Hey fam!

For folks who are in the process of choosing a midwife for their prenatal care, I’ve compiled a list of questions to consider during your interview. These questions were inspired by a list created by doula and birth photographer Paulina Splechta  I edited and organized them based on my years of professional experience in this field. I hope you find this as helpful as my families have over the years.

Prenatal/Postpartum Care:

  1. *What is the cost of care and what is included? How does it work with my insurance covering your midwifery services and how often are clients reimbursed the full fee by their insurance? Do you offer payment plans or discounts for early payment in full? What “extra” or surprise costs might we encounter while in your care? What is your refund policy if we decide to switch care providers?
  2. What is your preferred method of communication (phone, email, text)?
  3. *What are your prenatal visits like? How long are they? Where do they take place? How often are they scheduled?
  4. Do you offer or suggest taking childbirth preparation (CBE) courses?
  5. My partner has concerns about home birth. How have you dealt with this in the past?
  6. *When do you consider yourself “on-call” for me? When can I expect you to join me in labor? What do you do if two families are in labor at the same time? Will you ever leave a labor?
  7. *How do you proceed in the event of pre-term labor or a medically necessary induction?
  8. *What are your policies or recommendations regarding urine dips, basic blood tests and labs, genetic testing, routine ultrasounds and growth scans, gestational diabetes testing, group beta strep (GBS) testing, iron levels testing? Are there any you don’t recommend declining? Can you draw blood or will we need to use an outside lab?
  9. *Do you continue to see clients with Gestational Diabetes, or do you refer them to an obstetrics practice?
  10. *What is your philosophy on weight gain, nutrition, prenatal supplements, and exercise? We will receive counseling or education on those topics?
  11. Do you facilitate water birth? Does a tub rental come as part of my package? Do you have a recommendation for where to rent or buy your favorite pool? Are you comfortable delivering in my bathtub?
  12. *How long will you and/or your support team stay with couple and baby after the birth? What kind of postpartum care do you offer? Do you work with postpartum doulas? How many postpartum visits are offered under your care and on what days do these visits occur? What changes if I transfer and deliver in a hospital? Does your visit include care for the baby? Will you be available for well-woman visits?
  13. *What are the pros and cons of vitamin K shot and eye ointment for the baby? Can you administer Vitamin K and Erythromycin if we want? Can you administer the PKU test or will we need to see our pediatrician? Will you administer Rhogam if needed? Can you provide us with a hearing screening, and if not, where do you recommend clients go?
  14. Is breastfeeding support offered? Do you have local IBCLCs that you recommend?

Birth Experience:

  1. *How long have you been practicing midwifery? How many births have you attended? Why did you become a midwife? What is your training/education/certification?
  2. *Do you have experience working with clients like me?
  3. Do you have references that would be willing to discuss their experiences with your work and care?
  4. *Are there any induction methods that you are comfortable using (stretch and sweep, foley bulb, castor oil, black and blue cohosh, breaking waters) and when might you suggest them?
  5. What is your experience with herbs, homeopathy, and alternative medicine as pregnancy and labor support?
  6. *Can you resuscitate an infant?  Are you NRP certified? 
  7. *Which hospital(s) are you approved for working in case of an emergency?
  8. *Do you have experience with postpartum hemorrhage, shoulder dystocia, breech baby or cord prolapse?
  9. *Do you deliver breech? Do you deliver all kinds of breech? Do you have training and experience in this kind of delivery? If not, do you have a midwife you would refer me to if the baby had not turned?  Do you have experience with turning babies?
  10. *What do you do in the case of a nuchal cord? Or if the baby changes into a breech position during labor and it is too late to be transferred to the hospital?

Birth Team:

  1. *Who comes with you to the birth?  If that person is another midwife, how does their experience compare to yours?  If that person is NOT another midwife, what qualifies them as a birth attendant?
  2. When can I meet your back up midwife and back up OBGYN? 
  3. *Are you and your team neonatal resuscitation (NRP) certified? Have you ever had to resuscitate a baby? Are you and your team CPR certified? Have you ever had to resuscitate a birthing person? How recently have you recertified?

Birth Procedures:

  1. How many vaginal checks do you do, during pregnancy, during labor; should I get them, how necessary are they, what are the benefits/downsides and when do I need to have them done? 
  2. *What equipment do you bring with you to a birth? What kinds of medications (Pitocin Cytotec, Methergine) or tools (birth stool, Rebozo) do you have access to in case of an emergency? Are you legally allowed to carry Pitocin (for rare post-birth hemorrhaging)? Do you?
  3. What methods of pain management do you recommend?
  4. *At what point during my labor will you come to my home? When should I call you?
  5. *How does it work if I am GBS positive – how often do you administer antibiotics during labor and do you do specific procedures with the baby after birth?
  6. Under what circumstances, if any, do you perform episiotomies?
  7. How long do you usually leave the cord intact? How long are you comfortable waiting for a placenta?

Hospital Transfers:

  1. What kind of medical situations during pregnancy would require me to be transferred into the care of an OBGYN?
  2. To what gestation are you comfortable waiting? What is your standard protocol for clients going over 40 weeks before you transfer my care to an OBGYN? How many minimum weeks pregnant must I be to be able to have a home birth (36 weeks? 37 weeks? 38 weeks?)
  3. If my water breaks before labor (contractions) even begins, how long can I labor at home for before you are required to transfer me to the hospital?
  4. What is your protocol for non-emergency transfers to the hospital? For emergency transfers? (Once this is answered, look to the following questions for things that were not covered in the Midwife’s answer that you may want clarification)
  5. Under what circumstances would you transfer to the hospital? In the event of a transfer, (whether or not you have any privileges at the medical facility or know the doctor who I was transferred to) will you stay with me and support me through my entire birth and for the first couple of hours once the baby is born?
  6. What constitutes a non-emergent transfer vs. emergent transfer? Where do I go in the event of a non-emergent transfer vs. emergent transfer?
  7. What things would make me “high risk” and necessitate transfer of care either during pregnancy or labor?
  8. What is your hospital transfer rate?
  9. If I change my mind about home birth during labor and ASK to be taken to the hospital, how will you respond? 
  10. How bad would a perineum tear need to be for you to feel it required a hospital transfer? 
  11. What would it look like to transfer a baby to the hospital if needed after birth? What would it look like to transfer a birthing person to the hospital after birth?

Self Reflection:

  1. How did you feel as the midwife spoke?
  2. How did the things they said make you feel? 
  3. Did they let you feel heard and not rushed?
  4. Did their personality help you to feel connected and instantly safe and supported?
  5. Take note of what feelings may rise from your instincts.