Whether it's a home birth or a traditional hospital birth attended by a midwife, moms know that there's a difference between having midwifery care and an OBGYN tending to things.
From where the appointments happen to how emergencies are handled, there are plenty of reasons moms opt for a midwife. But in their excitement and, often, inexperience (at least for first-time moms!), lots of moms aren't really sure what to expect from the whole midwife route.
Is she going to show up wearing patchouli oil and Birkenstocks and insist on mom eating a plant-based meal complete with gallons of coconut oil? Or will she recommend some alternative pain relief that's not too far off from what the medical community recommends?
There are so many things that are unique about the midwife birth experience for both the mom and her baby, so it can be difficult to know what to ask about when interviewing midwives.
A lot of moms think that the most important question they can ask their midwife is, "how's the baby?", but there's more they should be thinking about. From the first appointment to the post-birth experience, here are 21 questions moms should be asking their midwives but often don't think to.
21 How Far Out Do You Book Up?
Even though hospital births are still the most common way moms deliver their babies, midwife services are becoming more and more popular. Which means the midwife you want might not have an opening until way past your due date! So the first question to ask is whether the midwife you're hoping to book with even has an opening in or around your anticipated birth month.
Ideally, you'll want to start looking for a midwife before conceiving, but at the very least, you'll want to start making calls the moment you get a positive pregnancy test! Otherwise, you might wind up with an OB or some other birth scenario that wasn't your first choice.
20 What If It's Twins?
As many mamas have found out, having twins changes a lot about the birth experience and, of course, life after delivery! But the first concern is often about whether or not a mom can still have a natural birth—if that's what she wants—with twins. So even if you're reasonably sure you're only carrying a singleton (or if you haven't found out yet), it's worth asking your midwife how she'd handle the scenario if it was multiples.
Sometimes midwives automatically refer their twin moms to an OB, while other times they'll remain the primary care provider. It can depend on the baby's position, whether it's mom's first birth and so many other factors, so it's truly up in the air until you consult your midwife.
19 What Happens If I Need To Transfer?
Hanging out at the hospital or clinic isn't really on any planned-homebirth mom's agenda. But sometimes, it's necessary for a laboring mom to transfer to a hospital at some point in her birth. The thing is, every midwife will have her own procedure and plan in place for transferring.
Some midwives will require a mom who needs hospital care to ride there in an ambulance. Others will stipulate it's strictly up to the mom to arrange a ride. Plus, some midwives have specific rules on transferring. For example, one midwife I interviewed told me that if a mom was having a tough labor and anyone on her team (partner or support person) was uncomfortable, they'd encourage her to transfer to the hospital. What?!
18 Where Do I Transfer To?
If you wind up with some sort of scenario where you need to transfer to a hospital in the middle of your labor, it's good to know what your options are, if any. And for many midwives, where they send patients who need further interventions or care often depends on the type of relationship they have with surrounding hospitals.
Some hospitals (and OBGYNs in particular) aren't big fans of midwives. On the other hand, some midwives have a great relationship with their local hospitals, so they might have a preference for where to send you if you require more care than they can adequately provide.
17 What Should I Have Ready? (For A Home Birth, Sometimes Moms Need To Buy A 'Kit')
For a lot of midwives who attend home births, they'll have a website or some kind of hand-out for what you need to have to get prepped for your birth. Other midwives bring all their own supplies, and literally, all they need is the laboring mama! Of course, if you want to labor in the water, you might be on your own as far as finding a birthing pool and getting it prepped beforehand.
But either way, an important question to ask your midwife is whether you need to have supplies on hand or if she's going to cover everything. And if she does bring everything, you can expect to be charged for it on an itemized bill, so you might want to ask about that too!
16 What Credentials Do You Have?
Although every midwife has to have certification, requirements do vary based on where she's practicing and how. For example, a midwife working in a hospital birthing center might have more stringent requirements for her education and keep up on certifications than a midwife who operates a freestanding birth center or business on her own.
Therefore, it's important to ask about your midwife's (or potential midwife's) experience and credentials early on. Maybe your midwife has extra training in emergency scenarios, or maybe she's just attended a whole lot of twin births. Either way, it's good info to know depending on the unique circumstances of your pregnancy and labor.
15 Are You Going To Visit Me At Home Afterward?
Part of the appeal of a home birth with a midwife is that you don't have to go anywhere! The midwife (and her team, as applicable) comes to you, then they leave when the job is all done. Afterward, you don't have to worry about hospital germs or your backless gown. You just get to enjoy your newborn and, hopefully, relax!
But a lot of times, your reverie will be interrupted if you need help with breastfeeding or it's time for the baby's first follow-up appointment (or yours). So a smart question to ask your midwife is whether she does follow-up visits at home. It's convenient and saves you some trouble, so this is a great perk to check on!
14 Do You Care For Babies, Too?
Every mom knows how tough it is to find a good pediatrician, and one that she feels comfortable with handling her baby. But it's also hard to find a pediatrician before your baby is born, and recommendations often depend on what insurance you have and where you're delivering.
With a midwife, though, sometimes you can delay that first pediatrician visit because the midwife can care for your baby as well as you. Not all midwives offer newborn care or checkups, but, for example, mine did, so she was trained to check out babies up to a few weeks old. Combining mom and baby visits (especially at home!) is a great benefit of a midwife... If she offers the service.
13 What Happens If I'm 'High Risk'?
It's not something that most moms think about the moment they get a positive pregnancy test, but so many of us wind up with "high risk" pregnancies. Everything from a diagnosis of gestational diabetes to carrying multiples can land a mama with a high-risk label. And in some cases, whatever the "condition" is that warrants the label can mean a mom "risks out" of midwifery care.
Therefore, another crucial question is whether your midwife will continue to care for you if some type of issue arises that means you might have a riskier pregnancy. In some cases, midwives hand their patients off by default. In others, they might work with an OB as the "backup" provider should your situation require it.
12 How Do You Handle Emergencies?
Sure, every midwife has the training that it takes to get certified and be granted the privilege of working with pregnant moms (and their babies). But what we want to know, specifically, is how each unique midwife handles emergencies. Does she plan for a hospital transfer at the first sign of trouble? Does she wait things out or consult the laboring mom for direction?
Part of having a midwife is developing a good relationship with her. So if you're not okay with how your midwife operates when it comes down to handling big decisions, asking this question could save you from making a mistake in hiring her.
11 What's Your Transfer Rate?
Not every mom who intends to have a home birth (or a birth center birth, for that matter) ends up achieving her dream. Plenty of moms end up transferring to a hospital, undergoing interventions, and even delivering via C-section. So even if natural or unmedicated birth is your goal, that doesn't necessarily mean it will happen.
While birth is not always predictable, knowing a midwife's transfer rate for home births does tell you a lot about how she operates. If your midwife has a high transfer rate, it might not mean she's a bad midwife, but it might mean she's not willing to let situations get too far before she taps out.
10 Are You Always On Call?
Part of the reason why midwives get so booked up is that they know they can only handle a certain number of births per month. After all, if every baby arrives on his or her own schedule, there's a certain amount of guesswork that goes into planning her work week!
So a good question to ask is whether she's always on call or if she has backup midwives in place to help you out if she can't make it. Imagine a scenario in which your midwife is attending another birth when you go into labor! Maybe she can make it, or maybe she can send someone in her stead, but hopefully, that person is someone you're already acquainted with.
9 Will You Help With Paperwork?
Although there are a lot of great things about home births, one of the not-so-fun parts can be getting your kiddo's paperwork done after they're born. From getting footprints and newborn testing to getting the birth certificate later, having a home birth can complicate things. But your midwife might have the solution to all of that!
A smart question to ask is whether your midwife helps with any of the paperwork for your baby. At the very least, she should sign something that confirms she was there and assisted with your birth, but many midwives also offer footprinting and birth certificate forms as part of their overall service package.
8 Do You Have Any Privileges At The Hospital?
Just because a midwife is trained to deliver babies doesn't mean that she can deliver them just anywhere! Even if a midwife has her own birthing service or works in a birth center, that doesn't necessarily mean she can tag along if you happen to need a transfer for some reason.
For some midwives, their job ends the moment you step over the threshold of the hospital doors. For others, they might have a good working relationship with the hospital or even have some sort of privileges there to make patient decisions. This is a crucial question most moms don't even consider, simply because they're hoping against a hospital birth in the end.
7 What Do You Know About Shoulder Dystocia
One of the most common complications in home births appears to be shoulder dystocia. It's the main reason why most people worry about big babies, too. Shoulder dystocia basically means when a baby's shoulders get stuck while they're coming out, and if your midwife doesn't know how to manage it, this might mean a very dangerous scenario. It could also mean an immediate transfer to a hospital, likely via ambulance.
However, there are ways to deal with shoulder dystocia in a home birth (without a transfer or a C-section!), so it's good to know whether your midwife has experience with these situations.
6 Do You Offer Pain Relief?
However you feel about pain in childbirth, it's good to know what your options are. And especially for first-time moms, it can be difficult to know what to expect. Therefore, checking in with your midwife on how she offers pain relief, or if she does at all, is a really important question to put on your list.
Some midwives can offer laughing gas for pain relief, while others might even be able to start an IV and administer something stronger if you require it. Still, others might suggest breathing techniques, massages, or even acupuncture as methods of pain relief. Clearly, you want your midwife's feelings on pain relief to vibe with yours, thus the importance of this question.
5 Do You Help Clean Up Afterward?
Sure, she will definitely help clean up the baby and then pose for an adorable photo afterward, but will your midwife help with any other clean up postpartum? Especially for moms who have had messy home births (such as her water breaking in the middle of a contraction as she's pushing!) or who have birthing pools set up, cleanup can be a looming frustration.
No one wants to spend time washing sheets or draining the pool in the living room or wiping up messes when they could be resting and snuggling the new baby. So asking whether your midwife helps out with those routine parts of birth is smart forward thinking.
4 When Should I Call You?
With my second child, I had a doula, and she told me to call her when my contractions were regular and were spaced a certain time apart. So when I called her as my contractions were still irregular and fairly far apart, she was unfazed. When I arrived at the birth center five centimeters dilated, however, she quickly got her bags packed!
Whether it's your first or fifth child, it's good to know when your midwife expects a call from you. Part of the scheduling will depend on how far away she is from you, but it will also depend on her expectations for your birth and how much time she's willing to (potentially) just hang out before catching that baby!
3 Will Someone Help With My Other Kids?
A lot of midwives have it written into their policies that someone else needs to watch your other children. They make it clear that your birth support person (typically your partner) needs to be there for you, not for the kids, so they suggest making other arrangements.
Other midwives will have an assistant or even an entire team to help with everything, from delivering the baby to playing with the older siblings to running out for food for everyone to cleaning up after! Therefore, this is a very important yet often overlooked question to ask. After all, knowing whether you need to have a babysitter on call will definitely help with planning for a home birth.
2 How Do You Go About Checking The Progress?
While most pregnant women are familiar with regular exams at their OB's office to check for dilation and other signs of impending labor, many midwives just don't operate that way. It might come as a surprise to many moms to realize that their midwives don't issue orders for ultrasounds, don't use anything other than a doppler to check the baby's heart rate, and simply don't care about cervical or other checks until active labor has set in, if at all.
If you're looking for more traditional reassurance that you and your baby are doing well during the pregnancy, this is an even more important question to ask. And, if it comes to labor and you just want to be left alone rather than being checked every hour or so, it's good to know her policies beforehand!
1 Will Insurance Pay?
For a lot of moms, the question of insurance coverage can dictate what type of birth she has. As unfortunate as that is, it's critical to know, as your insurance company may outright deny covering a home birth, even if your midwife assured you that yes, she will bill your insurance for you.
The best thing to do is question whether your midwife has worked with your particular insurance before. That will tell you whether she's had other moms whose home births were successfully covered under the same plan as you. But you'll also need to follow up with your insurance company to ensure that you've got the right info! Otherwise, a traditional hospital birth might be your only option when it comes to finances.