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Saturday
Oct082011

Interviewing a Homebirth Midwife (Part 1)

Over the years, I’ve read and heard a slew of interview questions for doulas and midwives. Some are almost unanswerable and others, terribly irrelevant. Over the next few posts, I’ll take some of the different questions various sites say to ask and I’ll talk about how to change the questions to something relevant and will give the searching woman enough information for her to make a decision about the midwife for her… hands-off… hands-on… or someone inbetween. 

But, whomever you’re hiring, it is someone to, ultimately, save the life of you or your baby if a tragic emergency occurs. When a complication occurs in the hospital, there is a team of folks to do the various parts of the job in keeping someone alive. If there are mistakes being made, there is almost always another person there to see it and fix the mistake. In a homebirth setting, you have one, usually two and sometimes three people to save the life/lives. If each person isn’t meticulous in their abilities, there is no back-up team to take over or even witness the mistake/s. This is why choosing the right homebirth midwife is so important. 

It is vital for women and their families to understand that while having a baby at home can mean avoiding some too-common emergencies that happen in the hospital (fetal distress from Pitocin or a cord prolapse from rupturing the amniotic sac artificially, for two examples), there are also emergencies that happen in the home that would be able to be handled better and safer if mom and/or baby were in the hospital. If a massive hemorrhage occurs, there are no blood products in the home, nor are there the plethora of means to control bleeding like they have in the hospital. Also, if a baby needs more than minimal resuscitation, the hospital is the place to be for their teams of personnel trained to attend to such emergencies. If parents are able to face these realities and accept the consequences (and I do mean that going both ways: hospital and home), then moving forward to finding the right provider can happen. 

When a woman is birthing at home and interviewing a possible provider, it’s important for her to know the answers she’s looking for. For example, if you’re asking about postpartum hemorrhage and “testing” whether the midwife knows her stuff or not, you need to know your stuff in order to gauge the midwife properly. This is one aspect of care that doesn’t happen with OB or CNM care. You know they know how to attend to postpartum hemorrhage, not only because they work with it all too often, but also because their education was standardized and that all of them have the same base of knowledge. In addition, OBs and CNMs regularly attend drills, even if they handled a hemorrhage a day, at least once every 1-4 weeks, they practice with each other so the skills are body memories and each movement is acutely accurate. More on drills later. 

This client-as-expert can be one of the most exhausting parts of looking for a homebirth midwife. In the discussion of whether midwifery should be regulated or not, the belief that a client needs to interview the midwife to make sure she’s qualified to attend to her birth is often stated as a reason to not require licensing, that it is ultimately the woman’s responsibility to hire the right midwife, the one that knows her skills well enough to save a life. But, how is the client supposed to learn how to be a midwife and be able to gauge whether the interviewees are wise enough to fulfill their promises during their pregnancy – all the while getting care from these midwives? It’s absurd to expect a woman hiring a midwife to know more than the midwife herself. This is where a standardized education and skills system being in place can not only save the pregnant woman time and energy, but perhaps also her life or that of her baby. 

But, for now, the woman does need to almost become a midwife herself before she can interview the midwife accurately. After reading the same midwifery books the midwifery students read, where does the mom begin?

Next: Pre-Interview Preparation

Reader Comments (5)

Having leapt over both sides of the home-hospital birthing fence, I’m wondering if you could clarify something for me. I am preparing to have my third baby and using the same CNM/CPM team that I did for my first two. The two most common horrific OOOH birth scenarios described by obstetricians, (and “concerned” friends and family who think they’re obstetricians), are neonatal resuscitation and PPH. I’ve dealt with both in an out-of-hospital setting. It’s a blur to me now, but I know that they used neonatal resuscitation equipment on my daughter and revived her within seconds. I know now that for PPH, they adhere to WHO protocol of active management of the third stageThey gave me Out of curiosity (and not debate initiation), how would this be different or—to use your words—“handled better and safer” in a hospital?

I suppose that I’m not 100% opposed to buying the hospital ticket, going on the hospital ride, and battling staff on everything from routine EFM to breastfeeding and the Hep B vaccine….all in the name of Just In Case. I just need to hear a staggeringly compelling reason to do so; from your blog posts, however, I’m inferring (perhaps incorrectly) that you see this not as an issue of “right way v. wrong way,” but more as one of trade-offs.

October 10, 2011 | Unregistered CommenterWendy

You're kidding, Wendy, right? Your baby needed resuscitation and you actually think that at a time when every second counted, the care provided by a midwife with a high school education and little education / training could possibly compare to having a neonatalogist, pediatrician, and trained neonatal nursing staff plus all of the relevant equipment right there?

Barb is right - the neonatalogists (etc) on hand at a hospital birth do all that for a LIVING. They are EXPERTS. The midwives aren't. They have education that impresses no one and no consistent training or routine drills. You really were ok with them practicing on your baby?

October 12, 2011 | Unregistered CommenterTired of Birth Junkies

Tired, Wendy said she had a CNM/CPM team. The CNM was certainly trained in neonatal resus. She probably makes sure anyone she works with has taken a class and drills. Are they as skilled as someone who uses this skill frequently? Likely not. But to have that person at your birth you would need to go not just to "a" hospital, but to one which has a high level NICU and a large number of women including high risk women, giving birth there. Because not every hospital has all the practitioners you are talking about around all the time either. Certainly community hospitals don't. OB's come in to catch babies, but there aren't always pediatricians there, much less neonatologists.

NGM has said that there are risks specific to home births, and risks specific to hospital births. In most hospital births these days they still cut the cord right away, for instance. Induction poses risks to babies, and the majority of labors these days are induced or augmented. etc etc.

People choose which set of risks they are more comfortable with. To my mind having a CNM who is familiar with birth in the home setting is just about ideal. Obviously your choices would be different. But I don't think you ought to try to tell Wendy her past choices were not reasonable ones. They were.

Susan Peterson

October 13, 2011 | Unregistered CommenterSusan Peterson

Finding the right midwife to attend your birth is important. The area you live in may have several midwives to choose from or you may not have a selection at all. Either way, it is important to ask a potential midwife questions that will help give you comfort in her experience and knowledge.

March 25, 2012 | Unregistered Commenterinterview techniques

First birth was an unnecessary C-section in a hospital...was told by next doc no need, I was not too small to deliver naturally. So, with second baby, I had a VBAC in a hospital, and they nearly killed my baby by delivering me flat on the wrong side, which cut off baby's oxygen. They wouldn't let me roll over until my hubby threatened to punch the doc because the baby's heartbeat had nearly stopped. Idiots! Next birth was AT HOME, and interviewed midwives. I picked first one because of her extensive, documented experience in Africa where she had personally performed about 10 C-sections resulting in live births and healthy moms. Because of my VBAC, I wanted a midwife who could do a C-section in third world conditions. Her birthing equipment was all in a huge, roll-up heavy-duty cloth, all pockets, each with a specialized piece of equipment. She had the stethoscope, forceps, scalpels, tweezer-type things, suction devices, different medications, including herbal mixes, oxygen tubing, thermometers, needles, syringes, suture equipment, various types of scissors, and all kinds of bandaging materials. Oh, this woman was prepared! Plus she asked all about my history, my philosophy of infant and baby care, and asked my husband a lot of very personal questions as well. She said that not every woman who wants a home birth should have one. She turned away about half of those who called her, because for one reason or another, she felt it was too risky for them and their child. I was thrilled that I "passed" her test (I had girlfriends who had "flunked")...and she answered every question, including all the bloody details about the C-sections she had performed..each gruesome layer of tissue. I knew what to ask because of my bad experiences in the hospitals. I was assured I would never need to lie down once during the birthing (and I did not!) and that if I was not able to efface sufficiently, she could do an episiotomy. She brought an oxygen tank with her for whiffs if needed. We never needed it. She was a certified nurse midwife. Thanks to her, my 3rd baby was born with no complications except it took a tiny period for her to "pink up" and my midwife had a graph with her so I could actually see where my baby was on the graph. At no point did I even think of calling an ambulance or ever wish I had chosen a hospital. Yes, moms, if you have a home birth, don't act like a stupid little girl. Read, study, ask, ask, ask. Your baby's life and your life depend on YOU no matter if you do a home or a hospital birth, and in my experience, the hospital was far more dangerous to both me and my baby. They were all about money and doctor is the god, and mom knows nothing. Sorry...that is not for me.

August 11, 2012 | Unregistered CommenterMarcia Ambler

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