Questions to ask a Midwife for a Home Birth

The question of choosing a midwife for homebirth comes up often on my on-line groups. One of the ladies was kind enough to post her questions and make it available for the public. Hope it helps:

Here's my own list of questions from when I was finding a homebirth midwife. IT's kind of long, but it was intersting to see the responses from different midwives that I interviewed; one of them looked at the list (it's 4 pages printed out) and kind of laughed and answered a few of them as she flipped through. The other one, the one we went with and whom we love and who we're having our 2nd baby with (our 3rd baby--2nd one with her attending) went through each question and answered/discussed them all with us.

Catherine

General

How many births have you attended total, and in this area?

What is your transfer rate? Typical reasons for these?

What is your episiotomy rate? Reasons for doing them?

Are your guidelines or restrictions about who can give birth at home strictly enforced?

Are you available for phone calls 24 hours a day for advice/emergencies?

How do you determine the due date?

What happens if I go past 42 weeks?

What are your experiences with/opinions of Bradley? Hypnobabes/hypnobirthing?

Do you encourage your clients to write birth plans? What is the intended benefit of them?

Will you be okay with attending me if I go into labor at, say, dinner time on Christmas Day?

Would you ever attend twin births? Singleton breech births?

Prenatal Care

What are your expectations of clients during pregnancy?

Do you perform/recommend a pre- or postnatal Pap smear if I’ve had a negative one within 3 years?

What are your normal guidelines for weight gain?

What prenatal tests/monitering do you recommend/perform routinely? (BP, weight, urinalysis, ultrasound?)

Do you suggest testing for GBS, and if I’m GBS+, what do you suggest?

Do you suggest testing for GD, and if I fail the glucose tolerance test, what do you suggest?
What are your standards for preeclampsia? How do you manage this condition?

Do you use a Doppler or fetoscope at prenatal visits? How often?

Have you ever had clients with partial/complete placenta previa? How was this detected? How rare are these conditions? How was this dealt with?

Labor

What are your expectations of clients during birth?

What supplies do I need to provide for the birth? Where can I purchase those supplies?

At what point after labor has commenced do you prefer I call you, and at what point in my labor will you and/or your assistant come to my home? How many assistants do you normally bring to the birth?

How many clients do you have due in any 4 week period, and what is the plan if I go into labor while you're with another laboring client?

Have you ever missed the birth of a client? If so, what were the circumstances?

What equipment do you normally bring to the birth (birthing stool? oxygen? ambu-bag? pitocin shot?)

Are you okay with my 3.5 year old daughter being present at the birth?

How long do you let things go after PROM, if there is little/no progress but the mother doesn’t want to transfer?

Would you be okay with mostly being in another room, if I wanted to labor and/or deliver alone or only with my husband in the room?

First/second stage

What do you perceive your role to be during my labor? During labor, how active are you in checking the mom and the fetal heartbeat, etc?

Under what conditions would you perform AROM or otherwise induce or augment labor?
What natural comfort techniques do you provide?

What pharmaceuticals, homeopathics and/or herbs do you use at births?

What is your usual approach to a labor that is progressing slowly?

How many/few people are you comfortable with being present at the labor and birth?

How do you deal with shoulder dystocia?

How do you deal with cord prolapse?

What percentage of your clients tear, and how badly? How do you try to prevent this?

How long are you willing to let a client push, or do you base it solely on the baby's stress level?

How do you think the pushing stage should be managed?

If I or my husband wish to catch the baby, are you comfortable with me/him doing so?

What positions do your clients most often give birth in? What positions do you prefer, and why?

Third stage

How much time do you allow for the delivery of the placenta?

Are you okay with the placenta being delivered underwater?

What is typically done with the placenta afterwards? Are there any legal restrictions on disposal?

How do you detect partially retained placenta? How do you treat this?

How often do hemorrhages occur?

How would you handle a hemorrhage? Do you carry pit or herbs for this? Legally? At what point would you recommend transfer for medical management of hemorrhage?

How soon do you like to clamp and cut the cord? Can my husband do this, if he wishes?

What would you do for a floppy baby? How often do you see this?

What are the most common minor complications you see, and how do you typically treat them?

What happens if my perineum needs stitching/suturing? Can you do that? Are you comfortable with repairing 2^nd/3^rd/4^th degree tears? How bad does a tear have to be before you use stitches?

Do you help with cleanup (laundry, etc.)? What do you typically do?

How long do you typically stay after the birth?

Complications
Do you have a working relationship with one or more particular OBs to whom I would be referred in the event of a complication? What hospital would you prefer I transfer to?

What situations do you consult an obstetrician for? How commonly do these occur?

What problems or complications in pregnancy would mean that a obstetrician would become my primary maternity caregiver?

Under what circumstances do you transfer to hospital?

What hospital would I be transferred to?

What would be the plan of action if a transfer to hospital were necessary during labor?

Would you stay with me in the hospital? In the operating room? For how long after the birth?

Post-partum

Do you examine the baby after birth? What do you look for? What tests do you perform? Do you recommend eye ointment and/or Vitamin K? Oral or shot? Why or why not?

Do you have any special things you do for the mom after a birth such as an herbal bath?

How do I obtain the baby’s birth certificate/SSN?

How many postpartum visits will there be? Where will these take place? What do they include?

Do you examine the baby at any or all of your visits, and if so, what does the examination include?

When do you recommend that we take the baby to his/her pediatrician for the first time, and why? (Assuming normal delivery and healthy baby.)

Financial

Will you try to bill my insurance company? How? (Billing codes, your status in PA, etc.)

How much is the fee for birth alone, vs. prenatal care plus birth? If I need extra prenatal visits or labs, how much are these?

What is included in the fees? What will I need to provide? (Birth kit, lab fees, etc.)

Anybody who wants to is totally welcome to publish it anywhere they choose, and/or alter it as they see fit for their own use. I'd love it if anybody else could benefit from having this list of questions.

Catherine

The decision is made

Dear Baby,

The decision has been made, you're going to be born here at home. A few years ago, a friend had a Cesaraen Section, then another, then another. Then my friends had C-Sections, and kept having them, and kept having them. I only have one friend who had natural birth, and that was by accident.

The reasons for the C-Sections were myriad. My friends were too fat, too thin, too old, the baby too big, and it was convenient for the doctor. I don't actually know anyone who went into labor. Rather, the doctor scheduled the due date, the women went in, had major surgery, and brought home a baby. I asked again, and again, but no one had a good reason why this was preferable. Rather, everyone focused on the outcome, healthy baby.

Then I saw the Business of Being Born, and it changed my life. I'm a conspiracy theorist by nature, but I didn't put that together with what I was seeing in all of this assisted labor. I've decided to bow out of that system. I'm a control freak by nature, and between inducement, and drug administration, and the ultimate C-Section, it was clear I would not be able to control your birth process in the hospital.

So we'll welcome you home - at home.

Love,

Dear Mama

BFP

Dear Baby,

It's unbelievable, but you are coming, finally.  After missing my period, and all the awful cramps, I started to get suspicious.  Also the too big for their bra boobs were a jumping around during exercise, like they had a life of their own.  That was the second clue.  The two positive pregnancy tests were the icing on the cake.

DH has the (last) pregnancy test and wants me to start a shoe box with belongings for you.  He thinks you're a girl, and have started talking to you already.  

I'm off to the GP tomorrow to have your existence confirmed, medically.  Now, the wait begins.  We've told a couple of people who've been ecstatic.  DH wants to shout it from the rooftops, but I've convinced him to keep his council for another couple of months.

Look forward to meeting you.

Love, 

Dear Mama

Clomid and IUI

Dear Baby,

On Friday,  our RE called.  He outlined our options, do nothing (meaning trying at home) or come in for vaginal ultrasound, start Clomid and schedule an IUI when I ovulate.

Last year, when I thought this would happen right away, I was in such a hurry.  Right now (as I age every second), not so much.  This month, I want to gear up to run a race, and increase my Pilates to three days a week to really work no my core.  None of those priorities matches up with spending four or five days in a doctor's office with my legs in stirrups.

So, I'm putting it off.  I hope that in June or July when I'm feeling better about myself, I'll be more ready for medical intervention.

Love,

Dear Mama

Millions of Sperm

The results are in for all the testing.  We're young, healthy, and normal.  DH apparently has millions (to the tune of 158 million) sperm.  Even counting out the one with two heads or three tails or who swim in the wrong direction - we're looking at a pretty high number.  He was quite relieved to hear that after the clinical experience of ejaculating into a cup.

Now, I know that our issues are advanced maternal age or 'just one of those things.'  We're one week into another two week wait.  We'll see how it goes, then either back to the RE for more advice (what could that be - 'be patient'), or maybe we'll be lucky this month.

A Quiet Room

Today DH goes to the RE for his sperm analysis.  C'mon, you've all wondered what actually happens when a man has to go in and perform on the spot.  Well if you haven't I have.  The nurse told us last week that they will provide a private room, magazines and videos.  And yes, you could bring your own.

DH wonders will the content be to his taste.  Diverse.  Soft core like Playboy or something far more provocative like Hustler or Penthouse.  Is it clinical or cozy?

We've spent the weekend speculating, and I'm absolutely dying to know.

Plus I was told one too many times this weekend to cover up (in 100 degree weather, no less), because he had to hold out and could not be tempted.  In just 15 minutes he'll be very tempted.

More acronyms and fertility testing

Tests, tests, and more tests.  Started down the road of 'fertility' medicine, and it's like hurtling down a highway.  On Tuesday, had an impromptu FSH (follicle stimulating hormone) test and today the much talked about HSG (hysterosalpingogram).  Not the most comfortable test mind you, but with a Valium and a bunch of ibuprophen, I sailed through the first test.  That's right the FIRST test.  Computer imaging malfunction required that I do the test again.

After sedation wears off, the second is not nearly as pleasant.  The good news is that my hormones are well within range and my reproductive organs appear very healthy.  It's now time for DH to get to that semen analysis.