Questions for Midwives
by Rosemary Romberg
Interviewing a Prospective Birth Attendant:
You have decided that you want to have your baby at home, or you are at least considering the possibility. Now you need to find someone to attend your birth. There are many important factors that you will wish to consider. If you are planning or considering a birth at a birth center or hospital birthing room with a midwife or even with a doctor, you may also find many of these considerations pertinent.
What about doing it ourselves?
Some women have given birth entirely by themselves, either accidentally or intentionally and they and their babies have fared perfectly well. However, nearly all women giving birth need and want the psychological support of other people at the time of birth. Extremely few women would consider giving birth alone to be a truly desirable way to have a baby.
Sometimes expectant couples consider the prospect of giving birth by themselves together, with the father assuming the role of birth attendant. Perhaps this alternative is justified in communities where absolutely no help is available for home birth, and nearby hospitals and services fall far short of meeting the couple’s needs. Establishment of progressive practices within hospitals, alternative birth centers, and qualified attendants for home birth should eliminate the need to resort to do-it-yourself home birth.
While the idea of the mother and father giving birth entirely by themselves may seem romantic to some couples, very often the results can be disappointing or frightening. While many expectant parents have given birth successfully on their own, few lay people have the knowledge, skills, or experience to handle complications such as a hemorrhage, or a baby not breathing. Of equal importance is the psychological need for parents to assume the sole role of new parents at the time of birth, and allow the responsibility of attending the birth to a third party. The experience of giving birth and becoming new parents is emotionally overwhelming enough in itself without assuming the dual responsibility of being the birth attendant. This consideration is important even if the expectant parent(s) also happens to be skilled and knowledgeable in this area. Most midwives, no matter how experienced or well trained, choose to have another birth attendant when they themselves give birth. Most male doctors, even if they have delivered hundreds of other babies, elect to be just fathers when their own wives give birth.
Some parents like the idea of the father catching his own baby. If this option appeals to you. the presence of a competent midwife need not prevent you from doing this. Many birth attendants will readily agree to step back and allow the father to catch his own baby if the couple desires this and if the birth is proceeding normally. If you, as an expectant father, are interested in catching your own baby you should be aware of your personal motives for this. Your primary role in birth should be to provide loving encouragement and support to the mother while sharing your babes birth — not to play obstetrician.
How do I go about finding a birth attendant?
In some communities, doctors will attend home births. In many other areas doctors are not available for home birth. Some expectant mothers prefer the more relaxed, feminine, unhurried approach of a female midwife to the more hurried, masculine, medical, and impersonal approach that some doctors would tend to impart. (This can be true even if the birth attendant is a woman.)
In some communities midwives are licensed by the state, and can be open about offering their services. In other communities, home birth attendance is more underground. The legality of midwifery and home birth attendance is in question in some areas, yet the need for these services persist. Parents continue to seek what they desire in terms of birth, and midwives continue to practice what they believe is right.
Most often people get in touch with midwives through local childbirth instructors or groups, through La Leche League groups, or through friends who have either given birth at home or know someone who has. Sometimes local hospitals and doctors are able to give out this information. Today some midwife services can be found in the yellow pages of the phone book or by searching on-line.
Some midwives are more qualified, skilled, conscientious and experienced than others. Some midwives started out as childbirth instructors, mothers who gave birth at home themselves, or simply friends of expectant couples who were called upon to help. Midwives such as this often simply fell into it by being repeatedly asked to attend other people’s births, and gaining knowledge and experience as they went along. Especially in communities where little or no official support for home birth was available, the empirical midwife has often come about out of necessity. Some midwives who have started out in this manner have become extremely skilled and knowledgeable.
Some midwives have backgrounds as nurses. Some have attended official midwifery training programs or schools. Some are Certified Nurse Midwives having additional special training in midwifery beyond their degree as a registered nurse.
Some people who have given birth in hospitals have chosen doctors giving very little concern towards the personal rapport that they feel, nor towards how he or she will handle their birth. The home-birth/birth center birth movement has in part, come about because expectant parents have wanted to be more personally involved and in control of their births. Therefore, few mothers planning home or birth center births would want to select a midwife without giving many considerations as to what she knows and how she practices.
Some considerations are matters which can be of extreme importance in the case of emergency. Others are matters of personal preference. Consider each area on this list carefully as to how personally important each thing is to you. The following is a list of concerns which expectant parents should ask of a prospective midwife: (The term “she” is used because most midwives are women )
1. Does she do prenatal care? Some midwives give their clients regular prenatal checks throughout pregnancy. Others do not know how to give prenatal care, or prefer not to do this. Most expectant mothers would prefer to receive regular prenatal check ups through the same person who will attend their birth.
2. How much does she charge for her services? Some charge nothing or simply ask for a donation. Others ask a substantial fee. If the midwife is official and certified, some insurance programs may pay for her services. Some midwives are open to trading goods or services in return for all or part of their fee. The least expensive midwife may not be your best bargain as so many other considerations are important home or birth center births birth. The midwife who charges a regular, established fee may have a more professional attitude about her work than the midwife who asks little or nothing.
3. What is her background and training? Does she have a license? Did she attend an official midwifery training school? At how many births has she been present? How many did she assist with during her training? How many births has she attended in the role of midwife?
4. Is she trained in Cardio-Pulmonary Resuscitation (CPR)? How would she handle the situation if the baby is not breathing? Has she had any actual experience with this situation?
5. Does she check blood pressure throughout labor and afterwards?
6. Does she do internal pelvic exams to check dilatation during labor?
7. Exactly what supplies and equipment does she bring to a birth?
8. Does she have any strong feelings about the presence of other friends or children during birth, taking pictures, tape recordings or videotaping, role of the father, or other important choices for birth? Most expectant parents would prefer to make their own choices about most of these matters and that the midwife be flexible about what they choose.
9. Does she have a doctor who is willing to back her up should need for hospitalization arise?
10. Does she know how to recognize and handle a hemorrhage? How would she go about treating this problem?
11. Does she have Pitocin or Methergine, which are drugs which will stimulate the uterus to contract and prevent excessive bleeding? (i.e. following birth.) If so, does she use them routinely for all mothers, or only in case of an emergency?
12. How does she go about working the perineum to ease the baby’s head out without tearing or episiotomy? There are a variety of different techniques for this. Some use warm oil. Some use hot compresses. Some use dry compresses. All have advantages and disadvantages.
13. Does she have the skills and equipment to do an episiotomy if necessary?
14. Does she routinely check the mother for tears after birth?
15. Does she have local anesthetic and suturing equipment for repairing a tear or episiotomy if necessary? While some would consider this type of thing too much medical equipment, it is much easier and less disruptive to have repairing done at home by one’s birth attendant than to have to go to a hospital for this.
16. Does she check fetal heart tones regularly throughout labor?
17. Does she have preferences as to position for giving birth?
18. How does she go about delivering the placenta?
19. How does she handle the baby immediately after giving birth? Will she put the baby on the mother’s stomach for skin-to-skin contact, or does she prefer to wrap the baby up first? How does she feel about Leboyer massage? Dim lights? Delayed cutting of the cord? Leboyer bath? Underwater birth? Quiet at the time of birth? Routine suctioning? Father assisting with catching the baby? Does she feel that the baby is not “okay” until it cries?
20. What is her policy about ointment for the baby’s eyes? Silver nitrate (which is stinging and causes temporary blindness)? Other ointments? Waivers? No ointment routinely used in eyes?
21. Does she do a neonatal exam on the baby shortly after birth?
22. How long does she usually stay with the mother after birth? What sorts of things does she check?
23. Does she come back for a return check on the mother and baby 1-2 days after birth?
24. Does she do a 6 week check-up? If so is she able to do a PAP smear or give birth control assistance at this time?
25. What type of actual experience has she had with various types of complications? (Breech deliveries twins, hemorrhages, etc.)
26. Under what conditions would she transport the mother and/or baby to a hospital? A midwife with little training may not be able to recognize serious complications. A midwife with lesser training, but a strong sense of responsibility may be very quick to transport questionable cases to a hospital. A midwife with more training, equipment, and experience may be more able to handle some types of questionable situations herself at home.
27. Does she have a lab that backs her up for routine tests, “blood work”, etc.?
28. What specific policies does she have as to what type of clients she will and will not accept?
29. Is she familiar with and supportive of the same type of natural childbirth techniques (i.e. Lamaze, Bradley, etc.) that you will be using?
30. Does she have another midwife who will work in her place in case unforeseen circumstances prevent her from attending your birth?
31. Finally and of utmost importance, do you have a rapport with her) Are you comfortable with her viewpoints, or personality? Does her spiritual attitude towards birth agree with yours? A midwife who is excellently qualified in all of these medical areas, or whom your friend just loved may not be the right birth attendant for you. These are the many, indefinable concerns which only you can decide for yourself.
c. January 1982 (Revised – 2012, Update 2013)
(Author’s note – On most of the considerations above, I am not intending to make a value judgment or advisement as to whether or not certain procedures or preferences are desirable or essential. My intention is to emphasize awareness of these things, preferably prior to labor and birth. For example, if you do not want routine pelvic exams, do not enlist a midwife who will insist on them. Conversely, if you believe that pelvic exams are essential during labor, do not choose a midwife who doesn’t do them. – R.R.)