4 Questions You MUST Ask Before Hiring Your Midwife

I’ve been attending births on my own for several years now. Every time I meet with a woman interested in midwifery or home birth, I realize how much I have grown and changed AND also how much I have to learn. I’ll never stop studying, researching, etc., but what these consultations make me realize is that learning about PEOPLE is a neverending journey as well.

From my own research, the “suggested” questions to bring to an interview with a midwife are amazingly terrible at getting to what you really want to know. The “standard” questions usually elicit the same answers from midwives that, in practice, are as different as night and day! So, what are some questions that might help you hone in better on what you’re gonna get? Here are just a few…

What is your philosophy about birth?

This one can be informative and not. On one hand, it can cut to the chase of eliminating a midwife pretty fast. Like, if she says that birth is a precarious, scary event and you should have your car tanked up with gas because you’d probably need it to get to the hospital! (Seriously, I got this answer when I interviewed a midwife, a CNM, for our first homebirth 8 years ago. Needless to say, I ran as fast as I could from her; so, really, this could happen.) More typically, the midwife will answer that birth is normal and safe, yada, yada, yada. But how do you know that isn’t just the answer she knows you expect? And how do you know that her version of “normal and safe” is yours?

Hmmm. That brings us to the next question….

Describe your role when attending an average homebirth.

I like this one. I think if more women knew to ask this and knew what they were looking for, more women would not only find the “right” midwife, but that slowly the medicalized midwifery model (you know, a hospital birth at home) would die a pretty quick death.

First, what’s an “average” birth for the midwife in question? Hopefully, most of the births she attends are pretty average (read: uneventful) because she’s been a good guide on a healthy pregnancy road and she’s also a trusted presence at the labor and birth.

But back to the “role”; what’s the million dollar answer? That HER role is whatever you say it is. If that’s looking for support and guidance and monitoring of you and baby, then that’s what she does. If you are looking for someone to wash the dishes or watch the kids in the next room, then that’s what she does. As the birthing woman, YOU call the shots. It’s OK to not know what you’ll need, too. If it were me, I’d like the midwife in question to very clearly express that usually, her role is not a central one. She may even admit to birth not being any “safer” with her there; imagine that! Even better if she says that at most births, the family is in the leading role and she simply observes from afar without actually involving herself unless completely necessary.

(On the contrary, if she tells you horror stories about unassisted births and/or stories about how she “saved” anyone from alleged disaster as a midwife be aware. Chances are, if she believes she is integral to a safe birth, then there will likely be interventions and interference at your birth in order for her to preserve her role.)

How do you see most moms birth?

There is a misrepresentation of homebirth that is, like I said earlier, hospital birth at home. If that’s what you are looking for, I suppose you don’t need to read any further. If you are looking for undisturbed birth as your body intended, birth that happens at home, then read on. Physiological birth happens in whatever room, in whatever position that YOUR body decides on. I have been to too many med-wife attended births of woman flat on their back in their beds, with the midwife “delivering” the baby. This is not physiological birth. Who knows how your baby will want to come out? My last (unassisted) babe practically yelled at me to be in a deep squat, something I never, ever saw myself doing. If you don’t get the vibe that absolutely ANY position, room, pool, land, tee pee etc. is perfectly acceptable for you to birth in, then move on! The BEST bonus of following your body’s lead and not letting anyone influencing you is that you will likely birth more quickly, easier and with minimal to superficial/natural tearing. I think the average midwife’s tear rate/suture rate is absolutely insane. But, that’s what you get (often) for not birthing on your own terms!

And about suturing. Is it a true benefit to hire a midwife that can sew up a tear? I offer that it is NOT. Unless she has been a surgeon in another life, most midwives don’t suture tears nearly enough to be quick, accurate and proficient. And, if she IS that quick, accurate and proficient, you should really find out why. I have known at least a few midwives to suture for fun/practice. Tearing to a degree that requires sutures is a pretty serious thing and a situation, again, not usually encountered when birth is allowed to proceed physiologically. My feeling is that serious tears need to be sewn by a surgeon. Any minor tears probably should be left alone for natural healing. End of story.

And that one leads me into the standard equipment and drugs line of questions. THIS one is super fascinating and gonna really go against the grain. In fact, you may still expect that the answer to doing/carrying all this “stuff” is a MUST for any midwife that will be at your home for your birth. But guess what? It is an illusion of safety. Drugs (specifically for hemorrhage) and most of all oxygen DO NOT make a midwife safe. In fact, I’d argue after recent study (with the all amazing Jill McDanal) that if a midwife you are considering carries oxygen and thinks it is vital for a home birth that you RUN. Sound harsh?

I don’t think so. Remember that “hospital birth at home” statement? That’s really the bottom line when it comes to bringing drugs (and oxygen IS a drug!) into the home for birth. I don’t want to give away all the wonderful knowledge, time and committment that Jill has been putting into educating midwives about the dangers of using oxygen, so I won’t. But I will say that I would never consider oxygen for use in labor for mom (and baby) unless I also acknowledged that the birth would need to happen in the hospital. The same goes for hemorrhage drugs. Once you learn about the action these drugs have on the body, the inept way they attempt to treat complications, as well as the risk factors and side effects, you won’t want them anywhere near your homebirth.

(On the other hand, if there IS truly an emergency that warrants medical treatment, you don’t belong at home anyway! This has been interpreted as me saying that postpartum hemorrhage NEVER happens; in normal, healthy women in developed countries, true hemorrhage is rare. However, for midwives in the US (and other developed countries) that have hospitals on every corner and are routinely administering Pitocin without need and without knowledge of other options, as well as lack of knowledge about how the drug works and what else it may do to someone…THAT is what I am referring to. If you are considering hiring a midwife that is “permitted” to carry these drugs, ask around in your community to discover how many women she’s used them on, and why and how many women were told they needed it, etc. We are talking about a ROUTINE, blatant misuse of a drug in a home setting, and this is NOT appropriate. Once again…a birth that takes a turn for the medical, needs to happen in a medical setting. If many of her births end up happening in a medical setting, you need to ask why.)

Last question.

What tests am I required to do and/or what testing do you recommend?

So, this one is a trick question, in a way. If there are ANY tests that are “required”, according to the midwife and/or her license, you should really think about what that means for you. Some women don’t mind signing up for testing , necessary or not. I tend to think it is a fairly big deal to be completely autonomous with your choices in pregnancy. I personally don’t care what is “required” or not because every choice, every test, every EVERYTHING is a choice that YOU need to make. Not a blind or influenced or biased choice. But a choice that you come to, based on what you know and believe. If there are tests offered, you should be completely satisfied with the education you have received (and done yourself) before you make a choice. Remember, it is not “informed CONSENT”, but informed CHOICE.

Hopefully you will notice a pattern with these potential questions and answers. My message is that YOU are in control of your pregnancy, birth and experience as a mother. If you are looking for someone to guide and support you in YOUR experience, then consider these “non-traditional” responses when interviewing your next midwife. Blessings on your journey!

The brilliant Jill McDanal is currently teaching a 4 week distance course, “The Truth About Oxygen”. I wholeheartedly recommend exposing yourself to Jill and her cutting edge knowledge; either before you bring an oxygen tank to a birth or before you consider hiring a midwife that does. She can be reached at truth.about.oxygen at gmail.com

Share This Article
Join the BIRTH REVOLUTION

Comments

  1. says

    Maryn, you “have been attending births for several years, now”, but you don’t say in what capacity. Are you a primary midwife? I practiced for 25 years and helped over 860 babies enter this world. I am now retired to pursue other areas of my life. When people ask me how many babies have I delivered, I say four, as mothers deliver their own babies.

    A lot of what you say is right on with the mother’s body telling her where and in what position to birth. I have experienced many kinds of births and situations. I did suture when needed and very well, too. Perhaps not as  quickly as a doc, but I was not about to transport a mother after a beautiful home birth if there was a tear that required a few stitches. This was not often, but it did happen. Yes, we practiced on beef hearts to know what kind of stitches would be best in varying situations. You do not have the luxury of knowing always, in advance, if a woman will have complications in birthing and that is why, I feel, it is essential to be prepared for any situation with O2 and meds. Thankfully, they were not usually needed. I have saved many moms from C-sections and brought back several babies who were not breathing with my innate skills and tools. I had my share of transports and have seen difficult situations arise in the hospital on more occasions than is usually admitted. Sometimes, the hospital is the right place for that particular birth. I have witnessed enough in my practice to know that there are as many types of births as there are babies being born. It was often hard to get out of my judgmental mind of thinking that I knew the best way for a birth to proceed. Often, because of my experience and guidance, we had a successful outcome when it seemed that we might have complications. I took “risks” when my intuition told me that all was fine and I learned that my best tool was my intuition. I, also, felt that every woman deserved a chance to have a home birth, if that is what she wanted and that her and her baby’s medical well being would not be compromised.

    If a midwife is working with the birthing parents with good comprehensive prenatal care, most births at home, without interference are perfect and beautiful. I would much prefer to be a fly on the wall, being alert and watching and letting the parents deliver their own babies. When, I was needed to assist the birth to a good outcome, I did.

    I do not speak for other midwives. Interviewing and asking questions are essential in choosing your midwife. There are many signals you get to know who is right for you and the bottom line is to trust your intuition. Whatever your choice is, make sure you are comfortable with it.

    May all your births be blessed.

  2. MamaRabbit says

    Prema Rose, With all due respect, then you need to get up to date on RESEARCH that shows that oxygen at births is dangerous and so are those “meds”.

  3. says

    Thanks for your thoughts, Prema Rose! Yes, I am a primary midwife and have birthed 6 babes myself. There will always be differences among us, and for that I am grateful. However, as far as the “debate” about oxygen and meds, I encourage you to do your research and always keep learning. Jill McDanal is a great contact, as mentioned, if you are still advising oxygen at a home birth. And meds deserve our attention too; again, not safe or appropriate for a birth at home. Blessings

  4. says

    Also….Yes, of course saying something like this would provoke controversy. I would like to instigate the idea (and I am not the first one to do so) that a physiological birth at home will rarely bring these complications; especially if nutrition has been paramount throughout pregnancy and the mom is supported in labor and birth without fear. We rarely see PPH unless there is disturbance of the “3rd stage” (or of the birth) and almost always any PPH is due to meddling by the attendant. My point is, as HOMEBIRTH midwives we need to focus on prevention. If a bleed does occur, our job is to figure out the source of the bleed ASAP. Transport may also be appropriate. The more I learn and study, the less appropriate I think it is for drugs to be found at a homebirth. I would not attend a hospital birth at home and if the woman needed medical help, I would not be the one to give that to her at home. I strongly encourage you to look into taking the course on oxygen (whether you are a midwife, or a mother) to understand why this dangerous drug should not be carried AT ALL by homebirth midwives. Jill McDanal (find her on FB) would be the expert on that. Thanks so much for your feedback, and blessings!

  5. jen says

    Hi Maryn,
    Just wanted to say that I love reading your blog posts. Always find it so insightful and wise.  My first baby was a planned homebirth that ended in c/s.  So am very keen to learn from my mistakes and heal before we have another baby and another hb.  The work that you do is priceless.  Thank you so much for your posts…

  6. says

     Thanks for your comment….glad it may help you find the support you need for a beautiful, healing and non-interventive birth at home.  Blessings:)

  7. sarah says

     So, only as an advanced midwifery student, here’s a scenario: you have a red head who’s just delivered a baby. you let third stage “happen” on its own and she starts bleeding out the wazoo. now what? you continue to let her bleed and eventually call the ambulance or you give her anti-hemmorhagic drugs which will be given to her anyway once she gets to the hospital. take your pick.

  8. says

     Sarah-

    I am asking you to expand your thinking, not ignore a serious problem should it occur.  I believe, that in most circumstances, the bleed can be prevented.  Think: no induction (even a “natural” one), allow mom’s oxytocin levels to truly be at their highest right when the baby is born but before the placenta (this is, as you know, the peak of oxytocin release with a physiological birth)..not to mention true blood volume expansion that would allow mom to lose blood.  How much interference are you used to seeing with “3rd stage”? Interference is talking to mom, touching her baby, putting a hat on the baby.  Again, I am asking you to consider EVERYTHING you do as potential intervention.  Remember too, that most PPH comes from birth attendants meddling.  We must consider our part more seriously instead of having our focus be on disaster control.  Lastly, should she bleed…what are you gonna do about it?  Why is she bleeding?  Have you tried a piece of the placenta, cord, herbs, homeopathics..is she retaining clots? Again, I urge you in your studies to consider all the possibilities.  Lastly, do your research on pitocin, for example.  Do you know what possible side effects are?  Do you know you could be precipitating a massive late hemorrhage hours later. after you are gone?  Again, I am not advising you to ignore the bleed.  But prevent.  Then problem solve; and if all else fails, you are manually compressing that uterus.  We need to think, think and think…and educate ourselves beyond belief in order to not become complacent.  True midwifery is not medicine, and should not be treated as such.  Thanks for the comment!

  9. Tinks says

    With regards to O2 I had a conversation with a neonatologist the other day who said it should be used only in very specific settings – I cited a couple of examples from midwifery around me and she was horrified. Shouldnt even BE at a homebirth. If you need to resus, it’s room air. Oxygen is toxic. And if you do need it you should be in hospital with that baby so that everything can be clearly monitored.

  10. says

     Yes, I agree.  If a babe or mom is in a situation where you “think” oxygen is needed (even if it wouldn’t solve the problem physiologically) then mom or baby or both need to transport.  Let’s stop practicing medical birth at home.

  11. Bette Kibble says

    This year in the Neonatal Resuscitation Program class required for renewal of Midwife license,every 2 years., using room air oxygen is what is actually being taught now,with the use of an oximeter at home. This is updated info from previous teaching by NRP, American Academy of Pediatrics. The standards of adult CPR and Neonatal Resuscitation are continually being updated. 

  12. Bette Kibble says

    …and Yes, if you are resuscitating a newborn..or anyone….911… for transport to the hospital should have already been called

  13. Paule Bezaire says

    Wonderful, wonderful post. And your answers to random questions is sublime. Keep telling the truth: it is worth speaking up for. <3

  14. conadrons says

    Are we still subscribing to the “redheads bleed more” rubbish? Having attended many I can only say that, like the vast majority of mothers who own their birth and do it their way, redheads lose little blood and hardly ever have any owrineak trauma that needs more than some honey to heal it. I love these questions.

  15. Jess says

    Hey! This post is beautiful. Thanks! I noticed in one of your comments that “nutrition is paramount” as a correlation to a healthy pregnancy and birth. Are there any resources, posts, or what have you that can help me learn more about a paramount diet. I am currently in a trying to conceive journey and it has been set on my heart that I need to be getting my body healthy and ready to conceive. Which is interesting because I have been trying to conceive for 3 years. So I think my mind is blocking the process until I feel ready. Ready will be when I eat better (cut out the processed food) and can handle my body weight functionally (think deep squats, standing up without using hands). So many people act like diet doesn’t matter or play a role in a healthy pregnancy. I just want to know what you think. Sorry if this is asking a lot.

  16. Maryn Leister says

    Thank you!! Yes, nutrition is crucial in all aspects of the childbearing year, among other things. We promote a whole foods diet, with as much organic as possible, local too and lots of good fats and nourishing foods. More detail can be found in our free podcasts, one of which is on nutrition: http://www.indiebirth.com/pregnancy-nutrition-made-simple-taking-back-birth-episode-4/

    Also, we offer a 5 week online course and nutrition is part of the first class and comes up again and again.
    http://www.indiebirth.com/how-to-have-an-indie-birth/

    Blessings on your journey and please contact us via email if we can be of any more assistance!
    Maryn

  17. says

    How about the “right” answers mirroring what the mother wants? That is what is missing for me in most of the questions asked to midwives. The only right answer is that which reflects the mother’s desire.

  18. Maryn Leister says

    Of course it’s what the mother wants..but how many midwives tell her she can “have” what she wants, and then introduce new information, at a much later date?
    Such as..of course I am hands off, and you can catch your baby. Until one asks around, and the midwife in question doesn’t ACTUALLY let that happen because there is usually a problem that needs to be solved, right at birth.

    I’m sure that’s not you….but sure goes for some midwives in these parts!
    And some women don’t know yet what they want, hence the suggestions:)

    Thanks for your comment!

  19. Simone says

    I’m so excited to have found your site, I’m not pregnant but want to prepare for my next birth! Thanks for all your posts, loving them. I wish we had more midwives to choose from! We only have two in our area :( I was given pitocin because my contractions were only coming from the side and not pushing down or something (would that be a valid reason or do you think my body would have sorted itself out alone?), I was told to push long before my body wanted to and everytime I had a contraction towards the end I had an annoying doula shouting “push in the bum, push in the bum!” Also 2 extremely painful internals. I was exhausted (probably from pushing so hard) and I eventually gave birth to my son on the bed with an episiotomy. They waited a little while to cut the cord and then the midwife pulled the placenta out! I was shaking uncontrolably and had an O2 mask on (do you know why this happens?). This was my “gentle homebirth”. I didn’t ask these questions, didn’t know what to expect so thought I’d trust my “gentle births” midwife and just go with the flow. That’s the last time I will ever trust my birth to someone else. I want to own my next birth, take responsibility and listen only to my body! I have been uneasy about the whole experience since my son was a few months old (he’s now 2) but have just told myself to be happy cause at least I did it ‘naturally’ at home and he was healthy, delayed cord clamping, skin to skin, breastfeeding. But its not OK and now that I’m acknowledging my feelings about it I’m starting to feel much better and can start preparing for our next baby! Sorry for the long msg! Thank you thank you thank you for your website and the work you’re doing!!!!

Trackbacks

  1. […] I hear from women regularly about their homebirth experiences. And being in the business of rabble rousing and questioning the status quo, many of these women who seek us out are unhappy with the care they received from their midwives, not just OBs. There are plenty of variations on the same theme. Midwives aren’t listening to women anymore. Midwifery care feels just as cold and clinical as OB care, just with a rocking chair and some nice music in the background. The rules and regulations are more important than the mother’s wishes. The midwife says she is hands off, or flexible, but when it comes down to it, she really isn’t, and the mother is left with few options at the end of pregnancy or during the birth – maybe the baby is breech, or she is getting closer to 42 weeks, or doesn’t want to transport but the midwife is unsupportive. Seriously. EVERY. WEEK. I hear stories, get emails, talk in person or on the phone to these women. They thought that they were hiring a midwife, and that meant they would get holistic, evidence based care, and flexible care that was woman centered. Well, they were wrong, and they are pissed. This is why I wrote “A Midwife is Not a Midwife is Not a Midwife” and why Maryn wrote “4 Questions You Must Ask Your Midwife”. […]

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>