I take a very limited number of birth clients per month so that I can focus my entire attention and love and support on them, my two daughters, my marriage and my home.
Once you are my birth client, you are also much more to me. I become a silent and supportive member of a mother's birth team.
I aim for you to feel safe and supported by me. I want you to have a happy, safe and supported pregnancy and birthing experience. Besides being your birth photographer or birth film maker, I aim to be a source of support and information so that you can feel this very positive way.
Every single birth client is incredibly special and unique to me, and it is especially moving to me when my birth client reaches out to me in search of guidance through their pregnancy and birth. I want to support the women under my wing as best I can with information so that they can make the best informed decisions possible for their pregnancies, their births and their post partum.
In the hopes of helping inform women about all their options, I have put together a list of questions I think are important to ask a Home Birth Midwife when you meet her for the first time. Many of these questions can easily be restructured to ask a hospital midwife and OBGYN, for moms who go that route.
There is also a secondary reason for me writing this blog post and it stems from my own experiences. I had a less than supportive experience during my pregnancy with my first daughter with my OBGYN. I did not feel honored and most visits I felt belittled, almost as if I should have been apologizing for arriving to prenatal visits with questions. My birthing journey with that provider was a negative one that impacted both my physical and mental health.
In an effort to avoid another negative experience, I chose a different type of birth team for my second pregnancy. I chose to hire a midwife and a doula. However, what I did not realize at the time is that not all midwives and doulas are the same. Not just with various level of skill, but also their personalities are different, their character, how they handle various situations, their personal preferences for prenatal care and labor / birthing decisions, and equally importantly, how they make you feel. In retrospect, two and a half years ago, I chose my birth team for my second pregnancy for three reasons: because I knew them from work and we shared some of the same friends, because they were available, and lastly, because they carried the titles "midwife" and "doula".
Years later, with my daughter's birth in hindsight, I realize now, those were not good enough reasons for me for choosing my birth team. What I had been wanting during that pregnancy was to find a team that would allow me to feel safe, supported, heard, special, honored, and not judged. All things I did not have during my first pregnancy and birth. But at the time, I wasn't aware that those were the criteria I was seeking of my birth team. At the time, I could not put words to what I felt lacking.
And because I was not aware at the time that all midwives and doulas are not the same and do not offer the same level of support and skill, and because I was not aware that not every midwife will be the right midwife for you personally, I chose my team only out of convenience and availability.
As a result of the decisions I have made that took me down a path of a negative experience with both of my births, besides informing women of what important questions they should be asking their home birth midwives, my secondary goal with this post is to bring light to what expecting moms should be expecting of themselves:
What is your own personal criteria for choosing a midwife?
I would like to precede this list of questions to ask a Home Birth midwife with question #1, which is really a question to yourself:
The most important questions, are going to be the Questions to Yourself. Because ultimately, as skilled, recommended and pleasant a midwife might be, they won't be the right midwife for you unless they meet your personal criteria.
As an innately wise woman, you carrying with you the gift of motherly instinct and intuition to guard yourself and your little growing life. I urge you to consider the following:
When you interview a home birth midwife, once the interview is complete, and you return home, allow yourself quiet, down time to reflect on the experience. Allow yourself to process how the meeting went.
How did you feel as the midwife spoke?
How did the things she said make you feel?
Did she let you feel heard and not rushed?
Did her personality help you to feel connected and instantly safe and supported?
Take note of what feelings may rise from your instincts.
Those feelings will always be 100% right.
They will become LOUD during your pregnancy and birth.
There is a difference, of course, between leaving the meeting with a midwife and realizing you have more questions for her, and feel unsettled until you follow up and clear up uncertainties. Not every first meeting will be perfectly complete.
However, if you feel hesitant or unsure regarding your very first meeting, and if any negative feelings are present, as your pregnancy proceeds, take into consideration that those instinctual feelings you had the first time will become louder and more pronounced and ultimately, unavoidable. It is impossible to hush the roar of your maternal instincts without compromising your peace. I speak so profoundly to this matter because I have lived this reality with my own experiences.
Alternately, if during the very first meeting with a midwife you felt connected, safe, supported, and you smiled, perhaps a tear welled up in your eye because you felt like you found 'home' with this person, those feelings will amplify as you get closer to your meeting day with your baby and aid in creating a positive mindset for your labor and birth and boost your self confidence. And in order to have the peaceful, calm birth you desire, you must believe in yourself and feel supported in your decisions.
Here are some additional questions from the Birth Without Fear blog that I felt are very helpful in aiding you to process how you feel after your first meeting with a new midwife:
- Would you be friends with this person? Why/Why not?
- Does either remind you of your mother? How do you feel about this?
- Were you able to ask all the questions you wanted to? Why/Why not?
- How did you feel about the birth when talking with them, compared to how you feel about it normally? More or less excited, more or less anxious?
- Was the visit enjoyable?
- If there were other family members present, what was their experience of the interaction?
The following questions depend on your preference of birth plan. Some questions may interest you and apply to you, so then write them down and ask the midwife you are interviewing, if you are curious to know the answer. Other questions you may naturally skip if you realize they are of no interest or do not apply.
How many vaginal checks do you do, during pregnancy, during labor; should I get them, how necessary are they, what are the benefits/downsides and when do I need to have them done?
Do you deliver breech? Do you deliver all kinds of breech? Do you have training and experience in this kind of delivery? If not, do you have a midwife you would refer me to if the baby had not turned? Do you have experience with turning babies, not hospital version-style?
What kind of medical situations during pregnancy would require me to be transferred into the care of an OBGYN?
Under what circumstances would you transfer to the hospital? In the event of a transfer, (whether or not you have any privileges at the medical facility or know the doctor who I was transferred to, ) will you stay with me and support me through my entire birth and for the first couple of hours once the baby is born?
What constitutes a non-emergent transfer vs. emergent transfer? Where do I go in the event of a non-emergent transfer vs. emergent transfer? Who is your back up OBGYN, Who is your back up midwife in the event you have an emergency when I am giving birth? How many weeks ‘overdue’ could I go before you transferred my care to a doctor? How many minimum weeks pregnant must I be to be able to have a home birth (36 weeks? 37 weeks? 38 weeks?)
When can I meet your back up midwife and back up OBGYN?
What is your hospital transfer rate?
Under what less than ideal circumstances would you stay at home?
Delivery & Cord Clamping
What are your feelings on the dad catching the baby, or me catching my own baby? Will you deliver the baby, or will you assist me in birthing him/her/them?
What are your feelings about delayed cord clamping?
How many births have you attended? (From the mamabirth.com website, "Some mothers prefer a very experienced midwife, some don't. Some want a midwife who can handle anything that goes wrong and recognize it well before it even happens. If one of the midwives is newer, maybe her back up OBGYN is more experienced and she may prefer to transfer you than handle a situation on her own. You may want to know how many births they attended prior to being licensed AND after.")
How long have you been practicing midwifery? Why did you become a midwife? What is your training/education/certification?
Do you do the Gestational Diabetes screening? Do you continue to see clients with Gestational Diabetes, or do you refer them to an obstetrics practice?
How does it work with my insurance covering your midwifery services, how much do you charge, and by what date would the full amount be due? Do you accept payment plans? What is your refund policy if we decide to switch care providers?
What equipment do you bring with you to a birth? Are you legally allowed to carry Pitocin (for rare post-birth hemorrhaging)? Do you? Are you trained in neonatal resuscitation?
Are you planning any vacations, trips, major surgeries, or other events 3-4 weeks before my due date, or up to 2 weeks after my due date that would interfere with your attendance at the birth?
What kind of postpartum care do you offer? Do you work with post partum doulas?
Do you do placenta encapsulation? Is there an extra charge? Do you facilitate water birth? What methods of pain management do you recommend?
My partner has x, y, z fears about home birth. How have you dealt with this in the past?
What is your preferred method of communication, prenatally (phone, email, text)?
Have you had any loss (baby or mother)? Why and what happened?
If I change my mind about home birth and ASK to be taken to the hospital, how will you respond?
Who comes with you to the birth? If that person is another midwife, how experienced is she? If that person is NOT another midwife, what qualifies her as a birth attendant?
Can you resuscitate an infant? Are you NRP certified?
How bad would a perineum tear need to be for you to feel it required a hospital transfer?
What things would make me "high risk" and necessitate transfer of care either during pregnancy or labor? (Again a question from mamabirth.com - "Some midwives are only comfortable with very low risk and very healthy women. Limit how often they see things go wrong and may impact if they will or won't recognize it." "You deserve to know what your midwife is or isn't comfortable with before the eleventh hour.")
At what point during my labor will you come to my home? When should I call you?
*** Mention any concerns at this point about a history of labors women in your family have had that may be of importance to you for your birth
How does it work if I am GBS positive - how often do you administer antibiotics during labor and do you do specific procedures with the baby after birth
What are the pros and cons of vitamin K shot and eye ointment
Do I need to order a home birth kit on my own or do you bring it and include it in your fees?
Do you bring an inflatable water birthing tub with you or do I need to privately rent one and purchase a tub liner for it? How easy is it to connect a hose to your sink to fill a tub and are there certain plumbing situations that could prevent that?
Do you prefer working with a doula?
What is your experience with herbs, homeopathy, and alternative medicine as pregnancy and labor support?
Do you offer or suggest taking childbirth preparation courses?
Do you routinely check glucose and protein levels via urine samples at visits?
If my water breaks before labor (contractions) even begins, how long can I labor at home for before you are required to transfer me to the hospital?
** I personally include this question on this list, because it was one of my biggest concerns that this would happen due to my history of a medical condition I had with both of my pregnancies, and because this question was answered incorrectly by my midwife during my pregnancy and during my labor, because she did not confirm the answer during my pregnancy with her back up OBGYN, and it ultimately affected how and where my child was born and how I perceive my labor experience to this day.
What happens in the event of pre-term labor or a medically necessary induction?
What do you do in the case of a nuchal cord? Or if the baby changes into a breech position during labor and it is too later to be transferred to the hospital
Under what circumstances, if any, do you perform episiotomies?
How long will you and/or your support team stay with mom and baby after the birth?
How many postpartum visits are offered under your care and on what days do these visits occur?
Is breastfeeding support offered?
Of course there are many more personalized questions that can and should be asked of each woman's midwife during her care. But I feel these are a good start that will give you an idea of whether this home birth midwife is the right fit for you and your unique birth plan and concerns. I feel that the right midwife for you will take the time to honor these questions, and as she answers them, you will know very early on during your first meeting based on how she is speaking, and what her answers are, if she is the right fit for you. Sometimes it won't even take you getting to the end of your list of questions to know either "this is definitely not the right fit for me" or "this is definitely the midwife I want attending my birth!"
Lastly, as the grand take away from this blog post, I want every woman to recognize that the instinct you have is the one you should be listening to. If it is telling you something is not right, honor that and explore that. If your instincts are telling you things are perfect, happy, calm, peaceful, embrace that and also yourself to feel empowered!