Thursday, February 27, 2014

Just for Fun

 We all think Hollywood is a little Hollywierd- who honestly thinks celebs are "normal?" But these ladies- who have every option available to them when it comes to birth and healthcare- chose to have their babies at home:

Famous People who have had babies at home:

Demi Moore 

Meryl Streep

Joely Fisher: 
"I had this miraculous birth...I decided to have her at home and had a lot of friends around, and of course, her father was there. And of course, the doctor, the doula, the midwife, the butcher, baker, and candlestick maker."

Julianne Moore

Pamela Anderson

Gisele Bundchen:
 "Giving birth was the most intense and life-changing experience of my life. I am blessed to have had the opportunity to deliver at home, surrounded by love and where I felt safe. It was a really great experience. I never felt so vulnerable but so strong at the same time."
 
Ricki Lake

Woody Harrelson's wife, Laura Louie

Jennifer Connelly

Maria Bello:
"I remember the night he was born.  It was 22 hours of labor and a thunderstorm with nothing more than an aspirin. I never felt so much love and fear at the same time... I had a midwife, and after 12 hours I said, 'We’re going to stay here and stick it out.' Believe me, there were times where I wanted to say, 'Get the ambulance — I’m done.' But then I thought, 'I can do anything for 24 hours' and it was almost exactly 24 hours."

Cindy Crawford

Jim Gaffigan's wife

Alyson Hannigan: 
"It wasn’t something I knew I was going to do before I got pregnant, but once I was pregnant, I did more research, and I watched The Business of Being Born, and that sealed the deal. It’s not the right choice for everyone, but it definitely was for me. I never wavered on it. I knew if I needed to go to the hospital I would, but thankfully everything went well, and it was a magnificent experience."

Alanis Morrisette

Evan Rachel Wood

Erykah Badu: 
"Maybe to some it's scary, but preparation is the whole key. I expected success and health, so I made sure I surrounded myself with it. By the time I had my third baby, childbirth seemed a very natural part of life to me."

Thandi Newton

Nelly Furtado

Evangeline Lilly: 
 "We decided to have the baby at home because we wanted it to be a natural birth, and it turns out that it was 30 hours of natural."

Tuesday, February 25, 2014

Doesn't it HURT???

Want to talk about pain? Talk to Mrs. Nufer of the 1500s.  She lived in Switzerland, and in her day, C-sections were only done to save the baby after the mother had died.  But not so for Mrs. Nufer.  After things started going bad during delivery, the midwife and doctor decided to save the baby.  Her hubby Jacob objected.  The others bailed, and he had to jump in.  Using his knowledge of animal anatomy (he was a butcher) he safely delivered his baby AND saved the life of his wife, who went on to have more kids and live a long life into her seventies.  No anesthesia. No antibiotics.  There now, doesn't natural childbirth sound great?  (Read more about incredible medieval women in Uppity Women of Medieval Times by Vicki Leon).

 Our culture has does an awesome job of ingraining in women an absolute fear of childbirth.  Think of any movie or TV show where a woman is giving birth. An absolutely screaming, freaking-out-in-pain woman is the typical birthing mother scenario. And just for good measure, she usually curses once or twice at her husband. I've been to two homebirths (that weren't mine) and neither were like that.  I would describe my friends as clearly uncomfortable and yes, hurting- but not in uncontrollable pain.  And there was no husband-cursing, but rather the opposite- they really looked to their husbands as their number one supports.

Pain is a perception, and the perception of pain varies from woman to woman.  My sister was at 9 cm before she went to the hospital to have her first baby- she just wasn't hurting that bad.  With my first, I was asking for the epidural at 4 cm.  We all have different capacities for pain, and we all feel it differently.  My homebirths have both been quick affairs.  I can't honestly say that if I had had 20-hour labors I wouldn't have said, "Take me to the hospital, I'm getting a freakin' epidural". I just might have.  And that would have been okay.  We are all different.  I write this blog based on my experiences, and you have to take what I say with a grain a salt- your body is different and you know best what applies to you and your body.
This said, I also think that, generally, our bodies are capable of a lot more than we think.  

When I was pregnant with my first, I was debating an epidural on the phone with my mom.  She told me I should probably go ahead and plan on it- I was kind of 'wimpy'.  And I knew she was right! I'm a TOTAL wuss. If you had told me then that I would have two (going on three) natural childbirths I would have thought no way am I capable of that.  

In preparing to have my first homebirth (baby 3), pain was big on my mind.  This was something the midwife couldn't help with, and in committing to a homebirth, I was committing to feeling whatever came along with it.  And that scared me.  I had had epidurals with both my first two babies.  And I liked not feeling anything. It was awesome.  But I really felt like the benefits of homebirth were worth it, and I was willing to try to do whatever I could to prepare myself.  

So my hubby and I took a hypnobirthing class.  It was really cool.  They showed videos of women birthing who were totally serene- it was incredible.  (You could probably find some on youtube.) Although I doubted that I could get to the level these women were at, I still felt like the hypnobirthing class was helpful.  It taught me about HOW a baby is born- which is pretty darn incredible, and the stages of labor.  It was really educational, and that knowledge later became power. I realized my body was capable of incredible things, and wussy or not, I could do a lot more than I thought. Talk about woman empowerment!

Here's a great secret of natural birth- there are BREAKS in labor.  You have a surge, or contraction, and then a moment of rest. It's amazing how your body gives that to you- it knows you're working hard and gives you the strength to manage it.  Yeah, childbirth DID hurt- I wasn't one of those super serene hypnobirthing women in the video- but I felt like it was manageable and I was never out of control freaking out about the pain I was in.  And at home, I could get in whatever position I felt I needed to be in to help myself manage the pain.  With both my homebirths, I had back labor- all of it.  Nothing in my abdomen, just pure back labor.  Had I been laying on my back on a hospital bed, I would  have NEEDED an epidural.  But at home, I was able to be on all fours, significantly helping relieve discomfort.

One of the best parts of having a baby naturally is that afterwards you feel pretty darn good. I stood up. I took a shower. I got into my nice clean bed and cuddled my newborn.  After my epidurals in the hospital, my legs were dead noodles for hours, and the coming out of that is not fun.  Not to mention that with my first epidural, my lower back hurt for MONTHS. I didn't have that problem with my second epidural, so I don't know why that was. 

I actually feel like I've gained something from having my babies naturally.  I don't mean to say that women who haven't are missing out. That's not true. The friend who recommended hypnobirthing classes to me has had high risk births and C-sections...but she still felt like hypnobirthing had been really helpful to her.  My first two children's births were incredible- epidurals and all- and I don't feel like I missed out on a thing.  But for me, personally- I'm just talking about me here- I feel like I gained something.  I discarded the notion that I'm a wuss- I'm not.  And that is empowering.  I also feel like this big, scary, mysterious thing- childbirth- isn't big, scary, and mysterious anymore and that's also empowering.  Like therapy, you know? Conquering your fears! I also feel sort of like a kinship with the millions of mothers who birthed this way- there was no other option for them- and I like that. 

From all that I've gained from natural childbirth, I can't help but feel that our culture does a huge disservice to women by telling us that we can't, it's too hard, it's too painful.  Blah. We are strong. We are capable. And I can do anything.  And even if your pregnancies and body don't give you the chance to go natural, you can still know that you are strong- and that's real empowerment.

Wednesday, February 19, 2014

What if Something Goes Wrong?

I'm going to point out here that something could go wrong in ANY pregnancy and birth scenario, whether you're low or high risk, a hospital or home birth. You're "expecting", nothing is for sure, and that element of pregnancy is scary! Pregnancy is a 9-month long prayer. 

 This is the first question that people ask: "What if something goes wrong?"  It's the first question I asked a good friend who was having a home birth (before I began having my own at home).  What if something goes wrong? I'm going to quote my friend Sarah, because her explanation is perfect and accurate then I'll share a few statistics:

"The vast majority of birth emergencies have some notice - meconium when the water breaks, baby's heart rate doesn't recover after contractions, baby's not descending properly. That's why it is very important to have an experienced midwife present at the birth to spot when things are going wrong and transfer to the hospital. In respect to a vbac birth, even the dreaded uterine rupture doesn't happen without signs occurring first that a competent midwife would notice and get you transferred to the hospital. Some emergencies have no notice - cord prolapse is one of the very few. But in that case the procedure is the same - turn over on all fours to take pressure off of the cord and have a c-section NOW. If you're at home, your midwife calls, they prep the surgery room while you're in route, and oftentimes surgery can occur as quickly as if you were at the hospital to begin with. I've had 6 homebirths and loved them all, but I truly believe that women should have their babies wherever they feel safest. It is so important that a laboring woman feel safe, cared for, and protected so that she can do the important work of birthing her baby. For many women, that location is the hospital. For me, it was home."

If for you, like Sarah, that safe place is at home, science says it's a-okay. Studies have consistently demonstrated that home birth is a good option.  The bottom line of these studies is that women have fewer interventions at home without an increased risk to mother or baby (see here and here for where I got my info: peer, reviewed, scientific research. These were large studies conducted with sound methods).  

I want to point out that these studies don't say that home-born babies are healthier than hospital-born babies, more successful, richer, or more likely to find a cure for cancer.  Some hard-core homebirthers will throw these types of things at you, but they are a) ridiculous and b) not backed by research. Home born babies do not have some sort of "organic" advantage that will enable them to get into Yale, be President, or save the world.  Studies show the outcomes for hospital and home births are the SAME. The means to that end is what differs: less interventions, my friend. 

A few stats:
12.1% transfer to hospital rate (for various reasons, including to simply get an epidural)
C-section rate: 5.2 % (compare with 31% , which is the current U.S. National Avg for full-term pregnancies)
Only 1% of babies required transport to hospital after birth

The conclusion: "Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States."  

What the heck does that mean? It means that home birth with qualified midwives has less interventions with the SAME outcomes as hospital births. Meaning mom and baby are just as likely to be healthy and happy after a delivery at home as at the hospital.  It also means that our bodies are more awesome and capable than we give them credit for. And that a good midwife is well worth her fee!

These studies tell me and you that I'm not putting myself or my baby at any increased risks by choosing to have my baby at home, and that's really why I'm writing this blog.  I want people to know that it's not a crazy idea. In fact, it's is a very valid option for many women.  Including me.

Thursday, February 13, 2014

So How Much Does All This Cost?

Well, that depends.  The midwife will have a fee, which usually ranges from $3,000-$5,000.  In addition, there will be costs of purchasing a birth kit (which is usually $60-$100), a water tub if you're having a water birth, and costs of lab work, ultrasounds, etc, which will depend on your insurance.

The good news is that sometimes your insurance will cover the cost of your home birth.  Sometimes they don't.  Basically, you pay your midwife's entire fee, and then you may or may not get reimbursed some or all of it from insurance. Your midwife should take care of submitting the paperwork to your insurance.  Your job is to be really whiny and persistent to your insurance company.  Your midwife may even have a pretty good idea of whether your insurance will reimburse you or not- she deals with a lot of insurances, and becomes pretty familiar with which ones are more willing to cut a check.

There's two good articles here and here about people's efforts to get reimbursed.

My first homebirth I got zip back from insurance.  And I had arranged for a water tub (an additional $200ish) that I didn't get to use because my labor was too quick. But I still had to pay for the water tub. My second homebirth I paid my midwife's $3600 fee, and later got a check back for $500- which I promptly used to buy a Vitamix, which I had long been coveting.

This is my current midwife's financial agreement, I just copied and pasted so you can see the real deal.  Though her fee is $4500, if I pay by 36 weeks I pay $3600.  You can darn bet I'll be paid in full by 36 weeks.  I am also planning on being a super annoying insurance customer and hope that it will pay off with a reimbursement check. If something did go awry and I ended up having to transport to a hospital, at that point the costs all go through my insurance, like any other hospital visit.

A few quick notes to help understand this: PN= prenatal, PP=postpartum. You'll also notice that I don't give up any essential tests or procedures by using a midwife:  the group beta strep test, Rhogam injection if needed, postpartum care, and my baby still gets tested for PKU and other metabolic disorders.  I will be passing on the Vitamin K shot for my wee one, though.  More on why in another post.

I also want to point out that a midwife is at your labor and birth the entire time.  That could be a two day affair, or perhaps a two hour affair. No waltzing in during the last 5 minutes to catch your baby, like many doctors do.  Your midwife is there the whole time, day or night, plus at least 2-3 hours after.  Then she comes to your home the next day to do any necessary stitching up, checks your uterus and the baby, sees how nursing is going, all that jazz.  Then there's still two more postpartum visits for you and your baby after that. The final visit is usually at 6 weeks postpartum, and you get your PAP smear (yay! so exciting!) and make sure all is well, just like at any OB/GYN 6 week postpartum visit. At that point, your midwife care is finished, and your baby starts seeing your pediatrician.




UMBRELLA ALL INCLUSIVE CHARGES:  $4500.00

                Global Maternity Care:            $3500.00
                        PN, PP, Birth
                        PN Homevisit
                        Group Beta Strep Test
           
            Initial Newborn Care:              $300.00
            Vitamin K                                $  15.00
            Metabolic Screening                $  85.00
           
            Follow up Newborn Care:        $600.00
                        Up to 4 routine visits
                        (2 home, 2 office)

          All other services are billed on top of or outside of umbrella billing.

The midwifery fee does not include:
  • The birth kit
  • Assistant at the birth
  • Your back up physician’s fee
  • Hospital bills incurred in the event of a transport
  • Any other costs related to transport (such as ambulance)
  • The cost of lab work
  • Ultrasound
  • Use of the birth tub
  • RhoGam injection, if indicated.


It is the understood that you are paying us to be on call day and night and for our skill and knowledge providing pregnancy and birth care as well as in knowing if and when to refer to a medical doctor or hospital.

  1. Non-Insured & Timely Payment Discount
The global fee is $4500. Clients will receive a 20% discount, reducing the overall out of pocket fee to $3600 to those that pay in full by 36 weeks. Balances due past the final postpartum visit will incur a 10% annual interest charge.

  1. Non-refundable
Once labor has started and a midwife has been notified fees will be considered earned in full. The midwives concern is for a safe birth, whether in home or hospital, and midwifery care includes helping you make the judgment for hospitalization, if necessary.
·         Transports: If a transport is required during labor, your midwife will accompany you to the hospital to support you during the birth. Transports usually involve the most intense care on the part of the midwife and birth team. You will receive the same postpartum support and visits you would have received if you had birthed at home. In the event of transport, no refund or discount applies.
·         Early delivery: If your labor has started and progressed rapidly to delivery before your midwife arrives, no refund will be made. The midwife must still assist with the delivery of the placenta and maternal and newborn exams. Postpartum watch and visits are also necessary.

  1. Payment Plans
In addition to the initial payment of $500 (which includes a $200 initial prenatal fee) and the $125 office prenatal visit ($150 home visit prenatal) fee at each appointment, we encourage that regular monthly installments be made. The $500 assistant fee will need to be paid in full by 36 weeks.

6. Discontinuation of Services
Should a decision be made to discontinue service before 36 weeks or it becomes medically necessary to transfer care before 36 weeks, the $500 initial payment plus $125 per each prenatal office visit ($150 home visit) will be retained. If you would like one of our team members to continue to assist you in a hospital birth in the capacity of a doula, your total fee will include, the $500 initial payment, $125/150 per each prenatal visit, and a $1250 doula fee.

7. Private Insurance
If you have private insurance or health care coverage, we will bill your insurance company or health carrier for you. By entering into this contract, you authorize Aspiring Birth Midwifery & Doula Services to release information to your insurance company or health care carrier for the purpose of processing your claims.

We may bill your insurance company or health carrier for the following services related to your and your baby’s care, including, but not limited to:
     
Initial visit, lab work, OB global fee including prenatal visits, intrapartum care, delivery, birth assistance, supplies, IV therapy and medications, newborn exam, newborn metabolic screen (PKU), and postpartum visits.

When we bill clients directly, we standardized all services into a $4500 package fee. However, when we bill insurance and health carriers, we itemize services in accordance with the insurer’s claims payment structure, which may require billing the payor in excess of the standard $4500 fee. Due to repeated claims processing and tracking expenses, it is more costly to bill insurance than to collect directly from clients. The reimbursement amounts are variable and based on what the insurance company considers “usual and customary”. Thus the amount we bill the insurance company may exceed the package amount of $4500.00 to account for these discrepancies. We have the right to accept reimbursement from insurance that exceeds the package fee of $4500.

If your insurance denies your claims, you are responsible for paying us the entire package fee of $4500.  Verification of benefits does not guarantee payment.

If, upon verification of benefits, your insurance company is likely to pay, we may agree to only collect the deposit, your deductibles for you and your baby, and approximate coinsurance amounts (patient responsibility or PR) up front, rather than collecting the entire $4500. If your insurance company pays, and we find that we have overcharged you, we will refund you accordingly. If the insurance assigns PR that exceeds what we have collected from you, we will bill you for the deficit.

If you have insurance and you’ve paid the entire amount in advance, and if your insurance company pays us directly, we will send you a refund. Your refund cannot exceed the amount you prepaid. Your refund amount will be affected by your assigned PR amounts and any deductibles (for you and your baby) applied to our claims independently of reimbursement amounts we receive.






So, that's a lot of boring money talk!  If you've had a homebirth, leave a comment and let us know your success in getting any reimbursement.  In the meantime, here's something on the lighter side; comedian Jim Gaffigan on homebirth:




Next Post:
What If Something Goes Wrong?

Monday, February 10, 2014

The First Appointment

I just got back from my first midwife appointment.  I met my midwife, Sherry, and her apprentice for the first time, and I think they will be great.  So what happens at a prenatal appointment with a midwife, you ask? Well, I'll tell you:

The first thing she asked was "Do you have any questions?" This is one of the biggest differences between a midwife and doctor.  Midwives encourage you to ask questions, are fine with you wondering why they are doing this or that, and want you to feel comfortable.  Personally, it makes me feel more in charge, more empowered, and I learn a lot too.  Typically the reverse is true for doctors- you do what they say and they are the boss. You are a doctor's 'patient', but a midwife's 'client'. There is a difference. We talk about my previous homebirth experiences, and she asks who my midwife in Las Vegas was.  I tell her it was Marvelys Lopez.  Oh, I know her, she says.  Sherry and other midwives go down to Vegas to re-certify and train in neonatal resuscitation, and they know the Vegas midwives.  Midwifery is a small world. 

Next, this being the first appointment, there's paperwork. I fill out papers about my previous medical history, pregnancies, and sign a contract.  She copies my insurance card.  Many insurances reimburse you for home births. I'll do a separate post on cost later on and I'll talk more about that.  You sign other papers acknowledging things like the fact that midwives don't carry malpractice insurance, etc. Basically the same stuff you sign at a doctor's office pertaining to liability.  Then you write a check- the initial partial payment of her fee.

Now it's down to business.  I go in the bathroom and pee in a cup, the apprentice tells me she'll test it, I don't need to.  There is strip they use to test it for all the same things doctors do.  Most midwives let you test it yourself, which is kinda fun and adds to the empowerment feeling. But the apprentice is learning, so she does it this time.

Then the apprentice takes my blood pressure and pulse (which is always low and just gets lower when I'm pregnant.  We joke in my family that we're all half-dead, we all have pretty low blood pressure). Then she asks my prenatal weight, and then it's time to try to find the heartbeat of my little kumquat-sized baby. I lay on the couch and get a squirt of the cold jelly, then the apprentice tries to find it with the Doppler.  She can't, so Sherry takes over.  Sherry gets a beat or two here or there but can't get a consistent reading.  That's not unusual at 11 weeks (it's happened to me before), and I'm not freaking out about it. We'll probably get a reading at the next appointment, which is in 4 weeks.

All this happened in Sherry's living room.  This might seem too casual for some people, but it's fine for me.  The first time I had a midwife, with my third baby, my midwife, Marvelys, came to my home for appointments.  She had a suitcase she'd bring with her with all her gear, and our appointments were in my living room.  My older kids got to help with putting the "jelly on my belly" and listening to the heartbeat. By the time I had baby #4, Marvelys was busier, and no longer did home appointments.  So I went to her home office.  Her home office was set up very similar to a doctor's office (she had previously been a family doctor, after all)- the same kind of exam table, etc.  So each midwife operates differently.  If it's important to you to have your midwife operate a certain way- home visits, a professional-ish office, or whatever, add that to your list of questions. 

Next Sherry tells me where to go to get my lab work done for a prenatal blood panel.  In Las Vegas, Marvelys drew my blood in her home office and had a lab-pick up service.  That was pretty awesome, because it didn't entail going anywhere else.  But here, with homebirth being a little more "underground" and obscure, I have to go to a lab to get my blood drawn.  So on the way home I stop at the place and get it done.  I had forgotten how many vials of blood they fill up - like 6 or 7! I'm feeling pretty cool, though, because I'm watching the vials fill up and not even looking away. Apparently it doesn't take much for me to feel cool. =)

My appointment at Sherry's is about 45 minutes, which is typical.  Each prenatal appointment will be 45 minutes to an hour.  This fact, independently, reduces the risks of a negative outcome for me and my baby.  Studies have shown that the better prenatal care you get, the more likely you are to have everything go right. When you have a doctor that sees you for ten minutes and doesn't address things like nutrition, exercise, concerns, or questions, quality prenatal care is harder to get.  (And I don't mean to imply that all doctors are like that- mine were, but I've talked to lots of people who got great prenatal care from their OB's.  So no matter what route you go, be an active participant in your prenatal care and you'll increase your odds of having everything turn out happy). 

So that's the run-down.  Do I miss my Vegas midwife's more professional set-up? Yes, a little. Plus, I connected with her more than I think I'm going to with Sherry.  But...it's okay. Do I think Sherry is smart and capable and will be able to deliver my baby? Yes, definitely.  Las Vegas was a home birth mecca- at one time, I had 5 friends all having homebirths, plus myself, and there were 4 different midwives between us.  Midwives had more of a foot in the door in the medical world down there.  Up here it's different, and that's okay.  Appointments are in living rooms.  Blood work is an extra car trip. But those are things that are cosmetic- the level of care I'm getting is every bit as awesome as I've gotten previously.  If you live in a home birth mecca (like say, in Oregon), you'll probably find more of a professional feel in the world of midwifery.  If you don't, your experiences will probably be a little more low-key. And that's okay.

Next post:
How much does all this cost?

Saturday, February 8, 2014

Midwife basics

So recently we've started telling people we're expecting baby #5. Ok, actually we just told our kids. And they told the rest of the world.  "Mom, I accidentally told my whole class today.  I couldn't help it!" That's what my oldest daughter told me a day or two after we spilled the news to them.  So if you're just hearing that we're expecting and you are our good friends, don't be offended that at least half the elementary school already knows. So, anyhoo, everyone and their dog knows.  And I haven't even had my first midwife appointment yet.

When you see a midwife, you typically have your first appointment between 10-12 weeks.  The reason being is that at 10 weeks, you can hear your baby's heartbeat with a Doppler (that thing they put on your belly to listen).  No gross vaginal ultrasound necessary, thank you.  Normally I don't want the whole world knowing I'm preggo before my first appointment- what if something's wrong? But, you know, if something was wrong, I'd need the compassion of all those people- I wouldn't want or be able to suffer in silence.

We recently moved to a new city.  So, good-bye to my old midwife (who delivered my other two homebirth babies and was one of my most favorite people ever), time to search for a new midwife.  In our new town, homebirth isn't quite as prevalent as it was in our old, so there wasn't a whole lot of word of mouth references for midwives.  But you just need to know where to look.  There is usually some sort of birthing network in most metro and suburban areas, so I started by getting on Facebook and searching for a local birthing group.  Check. Found one.  Then I posted on their page, asking about local midwives.  They replied, giving me four or five names.  Then I got online and searched, finding each of their business webpages and started perusing.  Midwives are professionals, they are educated, they are running businesses, and any midwife worth hiring will have a website about them, what they do, and their services.  Every midwife I've every encountered also will meet with you for an initial consultation (for free) so you can see if you want to use them.  They realize that you are hiring them.  They work for you.  You are paying them.

The midwife I chose I haven't met yet, though. I did send her an email in which I asked her a few basics: does she service where I live, what is her fee, and how many births does she do per month (she limits herself to 3-4 a month.  That's good.  You don't want a midwife doing 10 births a month.  Odds are good she'll miss yours).  She responded super quick (a good sign), and I went ahead and made an appointment.  Which is in 3 days.  So I'm excited to meet her.  If I wasn't so lazy I'd have gone for the free consultation, but...I am lazy. And if I don't feel comfortable with her, I can go elsewhere, I'm not locked in.
Other good questions to ask a prospect midwife: 

  • What is your hospital transfer rate? 
    •  5-10% is good. The national overall hospital transfer rate for homebirths is 12%.
  • What OB/GYN's do you have a good working relationship with? 
    • Good midwives will have good relationships with doctors.  Doctors will know them and respect them.  If your midwife has a negative opinion about doctors and doesn't have a good working relationship with any, that is a red flag. From time to time, a low-risk pregnancy will develop into a high-risk one. You may have your own OB/GYN you'd want to transfer care to, or you may want to continue with a doctor who respects your midwife and will continue to allow her to be part of your care.
  • Who are your apprentices? 
    • Most midwives will have at least one, if not several apprentices who are learning the trade. This is good. It shows that people want to work with your midwife; she must be knowledgeable and respected.  
  • What other midwives do you work with?
    • Midwives cover for each other; if there are births that are overlapping or some sort of something happens and your midwife can't come, she will have an agreement in place with other area midwives. 
  • What difficult situations have you encountered? Breech, twins, etc... 
  • Are you comfortable with a water birth? 
  • How many babies have you delivered?
  • Have you ever missed a birth?
  • Can I bring my kids to appointments?
    • Most midwives are fine with this, some even encourage it.  Prenatal appointments can definitely be a family affair. 
  • What's your favorite food? 
    • Just kidding. But it is great to feel like this woman who will be caring for you and helping you birth your baby is your friend.  A very, very smart friend. 

Keep in mind I am not some midwife/homebirth expert.  Everything I write in this blog is strictly based on my own past and present experiences as a patient.  If you're a midwife or a doula and I have something totally, red-faced wrong, comment and let me know! Who doesn't like to learn something new?

Next post: 
What happens at prenatal appointments with a midwife?