Thursday, January 27, 2011

Questions to Ask a Homebirth Midwife

The following list of questions was compiled by a local midwife to assist women in determining which midwife is right for them.  Reposted with permission.


This list includes many questions you may wish to ask me, or any other midwives you interview. Reading through the list may also help you think of other questions of your own.
Because home birth midwives are not regulated in Ohio, it is “buyer beware” in this state –you should ask lots of questions, ask for references, and feel good about your choice of midwife to care for you in your pregnancy and attend your home birth. Your “personality fit” or a particular midwifeʼs style may be as important as her answers to your questions.

General Questions
Tell me about your training / education / background and how you became a midwife? Are you certified or licensed and by whom?
How long have you practiced? Approximately how many births have you attended? Would you give me the name of a few mothers as references?
Do you work alone, or with another midwife and/or an assistant?
What is your transfer rate? Typical reasons for these?
What situations would cause me to “risk out” of home birth during pregnancy? During labor? Are your guidelines or restrictions about who can give birth at home strictly enforced?
Are you available for phone calls 24 hours a day for advice/emergencies?
How do you determine the due date? What happens if I go past 42 weeks?
What are your experiences with/opinions of Bradley? Hypnobabies/hypnobirthing?
Do you encourage your clients to write birth plans? What is the intended benefit of them?
Will you be okay with attending me if I go into labor at, say, dinner time on Christmas Day?
Would you ever attend twin births? Singleton breech births?
Do you maintain statistics from your practice? May I see them? Do you participate in regular peer review?

Prenatal Care
What are your expectations of clients during pregnancy?
What prenatal tests/monitoring do you recommend/perform routinely? (BP, weight, urinalysis, ultrasound?)
Do you suggest testing for GBS, and if Iʼm GBS+, what do you suggest?
Do you suggest testing for GD, and if I fail the glucose tolerance test, what do you suggest?
What are your standards for preeclampsia? How do you manage this condition?
Do you use a Doppler or fetoscope at prenatal visits? How often?

What are your expectations of clients during birth?
What supplies do I need to provide for the birth? Where can I purchase those supplies?
At what point in my labor will you come to me? How long will it take for you to get to me?
Will you stay with me during my whole labor if I want you to?
How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?
Have you ever missed the birth of a client? If so, what were the circumstances?
What equipment do you normally bring to the birth?
Are you okay with my older child(ren) being present at the birth?
How long do you let things go after membranes rupture, if there is little/no progress but the mother doesnʼt want to transfer?
Would you be okay with mostly being in another room, if I wanted to labor and/or deliver alone or only with my husband/partner in the room?

First/second stage
What do you perceive your role to be during my labor? During labor, how active are you in checking the mom and the fetal heartbeat, etc?
Under what conditions would you perform AROM or otherwise induce or augment labor?
What natural comfort techniques do you provide?
What pharmaceuticals, homeopathics and/or herbs do you use at births?
What is your usual approach to a labor that is progressing slowly?
How many/few people are you comfortable with being present at the labor and birth?
How do you deal with shoulder dystocia?
How do you deal with cord prolapse?
What percentage of your clients tear, and how badly? How do you try to prevent this?
How long are you willing to let a client push, or do you base it solely on the baby's stress level?
How do you think the pushing stage should be managed?
If I or my husband wish to catch the baby, are you comfortable with me/him doing so?
What positions do your clients most often give birth in? What positions do you prefer, and why?

Third stage
How much time do you allow for the delivery of the placenta?
Are you okay with the placenta being delivered underwater?
What is typically done with the placenta afterwards? Are there any legal restrictions on disposal?
How do you detect partially retained placenta? How do you treat this?
How often do hemorrhages occur?
How would you handle a hemorrhage? Do you carry pit or herbs for this? Legally? At what point would you recommend transfer for medical management of hemorrhage?
How soon do you like to clamp and cut the cord? Can my husband do this, if he wishes?
What would you do for a floppy baby? How often do you see this?
What are the most common minor complications you see, and how do you typically treat them?
What happens if my perineum needs stitching/suturing? Can you do that? Are you comfortable with repairing 2nd/3rd/4th degree tears? How bad does a tear have to be before you use stitches?
Do you help with cleanup (laundry, etc.)? What do you typically do?
How long do you typically stay after the birth?

Do you have a working relationship with one or more particular OBs to whom I would be referred in the event of a complication? What hospital would you prefer I transfer to?
What situations do you consult an obstetrician for? How commonly do these occur?
What problems or complications in pregnancy would mean that a obstetrician would become my primary maternity caregiver?
Under what circumstances do you transfer to hospital?
What hospital would I be transferred to?
What would be the plan of action if a transfer to hospital were necessary during labor?
Would you stay with me in the hospital? In the operating room? For how long after the birth?

Do you examine the baby after birth? What do you look for? What tests do you perform?
Do you recommend eye ointment and/or Vitamin K? Oral or shot? Why or why not?
Do you have any special things you do for the mom after a birth such as an herbal bath?
How do I obtain the babyʼs birth certificate/SSN?
How many postpartum visits will there be? Where will these take place? What do they include?
Do you examine the baby at any or all of your visits, and if so, what does the examination include? Do you do the state-required newborn screening blood tests?
When do you recommend that we take the baby to his/her pediatrician for the first time, and why? (Assuming normal delivery and healthy baby.)

Will you try to bill my insurance company? How?
What is included in your fees? What will I need to provide? (Birth kit, etc)