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

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