Apart from fees and insurance inquiries, there are many questions to consider when seeking midwifery care. Consider asking the following questions when interviewing a homebirth midwife:
1) How many births have you attended, and how many were successful homebirths? What is your rate of transfer? Do you transfer if the mom desires pain relief, or only in emergencies?
2) Do you have references that I can contact? (It is always a good idea to call a few of the references provided.)
3) What are your expectations of clients during pregnancy? (This will probably be included in the provided reading material. It will most likely consist of remaining low-risk, among other things. The midwife I interviewed -see bottom for link- even has a list of books and videos that she loans to clients, which must be watched before committing to homebirth.)
4) What natural comfort techniques do you provide? Do you explain them or do you recommend childbirth education classes for this?
5) Do you require or recommend that my husband and I take a childbirth education class or attend pregnancy discussion groups? (This may even be offered by the midwife, or included in prenatal visits.)
6) Do you provide any written material for me to read over? (The midwives I know are very professional and have more reading material than doctors. Many or most of the questions here are actually covered in their reading material. They also have extensive lending libraries with videos and books available to borrow.)
7) Do you have guidelines or restrictions about who can give birth at home? (Make sure you qualify for homebirth, and if one midwife risks you out, feel free to interview another – just as you would with a doctor.)
8) What is your definition of “high-risk”? (This can vary between midwives.) A related question may be: What problems or complications in pregnancy would mean that a physician would become my primary maternity caregiver?
9) When do I call you if I think I am in labor? (Ideally, you should be able to call immediately, although the midwife may not come to your house for several more hours).
10) Have you ever missed a birth? If so, what were the circumstances? Are you available 24 hours a day at all times? (Midwives are human and unforeseen circumstances may cause them to be late or miss a birth entirely. It’s important to understand what the circumstances were. Midwives are usually available at all times for consultation, within reason.)
11) Do you allow the mother to go past 42 weeks and still have a homebirth? (This is an important one. Most doctors will recommend induction after 40 weeks, but many midwives respect the body and will take a wait-and-see approach. They may suggest ways to induce labor naturally.)
12) What about premature delivery? When is it too early for a homebirth?
13) What situations do you consult an obstetrician for? (The midwife may have a specific doctor she refers to for things like ultrasound and certain blood tests.)
14) What equipment and supplies do you bring to a birth? (Things like an oxygen tank and neonatal resuscitation equipment are things to look for, aside from the obvious Doppler and hemostats for cutting the cord. Be sure to ask if they have received training in using said equipment.)
15) What is your usual approach to a labor that is progressing slowly? (Look for a mention of inducing labor using natural techniques.)
16) How often do you listen to baby during labor? (This may be a matter of preference, if it helps to reassure you during labor to hear the heartbeat. Usually during the pushing stage is when it is listened to most often to make sure the fetus isn’t under stress from pushing.)
17) How many people are you comfortable with being present at the labor and birth?
How do you feel about having a doula at a homebirth? (If you would like several people or a doula present, make sure your midwife is comfortable with this.)
18) How much time do you allow for the delivery of the placenta? (My first delivery ended with a retained placenta because it was not delivered for about an hour. The placenta should be encouraged to deliver shortly after birth so that it can be examined and your uterus can begin shrinking back immediately.)
19) Do you allow the baby to be delivered underwater in a waterbirth? (Many people consider this a primary point to having a waterbirth, and this is almost never allowed in a hospital.)
20) Do you know infant CPR? Have you taken courses in infant rescusitation?
21) What happens if my perineum needs stitching/suturing? Who will do the stitching? (The midwife may be qualified to do minor repair, or will recommend you go in for higher than a second degree tear.)
22) What supplies do I need for the birth? Where can I purchase those supplies? (See my article regarding your Homebirth Supply List for more about this.)
23) How long do you stay after the birth? Do you help with cleanup?
24) How many internal checks do you normally perform? (Internal exams are often times unnecessary, and can introduce bacteria to the birth canal. This may be of personal preference. I did not have any internal exams during my second pregnancy.)
25) Do you have a problem using a fetascope instead of Doppler most of the time? (Doppler devices can be harmful to a fetus. After 20 weeks, a fetascope or pinard may be used instead.)
26) Do you deliver breech babies? What do you try to turn a breech baby? How long are you willing to wait for a baby in a bad position to change positions before labeling the pregnancy high risk?
27) Do you cut the cord immediately or do you wait for it to stop pulsing? (There can be significant benefits to waiting to cut the cord after the placenta is delivered.)
28) Under what conditions would you artificially rupture the amniotic sac? (Some women view this as an intervention and desire to avoid it when seeking a natural birth.)
29) What is your back-up system during pregnancy and labor—when you go on vacation, are sick or with another laboring mother? (The midwives in my area are networked with each other – they are not in competition like doctors from different hospitals can be. They will have another midwife on call if they see a need for it.)
The list goes on and on, but most things will probably be covered in your prenatal exams. Decide what topics are most important to you before hiring and ask them at the initial consultation. Other questions may be addressed at a later date.
See also:
The Let’s Talk Blog Top Ten – Reasons for a Homebirth
Let’s Talk About Pregnancy Support Groups
Let’s Talk Interview – With the Midwife