how to choose a midwife

I can’t seriously tell you how to choose a homebirth midwife, of course, because everybody’s situation is different and the options are different from state to state, country to country. But several people have asked how we went about choosing a midwife, and we were a little baffled by the task when we first faced it. So here’s what we did, for what it’s worth:

  1. After we decided to have another baby, Eric and I looked into the legal options in our geographic area and did some basic research into who works here. We are spoiled for choice where we happen to live, which is just awesome.
  2. Then we sat down and had a conversation about what mattered to us, and specifically about whether and how much we each cared about certification, licensing, and path to midwifery (through nursing or not). We also talked about more personal preferences: I realized that I wanted someone roughly my own age rather than an older-and-wiser type person, for instance. I worried about whether that was a legitimate preference–after all, it’s age discrimination–but ultimately decided that my own comfort level trumps fairness in such an intimate hiring decision. We also came up with a list of questions we might want to ask potential care providers.
  3. Next, I did some more research into the midwives who suited our preferences and chose about five to contact with some initial questions, which I chose from our longer list. During this step, I realized that we just weren’t interested in anybody who couldn’t be contacted easily via email (and were annoyed by people not having websites: you can make one for free, people), in part because it was very important to me to have email communication throughout the pregnancy.
  4. I emailed about five midwives to say that, although I didn’t think I was pregnant yet, we were trying and would be planning a homebirth, and could you answer these questions? Some did; some asked for a phone call or in-person meeting instead. We got better and worse feelings from various responses. One seemed too medical and rigid in approach for us. One lived so far away that we’d only consider her if other options didn’t seem great. And so on.
  5. Eric, Noah, and I actually met with two midwives, asked lots of questions, and then compared notes. Well, honestly, after the first one we compared notes (she was clearly competent and kind, we all liked her, but she didn’t really seem to notice that Noah was a human being and didn’t … I don’t know … light me up with the passionate desire for her to be my midwife). After the second one, Eric was just like, ‘I see she’s going to be our midwife …’ And I was like, ‘look, dude, I may leave you for her: I’m in love.’

I read somewhere that you should choose a midwife who makes you so comfortable you could pretty much just rip your clothes off, as you are going to have to be at least kinda naked and have this wildly personal physical event in her presence sooner or later. The midwife should light you up with oxytocin. I think that’s pretty good advice.

Here are some of the questions we asked as we made this decision:

  • Cost?
  • How does insurance work? (likely reimbursement? who begs the insurance company to reimburse?)
  • Location of prenatal appointments? (We preferred, and got, at our own home–by being flexible about timing and asking for it, even though that wasn’t our midwife’s standard operating procedure.)
  • Do you answer clients’ questions via email?
  • What are your practices–and your feelings–when a client gets to 42+ weeks? [This one was big for me, as I gave birth to Noah at 42+4 and did not love the atmosphere of freakoutiness.]
  • Long/‘stalled’ labor: practices/feelings? [also prompted by my first labor]
  • Are you a feminist? What does that mean to you?
  • We’d welcome our five-year-old to attend his sibling’s birth if that’s what he wants to do once it’s happening. We’re planning to hire a doula to be his friend and explain things to him during my labor, so that he has a caregiver who understands and is comfortable with birth. How do you feel about young children at births? And do you know of a doula who might be willing to support my family in this way?
  • What do you see as your basic role at births?
  • Education/training/experience?
  • How does hospital transfer work? Do you have a backup OB? Admitting privileges somewhere? Will you stay with us if I have to transfer? What sort of relationship do you have with the doctors/nurses at the hospital you use?
  • What’s your transfer rate? What’s the most common reason for transfer?
  • What disqualifies a person from birthing at home with you?
  • When and why do you do pelvic exams?
  • Whom do you take with you to births?
  • What do you take with you to births?
  • How many clients do you take for a month? What happens if two are in labor at the same time?

How did you choose your care provider (midwife or otherwise)?

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  1. ab
    Posted 10 December 2012 at 1:52 PM | Permalink

    This is super interesting – thanks for sharing your process!
    We live in Montreal so for us “choosing” a midwife meant putting our name on the waiting list at the local birthing centre and waiting (breathlessly, because we really wanted a midwife and the publically-funded ones are in short supply) for a call if we had a spot. The midwife that we were eventually paired with was AMAZING. We also met with 2nd and 3rd midwives from the birthing centre in case I gave birth when our primary midwife was not on call. Because this is all free, there was never a sense that we were “hiring” someone. I wonder if those who actively choose their midwife end up more satisfied that those who are paired randomly. I also wonder if the midwives here learn to tailor their approach to a wider variety of clients because they are paired randomly.

  2. Posted 10 December 2012 at 7:22 PM | Permalink

    I’m nowhere near ready to get pregnant and have kids, but I know that when I do I want a midwife. I’ve always been overwhelmed thinking about how searching for that person would work, so I’m really grateful for this post. Thanks!

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