Beginning the Questions
So, now you’re sitting in front of the midwife. Be sure to never ask questions that can be answered in the affirmative or negative:
- “Do you attend twin births?”
- “Are you a hands-off midwife?”
- “Have you ever transported a woman during labor?”
The biggest un-question of all is “Do you trust birth?” Asking this is opening the door to a dogmatic, cult-like belief in the minimization of all care, including care that is used in an emergency.
Open-ended questions are much better ways to learn about the midwife and her practice.
- What is your general philosophy about pregnancy and birth?
This question is really broad and should not be answered with a rehearsed statement. It was one of the most ambiguous questions I was ever asked and wondered if I answered it right each time because the answer can be so expansive. And someone’s philosophy can be incredibly different than what actually goes down at the birth.
Instead of “What is your philosophy?” asking “What does normal birth look like to you?” can give you much more information.
Asking what normal birth looks like to the midwife can let you know where her parameters are. Does she say a breech or twin birth is a “variation of normal”? This lets you know she’s on the liberal side of midwives, more amenable to delivering breeches and twins at home. If she is on this side of the spectrum, you might ask these next questions.
- “What is your experience seeing breeches and twins born?”
- “Have you ever assisted with them? Tell me about the experiences.”
- “Have you ever been the primary with them? How many and what were the outcomes?”
- “How did you learn your breech and twin skills?”
- “If we agree to birth either one at home, who else would you have at the birth?”
- “Does she also have hands-on skills? Where did she learn her skills.”
Through these questions, you’ll be able to see her exact experience with breeches and twin homebirths, as well as getting to know a part of where she stands on “What’s a complication to you?”
Later, I’ll talk about neonatal resuscitation and hemorrhage which are vital to be explored with both breech and twin births.
If there is no experience and she lets you know twins and breeches are out of her scope of practice, move to these questions that refer to the pregnancy and transfers, more than the actual birth.
- “What is the upper limit of a high blood pressure you would feel comfortable with at home? If my blood pressure started going up, what is the process towards eventual transfer?”
- “What do you consider a fever in labor and when do you transfer for one?”
Remember to know the answer you're looking for. If you are looking for a conservative midwife, it's important to know the standard of care is to transfer a woman if her blood pressure is 130/90 or 30/15 above her normal blood pressures. (If your blood pressure is usually 90/56, by the time your BP is 130/90, you could be having a stroke!) If you're looking for a more liberal midwife, one who doesn't stick to the rules of what most (medical folks) would consider safe, then knowing her answers will help you here as well. How she answers gives you pieces of the total picture of the type of midwife she is and a decent guideline-roadmap for a normal and inching-out-of-normal pregnancy and birth.
Gentlebirth.org suggests this series of questions:
“What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?”
I’m not terribly fond of this line of questioning because the way it’s worded, it presumes the midwife believes preeclampsia is nutrition-based, which, it has been scientifically proven, not to be. I guess if you want to know if she’s still of the belief that the Brewer Diet can help a woman avoid or if she has preeclampsia already, the Diet can relieve the condition, that would be good to know, demonstrating she is not an evidenced-based midwife (some of the links have been locked for privacy), despite her possibly saying she is.
I encourage you to spend as much -or little- time while in the midwifery consult as you need. If after ten minutes, you realize she isn't the one for you, do you both a favor and end the interview as soon as possible. You can always just say, "Thanks for your time, but I can tell we're not a good fit" and be on your merry way. I used to limit the time with interviews, frustrated at hearing the same questions over and over again, ones that were so unimportant in a homebirth interview:
- Do you let the cord stop pulsating before you cut it?
- Will you let me move around in labor?
- Can I push in any position I want to?
- Can I keep the baby with me all the time?
As if we were in the hospital. I felt bad that women expended worry and planning time on such basic questions that all have "OF COURSE!" answers. I most certainly answered the questions and also suggested reading materials so they'd get a better idea of what homebirth looks like, but wished I didn't have to go through them at all.
But now, I would take the questions and answer them with more inner patience, using the time to expose the type of midwife I am... one that sees/hears the same thing a thousand times and acts as if it is always the first time. I would not limit the appointments at all. I would not sigh if someone came in with a several page list of questions. I would not say, "We all pretty much have the same training, so pick the midwife you wouldn't mind spending 20 hours with in a small room" because it's not true. Choosing a midwife is not just about personality meshes. It definitely has elements of that, but it is not crucial to become friends with your midwife. In fact, I've found (through my own many mistakes) that not being friends keeps the boundaries clear and allows for decisions to be made autonomously by both provider and client. Each woman has the right and responsibility to keep mom and baby safe and having the space to give the sometimes difficult news of needing to transfer or transport can help the relationship stay in that professional -and trusting- place. There are no pity decisions being made, keeping a mom home because the midwife feels sorry for her, thereby risking the health and possibly life of the two clients. As I said, I learned this the hard way. More than once. If I were to begin my midwifery career again, it would include never (or only on the rare occasion) becoming friends with clients.
Next: More Suggested Questions from Various Websites & Why Not to Ask Them