We're leaning toward homebirth and we're interviewing midwives. What questions should we ask her? What factors matter?
- Read, read, read about homebirth. The more you know about the process and possibilities, the more qualified you will be to review candidates.
- After determining what you and your partner are looking for in a birth (excellent advice from Meg), review your expectations of the birth with potentials to see how compatible it is with their style.
- Get references, and speak with the other parents. While any reference parents the midwife provides are likely to have a positive experience to report, the educational portion of this will be seeing if the midwife provides a birth experience similar to what you're looking for. Think of this as double checking the prior point.
- What does she consider an acceptable delivery window - how early, how late, etc.
- Question them about backup plans, assistants, etc -- Make sure the midwife you choose has a backup you can contact if she isn't available when the baby is ready. Ideally you should be able to meet the most likely backup midwife beforehand too, to make things more comfortable during delivery.
- Discuss transfers -- How often has she transferred to the hospital, in what situations does she do it, will she stay with you, does she have a good relationship with the local hospital, etc.
- How is she equipped/trained to deal with emergencies? Neonatal resuscitation, tearing or hemorrhaging, etc
And you can't forget the business end of things...
- Cost. Payment plan available?
- What's bundled with the cost?
- What do the parents need to contribute (supplies to purchase, for instance)?
This seems like an excellent resource for you:
- Is she licensed (by your state/country/whatever)?
- What are her credentials as a midwife (licensed midwife, certified nurse midwife, certified professional midwife. Is she a member of any professional organizations)?
- How many years has she practiced?
- How many births has she attended as a midwife?
- Where does she do her prenatal visits? Home? Office? Birthing center?
- Does she have a consulting/backup obstetrician and who is it?
- What are her views regarding labor and birth? For example: How will she monitor mother and baby? How often will she monitor the baby? Can you labor in water? Can you birth in water? Does she consider herself hands-on or hands-off and will she work with you to establish a birth plan?
- What is her rate of prenatal transfer?
- Will she stay with you if you have to transfer while in labor?
- Will she attend the birth or does it depend who is on-call?
- How long does an appointment with her normally last?
- How many babies is she personally delivering per month?
- Is she certified in neonatal resuscitation? Does she carry oxygen to the birth?
- What happens if she has two patients in labor at the same time?
- Has she ever missed a birth?
- When will she come to you after you begin labor?
- How long does she wait to cut the cord after birth?
- What does she do if there is an emergency, such as a post-partum hemorrhage?
- What are her fees and what do they include? What is her payment schedule?
- What does she do if a mother goes past her due date? What if she is approaching 42 weeks?
- Why did she become a midwife?
- Does she participate in continuing education beyond what is required to maintain her license?
- What does she expect regarding self-care during pregnancy?
- What is her view on nutrition and weight gain during pregnancy?
- Has she ever had to resuscitate a baby?
- Will she help with breastfeeding?
- How does she feel about circumcision/immunization?
- How do I get my baby's birth certificate/social security card/whatever?
- How will my partner be included in my visits and during labor?
- Can my partner catch the baby?
- Does she have a lending library?/Can she recommend any books to read?
- How is she contacted? Do patients contact her via cell phone, pager, etc.?
- Does she have student midwives in her practice?
Also, I think it's important that you and your wife be able to clearly and concisely discuss your own personal "birth plan" for lack of a better word. Some people want their midwife/doctor to be much more hands-on, and some people want their midwife/doctor to be more hands-off. One question I don't see on the list that I would want to know if I were hiring a midwife is Under what circumstances would she recommend a hospital birth rather than a homebirth? That way if, say, your baby is breech you won't be blind-sided when your midwife suddenly recommends a hospital birth. It can be very difficult emotionally when you have this idea of a birth plan that suddenly and unexpectedly gets changed due to circumstances beyond your control, so knowing her policies on high-risk pregnancies, emergency c-sections, and other unexpected events during pregnancy can lay the foundation for the "what-ifs". She can also be a great resource for parenting, Lamaze, and breastfeeding classes and support groups so don't forget to ask about that!
Congratulations to you both!