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Making the Final Decision on a "care provider"
 
This is your body, your pregnancy and your baby. You are designed perfectly to birth your baby. This is a sacred time in your life. You will remember vividly the details of your pregnancy and birth all your life. Trust the process.
 
Finding the best person to fill this very important role of educator, guardian and caregiver, it is best to begin your search early. Don’t panic, if you’re already 2, 3 or even 4 months pregnant and still searching. It would be ideal if the first person you interview was the right one for you, but this is not always the case. It is wise however to try to make your choices as soon as possible so you can receive continuous, unified care, encouragement and education from the earliest point possible.
 
Interviewing a potential midwife takes time and money. You are wise to discover all your options. It is preferable to bring your spouse. Many times a friend or relative can provide moral support and help to ask questions you may feel too intimidated to ask.
 
It may help you to develop a “dream sheet”, a written list of issues that are important to you. With this tool you will be less likely to get overwhelmed and forget your desires concerning your pregnancy and birth.
 
No question you have is silly or dumb. The best way to educate yourself is to ask many, many questions. Our desire is that you be informed of all your options for pregnancy, birth and beyond. This is so that you can make the best choices for you and your baby.
                                                                                                                                        
Here are a few things to consider when interviewing a potential midwife for you & your baby.
 
1.  Observe the office environment: Is it relaxed or formal? Impersonal or warm? Orderly or messy?
2. Is there information about pregnancy and childbirth readily available? Lending library?
3.  Are the potential attendants friendly and helpful? Does everyone make eye contact when they talk with you? Do you feel valued?
4.  How is the phone answered? Can you call with questions and concerns or possible emergencies? Are calls encouraged or frowned upon? Who handles calls? Are your calls handled in a friendly timely manner?
5.  Are your questions welcomed or are they answered defensively, even hostilely?
6.  Is this a group or single practice? Will you get to spend a sufficient amount of time to get to those who will be at your birth?
 
Questions to consider asking a potential midwife:
 
1.  How busy is the practice?
2.  How many clients do you take per month?
3.  Do you take high risk pregnancies such as twins, breeches, diabetics or other special medical conditions.
4.  What typically happens at and how long is a typical prenatal appointment?
5.  What topics are typically discussed at a prenatal appointment?
6.  If I have questions, how can I contact you?
7.  Do you have a list of recommend resources to read or view? For me to borrow?
8.  Why did you become a midwife?
9.  What is your midwifery philosophy?
10.  How did you educate yourself?
11.  Where did you get your hands on training?
12.  How many births have you attended?
13.  How do you keep current with all your skills and midwifery knowledge?
14.  Are there birth assistants?
15.  Do you have a backup doctor or Midwife?
16. What is the difference between a complication and a true emergency?
17. How are you prepared for an emergency situation? How do you handle emergencies?
18.  Can I have a doula at my birth?
19.  Can my partner be active in “catching” my baby?
20.  Can my other children be present?
21.  Can I have my family and/or friends at the birth?
22.  Do I have complete freedom to do the things I want to do in labor?
23.  How do you feel about a mom eating and drinking in labor?
24.  Can I labor in water?
25.  What do you actually do during labor?
26.  How often do you listen to the baby in labor?
27.  Do I have to have all those dilation checks?
28.  How often have you transported? Reasons?
29.  What are your guidelines for hospital transport?
30.  What type of postpartum care do you offer?
31.  Do you require me to breastfeed my baby?
32.  What are your services and fees?
33.  What is included in the fee?
34.  When & how do you expect to be paid?
35.  Do you accept and/or bill insurance?
36.  What additional supplies and expenses am I expected to cover? 
 
Most midwives expect questions and are used to answering them openly.
 
 
  
 
                                      
If you have decided to have a traditional
medically managed
hospital birth:
 
 
When interviewing a physician, remember their time is very limited. Often they are misunderstood as uncaring when answering many questions, when truth be told, they are on really in a tight time schedule.
 
Many doctors are used to being authority figures, and it is possible that your questions will make them feel defensive, especially if the subject is sensitive. Credentials are easy to verify, but attitudes are more difficult to pinpoint.
 
Don’t get nervous. Relax. Smile. You are just gathering information.
 
Important questions you might want to ask politely:
  1. Can you tell me how a typical normal low risk labor usually goes?
  2. What type of pain management would you typically suggest? Why?
  3. Am I free to move around during labor?
  4. Am I free to choose my position for the delivery of my baby?
  5. Do you perform episiotomies routinely? What is your percentage rate?How do you suggest I prepare for birthing my baby with out risk of being cut?
  6. What is your policy on induction?
  7. What if I want have natural childbirth with no pressure of time to birth my baby? How will you support my wishes?
  8. Am I required to wear a fetal monitor during my labor?
  9. Can I eat, drink and move freely to keep up my strength while I labor?
  10. Will I be pressured to have an epidural or other pain medication?
  11. What is your overall c-section rate? What are your policies regarding them?
  12. If I choose a homebirth, are you willing to provide parallel and back up care?
  13. Do you feel breastfeeding is the best nutritional choice for a newborn? Do you encourage mothers to breastfeed?
  14. Will I ever be required to be separated from my baby? Because I want to bond with my baby, am I able to “room in” with my baby?
  15. How do you feel about birth plans? Will my birth choices be honored?
  16. What if I choose to have a doula, will she be welcome?
  17. What is your policy regarding siblings at my birth?
 
If the caregiver you interview says that they find more than 50% of mom’s require an intervention, episiotomy or c-section, don’t kid yourself into thinking that you will be one of the 50% that will not be subjected to such interventions.
 
It is wise to face the fact that their medical management beliefs and attitudes are what they are. This was how they have been trained….what they are use to.
 
Base your choices on the realities of the situation, not what you wish it would be.
 
Don’t be frightened by the “what if’s”, scare tactics or worse case scenarios.
 
Don’t get discouraged……….
 
Remember that you are designed perfectly and are fully capable in birthing your baby. You know what is best for you and your baby. Trust your instincts. Keep abreast of your patient rights.
 
Keep looking until you find the answers you know are right for you and baby.
 
Articles of Interest:
                                            
The art of midwifery is blending with the science of obstetrics to give a higher standard of care to the laboring mother. A midwife gives routine prenatal care and attends normal births, freeing the doctor to do that for which he or she is trained - caring personally for those mothers who have complications. 
excerpt from: The Baby Book by  William Sears, M.D. pg 22
 
 
 
 
Please visit Informed Choice Links Page & Resources to Consider page for valuable articles and resources for
your successful pregnancy & Birth.
 
 
 
 
Patient Bill of Rights:
The patient has the right to:
  1. To be given considerate and respectful treatment.
  2. Obtain from their physician, complete information concerning their diagnosis, treatment options and prognosis in language the patient can reasonably be expected to understand.
  3. Know by name the physician(s) responsible for their care.
  4. Receive from their physician all information necessary to give true informed consent prior to consenting to any procedure or treatment. This information should include a description of procedure(s) or treatment(s), the risks involved with each and the probable duration of the incapacitation.
  5. Information regarding medical alternatives for treatments.
  6. Refuse medical treatment
  7. Refuse to participate in any form of medical experimentation.
  8. Know & question hospital rules and regulations that apply their conduct towards patients.
  9. Examine, receive and explanation of their bill regardless of the source of payment.
(This is based on Midwifery Today article- Homebirth Choice)
 
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Pragmatic look at your options for a provider:
 
Direct Entry Midwife (DEM)
A Direct Entry Midwife or Traditional Midwife is one who has trained with 1 or more experienced midwives, mastering skills and experience needed to practice the art of midwifery. A practicing DEM is usually an independent practitioner that provides out of hospital birthing option to families. Didactics, education in the disciplines of midwifery, is completed through self-study, apprenticeship model, a midwifery school or college based program. Many practicing DEM’s decide to pursue national CPM certification through National Registry of Midwives for either state licensure requirements or personal fulfillment.
 
Certified Professional Midwife (CPM)
CPM is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set forth by the North American Registry of Midwives (NARM). A CPM is qualified to provide the midwifery model of care to homebirth families. The CPM (domestic and international credential) is required to be trained extensively in out-of-hospital birth setting. State licensure is typically granted using the NARM certification as the standard of care.
 
Certified Nurse Midwives (CNM)
Certified Nurse Midwives have a nursing degree and subsequent master’s degree in midwifery. They generally practice medically managed childbirth under the supervision of a physician in a hospital or birthing center. Some CNMs have chosen to be to have a family focused practice independent of an overseeing physician. Many operate free-standing birth centers or serve home birthing families. All states recognize CNMs, but laws differ from state to state regarding their ability to serve homebirth families. Scores of state organizations are summiting legislation that would allow CNMs to maintain their license while still serving families in their homes. Many CNMs who desire to serve homebirth families, actually obtain their CPM so they can practice as an independent midwife.
 
 
birthquestions@bellywater.com                                       
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