level is, and how your choices affect your ability to birth biologically. Having a provider that matches your birth philosophy will be a very important decision.
People tend to throw around titles like they actually mean something, and I really want to stress that birth is a natural event - there are rare situations that need medical assistance when birth is able to continue as nature designed. So, what is important when finding a care provider for your birth? Experience, of course. A certified nurse midwife who hasn't been practicing home births very long will likely not have nearly the experience of a lay midwife who's been practicing 30+ years. Likewise, a midwife who has been in practice for a long time doesn't simply mean she is a good attendant. You have to ask questions. Period. Without asking questions, you can't know how she is going to attend your birth. You also need to talk to other mothers that have used that attendant, and get their feedback on the whole experience, making sure you ask if there is anything they would do differently next time.
Many questions will come from your own thought process and concerns depending on previous birth experience, or not, but here is a basic list that I recommend parents ask when interviewing a home birth midwife. And, yes, emphasis on the "patrentS" - as in the mother and her birth partner need to go together. Too many times moms talk with a midwife, and daddy is at home or work and doesn't get all his fears taken care of and questions answered... mom goes home ecstatic about her home birth, and dad still says "eh, I don't know." Such a common scenario that can easily be worked out with a little bit of rescheduling.
- Why are you a midwife? What do you feel your role is during pregnancy, labor, birth, and postpartum?
- Do you come to my house for prenatals and other appointments, or will I visit you?
- Do you have an OB backup? Would I transfer to them during labor if complications arose?
- Do you recommend moms hire a doula? (Which ones?) How do you feel your role differs from a doula?
- How many births have you attended? How many have been home births?
- What prenatal testing do you recommend? Are there any tests you require?
- Do you use a fetoscope or Doppler? Would any situation cause you to use something different than your routine option?
- What are your beliefs and procedures for things like Group B Strep & Gestational Diabetes?
- At what point during my pregnancy would I be required to see an obstetrician?
- At what point during labor would you suggest transferring to the hospital?
- What is your transfer rate? Cesarean rate? Episiotomy rate? Breastfeeding rate at birth? Are you aware of your breastfeeding rate at 6 months? What do you think has influenced these rates?
- How would you handle a hemorrhage during labor/birth? How would you handle a hemorrhage after the placenta has been birthed?
- How close do you feel a mother should be to a hospital in case of an emergency?
- How would you handle newborn resuscitation? (Are you capable of providing resuscitation with room air instead of oxygen?)
- Do you routinely provide natural cord clamping? In what instances would you recommend clamping the cord before the placenta has birthed?
- When would you come to me in labor, and how should I contact you?
- Do you attend water births? (Do you have a tub available, if not, how could I obtain one?)
- For what reasons do you perform vaginal exams? Are you comfortable with no vaginal exams before or during labor?
- Do you recommend your mothers take herbs to "prepare" her for birth? Why? How can I research this further?
- Do you allow a quiet and intimate space so your moms can instinctively labor and birth? At what point do you start suggesting positions and pushing?
- Do you perform perineal massage? Why?
- Do you stitch? If not, and I tear, how is this handled? If you would recommend medical stitches, how is this handled?
- If transfer during labor is required at any point, how is this handled? Will you stay with me? At what point would you leave?
- If transfer during labor, do you still see me for postpartum visits?
- What do you do to ensure mom has uninterrupted, quiet, bonding with her baby?
- Do you hat newborns? Why?
- How do you help moms with breastfeeding immediately after birth and during postpartum?
- When will you visit after the birth?
- How do you help me achieve the birth I desire?
- May I see videos of you attending births?
Then, finally, talk about fees. Discuss any contracts the midwife would require, ask about payment plans, and don't be afraid to ask about bartering/trade if necessary. Be sure to ask how fees are handled if you should transfer during pregnancy and/or labor, birth, or immediately afterwards.
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