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