Recently I have seen a rise in people claiming to be a home-birth midwife that are not trained or equipped to provide the services they offer all across the US. This has resulted in multiple fetal deaths, maternal deaths/harm, and unnecessary birth trauma. These midwives are something to shy away from here is how you can avoid them for your own birth.Midwives are not interchangeable; no two are the same. Most serve with a heart of true passion and care; some serve solely with a wallet to fill or ego to boost. Some will walk with women throughout their entire journey, and some will bail on them for various reasons. Some midwives undergo years of training/attending/learning/practicing. Some claim to be a midwife but has nowhere near enough training to do so. It is crucial to interview properly to make sure your midwife is a good fit for you. Don't hire a woman who will be a deer in the head lights when you or your baby needs assistance.Keep in mind, a licensed midwife does NOT mean a well-trained and educated one. More often than not, it only limits how they can serve you. In my experience, it is the licensed midwives who can be fear ridden, as taught in their medicalized schooling not all though! Again, none are the same. It should never be a degree or license you are looking for. You want one who is there to serve YOU, not serving the state or medicalized model of birth. Here are a few questions that would be great to ask a possible Midwife. Be sure she has answers, if you have questions that go unanswered you should not take this lightly. She should not be hired. Never settle on a Midwife.
What training have you had? Schools, degrees, certificates, preceptorships, internships, etc.? (You can look up their schooling history, degree, and certificates online. Do not take anything for face value. Do your research before signing a contract. Again, some midwives do lie about qualifications. If they attended internships/preceptorships, ask to reach out to their preceptors. Some are fired or let go before completion and choose not to disclose this information. You may want to know why.)
Are you trained/certified in neonatal resuscitation? (You can ask to see their NRP certification card as proof. Yes, many birth workers do lie about their trainings!)
How many times have you had to resuscitate in your career?
How many births have you attended?
Where can I find reviews for your services? (You want to be sure you hire someone who is backed by past clients. If she does not have reviews, this could be a red flag)
How long have you been attending births as a primary midwife? (This asks how long they have been attending on their own, without a preceptor - someone guiding them)
How many births do you attend per month?
Do you have a backup midwife? Will I meet her? (Every midwife should have a backup. You should ask to meet this backup prior to labor if you do not want a stranger possibly walking into your home on birthing day)
Do you have an assistant or will you be attending alone? (Some bring an assistant and some charge more for the assistant)
How many times have you had to transfer during labor? (A midwifes transfer rate says a great deal about her ability to serve women)
Do you stay with mom once she is transferred? (Many midwives will transfer mom to the hospital then leave once she is admitted. This likely isn't something you want, be sure it will not occur)
How many times have you had to transfer mom/baby postpartum?
Will you attend twin, breech, and VBAC births? Why or why not?
What complications and emergencies have you seen and how were they handled? (i.e. prematurity, prolonged labor, fetal distress, breech, bleeding, dystocia)
What circumstances/conditions would rule out your attendance? (In many states, especially with licensed midwives, they are required to drop you from their care for many unnecessary reasons. Do not get to 37 weeks and find out she is dropping you because your baby chooses to present breech. If she is not competent, or holds her license above your births wellbeing – she might be a MEDwife and might leave you hanging with no care or reimbursement.)
Can you list each scenario that could possibly risk me out of your care?(Know ahead of time EVERY reason you could be released from her care. Depending on state, the midwife's knowledge, her licensing, and her competence, there are many reasons they can drop you from care. Things that are not in your control Be aware of EVERY possibility before signing a contract)
What complications/emergencies are you prepared to handle?
Under what circumstances do you transfer to a hospital? (Some midwives are known to transfer women for silly reasons that are not science based. Be sure your midwife will not bail on you when you are vulnerable.)
What percentage/exactly how many clients have had cesareans in your practice?
Will you accompany us through a hospital birth if one was necessary?
Do you offer prenatal care? What is your schedule for visits?
What is included in prenatal care? (i.e. lab work, urine checks, blood pressure, fetal heart tones, fundal measurement, baby's positioning, & vaginal exams & PAP)
What type of nutrition counseling do you provide?
Do you visit the home at any time before the birth?
Am I required to complete any kind of testing? (Some Midwives require specific testings or they will drop you from care. This is not autonomy and likely not something you want to sign up for. You should have complete control and say over your prenatal care)
Am I required to attend a certain amount of prenatal appointments?
What happens if I refuse appointments, procedures, or suggested medications? (If they have an issue with your having say over your pregnancy and refusing XYZ, run the other way)
When do you like to be called once labor has begun?
When do you come to the home once labor has begun?
What equipment do you bring and what must we provide? (You can tell a great deal about a midwife and the care she supplies by what she carries in her bag. Does she carry herbs and tinctures or does she simply carry Pitocin and oxygen. Know what she will be showing up with! Know what you are comfortable with being used.)
What emergency equipment do you provide?
How do you view the fathers role?
What is your role during labor? birth?
How do you feel about sibling participation in birth?
What non-drug measures do you suggest for pain relief?
How often do you listen to the baby's heart rate during labor?
How often do you check the mothers blood pressure?
Do you require vaginal checks at all, ever? (Vaginal checks can be harmful and mean nothing in regards to progression during labor. If she requires vaginal checks, she might not be a good fit. That would be a red flag that she does not support autonomy.)
What is considered fetal distress in your opinion?
What do you consider prolonged labor/birth pushing?
Do you have preferences for labor/ birth positions? (This answer should always be. It's the mothers choice. If she requires you to lay in a certain position, this is a concern.)
How do you feel about water-birth? Have you attended any?
What measures do you take to prevent tearing?
Will you allow partner to catch the baby instead of you?
Do you check for tears after delivery?
Do you have local anesthetic & suturing equipment for this repair to be done without going to the hospital? Do you suture all tears or only major?
How do you prevent/treat excessive postpartum bleeding?
How do you handle the baby immediately after birth?
How long do you stay after the birth? What do you check at this time?
What is your schedule for follow-up care?
Do you do the newborn screening tests?
What are your thoughts regarding circumcision?
How is the filing of the birth certificate handled?
Do you routinely give me a copy of all my records after the birth?
How much do you charge for your services?
What services are not included in this fee?
Do insurance plans cover your fee? Do you accept direct payment?
When do you want the full fee paid?
Are there any refunds if I risk out of care? (I see it occur so often that a mom risks out of care and mom is left with no midwife and no refund. 7K+ down the drain at no fault of her own, and no home birth to show for it. Know about her refund policy and make sure you agree before signing!)
Final Thoughts
Determine the midwife's willingness to be open to communicate, explain things that you don't understand, and willingness to let you make your own decisions. If she is unable to answer all questions without hesitation, be wary.Be sure to reach out to your local birth community and ask around. Some providers will present themselves to be something they are not. Their abilities will reflect in their past client's experiences. Read all reviews, ask questions.
Hiring a midwife is not a simple choice, this plays a HUGE role on birth outcome. Knowing the difference between a CNM, CPM, and traditional midwife is also helpful in making a midwife selection. Again, Midwives are not interchangeable none are the same. Do not settle, find one that is a perfect fit for you!!
