The Ultimate Guide to Hiring a Midwife
Here is a list I've compiled of all the questions that came to mind before meeting with a midwife. It's important to interview multiple people to get a feel of how they work, and how they will interact with you.
Ask about their experience. Example: "Tell me about your experience? Who trained you, and how long was that process? When did you pass your CPM exam? How long have you been in practice?
It's important to know how green they are. Connecting with a midwife is one thing, knowing that they are well trained is another. The reason I say this is because in my state (Kansas) midwifery care is unregulated, meaning that not all midwifes practice equally. Some may have passed their CPM exam but only have a couple years experience, and others might not have the title of CPM but have been actively practicing for 10 years or more. It's ultimately up to you what you're comfortable with, but you won't know until you ask!
What does continuing education look like for you? Do you practice trauma-informed care?
When choosing a midwife you want to make sure you find someone who is a lifelong learner. Someone who keeps up to date with the latest evidence-based changes. Someone who cares about your past and any trauma that may come along with it. A lot of people of color (myself included!) feel nervous or skeptical or afraid in medical settings. Midwifery care is a completely different type of healthcare model when it comes to giving birth and prenatal care. Midwives take their time with you, they ask about your family and your work. They take into consideration the everyday things and how it may affect your stress. It's important you trust them enough to be honest with your difficulties throughout your pregnancies.
Ask about what happens in the event of a loss. Example: "I'm sure you've had clients who have suffered a loss at or around 12 weeks. What's your protocol, and how do you support those clients?"
In the event of a loss, you want to know that you won't be forgotten about as a client. Thankfully, the chances of having a miscarriage after the first trimester are significantly lower (between weeks 14 and 20, the chance of experiencing a miscarriage is less than 1%) it's a relevant question to ask your potential midwife.
Can you estimate the percentage of clients you have had to transfer care? What is your protocol, do you go with them and how long do you stay? Do you keep in touch?
Whether it's a transfer in the last couple of weeks, or during active labor, you want to know what will happen in this situation. Oftentimes, hiring a doula is an investment that pays off. They stick with you through it all for emotional and physical support. However, make sure you are on the same page of what your midwife will be doing! Sometimes, if it's a low-risk transfer, they might not need to tag along and will check in with you later to make sure everything is okay. But there could be an expectation you have of them. Having this conversation sooner rather than later is best for all parties involved.
Ask about their birth assistants! Example: "Do you have birth assistants or student midwives that come with you to every birth? Is it possible to be selective in who is in the room when I give birth, and opt out of having students or assistants present until I am modest?"
As a birth worker, you become desensitized to naked people. That's just a fact. But I have been on both sides of the equation. I have been the naked person, and I have also been the doula helping to keep the birthing person modest. You might actually be the type of person who doesn't care about modesty in this setting! That's amazing. But as the birthing person YOU get to choose who is in the room. You get to kick people out, you get to invite people in. No one is entitled to your space. So, get to know the assistants. Their names, their vibe, it's all relevant!
Is this your first baby? If not, make sure everyone knows the level of involvement you want from your other kiddos! Example: "How comfortable are you with toddlers in your space?"
Your older kid might be 10 or 2, either way you will want to be sure that the midwives know what to expect so they can do their job to the best of their ability. Some people want theirs kids nearby, but not in the room. Others prefer a more hands-on approach with their older babies! All the options are valid. However, most midwives will prefer that there is another adult present (like spouse or another relative) to watch out for the kiddos in case they get rowdy or you decide you don't want them in the room after all.
How do you normally approach birth? Are you someone who uses a lot of 'words of affirmation' or are you more of an observer who intervenes when necessary?
You will get to know your midwife over the course of the 6 months or so you are in their care. However, ask about their presence in the birth space. Will they walk in while you are actively laboring and sit in the corner? Will they sit next to you and hold space while you manage the pain? It's nice to know what to expect!
Do you have tools I can borrow during labor? Such as, a birth ball or stool, a swing, a TENS unit?
Your doula will often bring tools in their birth bag, but if you are birthing outside of your home (like a birthing suite) it's nice to know what is available to you.
Know their back-up situation. Example: "I recognize that midwives are more patient than anything, but, at what point do you need to take a break and send in your back-up?"
Most midwives work with a back-up. Someone they trust to come in during an extra long labor and give them (and you!) some support. Ask about who they work with, make sure you are comfortable with them too.
What does postpartum support look like? Can you help me with diagnosing things like prolapse, or postpartum depression and/or anxiety?
So many families prepare for birth, but nothing past that. Postpartum is probably harder than anything, and while most of your support will come from relatives or your spouse, a postpartum doula or friends who stop by, you will want to know how involved your midwives will be after the birth of your baby. This can include referrals to pelvic floor therapists or lactation consultants.
Who is your ideal client? How many clients do you accept a month?
This might not be such a pressing question for most people, but as a formal birth worker I remember needing to be selective with how many clients I accepted. If your midwife caps their client intake at 6 a month, you might have to decide on your midwife sooner rather than later depending on how full they already are!
What will our dynamic be after I am no longer your client?
Will this midwife be your midwife for life? Will you be able to call or ask questions as your child grows? Will you feel comfortable being vulnerable as your body heals and you want some more insight in postpartum? This is something I failed to think about after the birth of my first child. I dealt with a lot in postpartum and I didn't feel entirely sure that I could call my midwives again. Establish this beforehand so you aren't questioning your place afterwards.
Ask about any extra costs! Example: "What are your rates for a home birth vs using your birth center? Will I have to pay extra for anything (like renting a birth pool or for interventions)?
You want to be prepared for all the things. Ask about those hidden costs. Sometimes midwives ask you to pay for extra supplies they use, or mileage. They are running a business at the end of the day. So, ask for any and all possible costs upfront so you can budget accordingly.
I hope this helps! Congratulations on your pregnancy, you are going to be an amazing parent.