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How to Choose a Good Home Birth Midwife

How do you know if your midwife is good?

If you’re looking into home birth, probably the most important thing is finding a good midwife.  Your midwife will be the one who cares for you, watches over you, and makes any decisions if something unexpected or difficult happens in your pregnancy.  It is imperative to get a midwife who is well-trained and experienced and whom you trust and feel comfortable with.

How do you know if you’ve found a good midwife?

It’s important to know that in many states, only CPMs (Certified Professional Midwives) attend home births.  In other states, CNMs (Certified Nurse Midwives) can attend them, and occasionally even OBs.  This depends on whether or not home births are technically legal in your state or not.  Home birth is legal — and regulated — in about half the states.  In the others, the law technically says that a woman can birth wherever and with whomever she chooses (meaning that if you choose home birth, you are not doing anything illegal), but that midwives cannot practice outside the hospital.  Your midwife needs to be well aware of what the laws are in your state and prepared to accept any consequences from choosing to attend births illegally.  Most do fall into this category, where necessary.

Here’s a series of questions you should ask your midwife:

1. What certifications do you hold?  Where and when did you receive them?

2. What was your training like?  How long did it last?  Did you take classes or attend any school?  How long did your apprenticeship last?

3. How many births have you attended, as a certified midwife?  How many did you attend as an apprentice (and/or prior, if you were a doula before)?

4. What is your transfer rate (to the hospital)?  What is the most common reason for transfer?

5. What rules a mom out for home birth?  (If the answer is “nothing,” giant red flag, run very far away.)

6. Have you ever had a mom or baby die?  What happened?

7. Do you work with a partner?  (Ideally, you would have two midwives present.  I do.  When a baby is born there are two patients.  In fact, although my practice will deliver twins at home if at least one is head down, they require three fully-qualified midwives to be present for such a birth.)

8. Do you have a back-up midwife, in case you are sick or attending another birth?

9. What supplies do you bring with you to a birth?  Pitocin, oxygen, etc.?

10. How do you handle emergencies?  Hemorrhage?  Baby not breathing? etc.

11. How do you handle things prenatally?  How often do you see me?  What prenatal care do you perform and what tests do you recommend?  Do I need to go elsewhere for tests?  (Ideally, they should see you as often as an OB would — monthly through your 7th month, then bi-monthly, and weekly in your last month.  Minimum tests include weight, blood pressure, edema, urine for protein and glucose, anemia.  Many will recommend going for a single ultrasound and having basic bloodwork — checking for cholesterol, anemia, blood sugar, immunities, etc.)

12. Do I need or should I see a back-up OB for supplemental care?  (Many officially recommend this.  You would see both on a regular basis until delivery, when your midwife would come to you for delivery.)

13. What happens if I do transfer?  Is there a particular doctor or hospital I should use?  (This will depend on the options available where you are and at what point you transfer — during pregnancy, or while in labor.)

14. What is your philosophy on birth? (This should generally match your own.)

Feel free to ask anything else that makes you feel comfortable.  In my experience, midwives are usually very cautious and ready to refer patients to the hospital or an OB at the first sign that something isn’t right.  The should be very conscious of the limits of their training, so that if any situation crops up that they feel uncomfortable about handling, they are prepared to rule you out as a home birth candidate.  This doesn’t happen too often, but it’s very important to know that if you are one of the “riskier” cases, your midwife will tell you so and refer you.  Any midwife who says that she never transfers or refers women because “all women can do this!” should be avoided!

Go with your instincts, too.  If you feel comfortable with the midwife and she’s answered your questions sufficiently, then choose her.  If not, keep looking.

(At my birth, I’ll have two fully-qualified midwives.  One who has been in practice over 40 years, one over 10 years.  I’ll also have an apprentice midwife who has 5 years of experience as a doula.  I feel totally comfortable with that team.)

How did you choose your home birth midwife, or other practitioner?

Click here for more questions you should ask your midwife or OB-GYN

Top image by eyeliam

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