Picking a midwife can be a difficult choice. Maybe friends recommended a midwife they love. Maybe you found someone via Google. Either way, you probably want to talk to your prospective midwife and get a feel for how comfortable you would be having them attend you through your pregnancy, birth, and postpartum period before hiring them to do so. Good connection, and a general feeling of comfort with your potential midwife’s presence are certainly important, but knowing if you are on the same page in how you approach birth is important too. Luckily, many practices offer free interviews, consults, or at least a meet the midwife event where you can ask a few questions.
If you are pregnant for the first time, or maybe just new to the midwifery model of care, you may be unsure what to ask once you get to that consult. I know I certainly was. My list of questions for the midwife who eventually caught my eldest child was basically, “Can I hire you?”. Later, I came to really wish I’d asked about a few more things.
As both a midwife and a mother, here are the top questions I wish I had asked in the past, and I wish more parents would ask me.
Qualifications and Experience
Credentials vary state to state in the United States. Some states license midwives. Some do not. In a few states a license is available, but midwives may also legally practice without one. There are also some national level credentials that midwives may earn, but these are not accepted in all states. To further complicate matters, license and certification requirements vary. The clearest way to know your potential midwife’s experience is to ask.
- Are you licensed or certified? If not, does (whatever state you are in) license midwives?
- What is your experience with attending births?
- What was your training like?
- Are you certified in neonatal resuscitation? CPR?
Philosophy and Beliefs
Midwives are often assumed to share a fairly universal approach to providing care. There are some things that are far more common in midwifery care than in the standard medical model, but nothing is true of every midwife. Open ended questions will generally let the midwife you’re interviewing give you a solid idea of where they stand.
- What is your philosophy regarding pregnancy and birth?
- What do you consider your role to be during the birth?
These questions are vague, and different midwives may answer with varying levels of detail. Additionally, some terms don’t have standard definitions. As an example, “natural birth” means very different things to different people. A midwife may say that they always consider a “natural birth” to be the goal, but they may mean a completely uninterrupted, unmedicated birth occurring outside the hospital, or they may simply mean a vaginal birth regardless of how much intervention and management is involved. When in doubt, ask.
Many people assume that risk of ending up with most interventions or having certain issues all comes down to the health of the pregnant person. In reality, there are often other things that come in to play. While random problems, and legitimate health issues certainly do occur, choice of care provider and birth location can make a dramatic impact on your chances of having the birth you are hoping for. Routine practices can be based on any number of factors, including accepted community standards, personal experiences, and research findings. It’s rare that a care provider does not feel like they have good reasons for practicing however they do, so how can you tell if their practices are a good fit for you? Enter statistics.
The numbers don’t lie (though it’s worth noting that individual care providers may not always know their statistics off hand). If the midwife you are interviewing generally transfers around half of the planned homebirths under their care, be aware that your chance of moving things over to the hospital is going to be about 50%. On the other hand, births simply do not always go according to plan, so don’t expect a care provider to never have had an emergency.
- What percentage of your clients need to transfer during labor?
- What is the most common reason for transfer in your practice?
- What portion of your clients end up with a c-section?
- What is your mortality rate?
Availability and Backups
One of the perks of hiring a midwife is that in most cases you will receive continuity of care. This means that you will be cared for during pregnancy, labor, birth, and the postpartum period by the same person or small group of people. Occasionally, however, this isn’t how it all works out. Sometimes, two people go into labor at the same time, and no one can be in two places at once. Midwives are also human and do occasionally get sick, have accidents, or have family emergencies come up. It’s worth asking about, just in case.
- Have you ever missed a birth? If so, what happened?
- How many births do you typically attend in a month?
- Do you have a backup midwife? If so, can you tell me a little about them?
Routine Prenatal and Postpartum Care
While the midwifery model of care is known for spending more time with the pregnant people in our care, and giving more individualized care to them, midwives still have routines like anyone else and they can vary. Asking a few questions about what is normal for the midwife you are interviewing can give you an idea of what to expect.
- How often do you have prenatal appointments?
- Where are prenatal appointments held?
- Do you do require specific labs? Ultrasounds? Other testing? If so, where is it typically done?
- What does a routine prenatal appointment look like?
- How long are appointments?
- What about postpartum follow up appointments?
Labor and Birth Care
You may already have a clear idea of what you expect your birth to look like. Many midwives are quite adaptable, but the interview is a good time to assess if there are any major differences between your expectations and what your midwife has to offer.
- Do you bring anyone with you when you attend births? If so, who? What is their role? Can I meet them in advance?
- When do you typically begin labor support?
- When do you do vaginal checks during labor?
- What kind of monitoring do you do during labor?
- Do you have any standard procedures you insist on during labor (ex. hep-lock, continuous monitoring)
- Immediately after the birth, what normally happens?
- What is your standard routine for the newborn? Will baby and I be separated?
When Things Don’t Go As Planned
We all look forward to a birth that goes smoothly, quickly, and easily. The reality is that, while most births will fall in that category, a few won’t. This can be an uncomfortable topic for some parents. No one wants to think about what happens in an emergency, especially while pregnant. If you’re like most pregnant people, plenty of people around you have already treated your pregnancy as an invitation to tell you horror stories, and you may be feeling really done with the subject. That’s very understandable, but this is an all too often unaddressed topic. If you end up not needing to know, great! If you should end up needing it, however, late pregnancy or labor is not the time you want to be trying to figure out what to expect.
- What would be grounds for being risked out during pregnancy?
- How many weeks gestation can I go to before being risked out?
- If I need suturing after birth, will you provide it, or will I have to go to the hospital?
- Do you have a limit on length of labor before you recommend transfer? What if my water is broken?
- If I have to be transferred, do you have a specific hospital or OB you prefer to transfer to?
- If I am transferred, do you go with me?
Specific Interests and Situations
Everyone’s needs and wants are a little different. If you are looking for something in particular, ask about it!
- Are you comfortable attending a doula supported birth? Do you have any particular doulas you recommend?
- How do you feel about waterbirth?
- Do you attend VBACs (vaginal birth after cesarean)? If so, do you have any specific criteria for VBACs?
The Practical Stuff
Liking what you hear? Pretty sure this is a good fit? There are a few practical matters to consider. Where this will fall on your priority list will vary. For some it may be the first set of questions you need to ask. For others, it may be the last. Either way, at some point you should probably ask about the financial responsibility aspect.
- What is your fee?
- Do you bill insurance?
- What is included in your fee?
- Is there anything not included in your fee that I will absolutely have to have? Birth supplies, testing, etc.
- Is there a refund policy? If so, what is it?
- What is the normal schedule of payments for your practice?
What Are The Right Answers?
Maybe the hardest thing in finding a midwife you’ll love is figuring out what you’re looking for. Much like different people are going to have different questions, different people are also going to be looking for different answers. There are no right or wrong responses to these questions. It is up to the individual to decided if the answers they get are right for them. Happy interviewing, and best of luck!