Tuesday, November 17, 2009

Questions to ask the Midwife

Going to see a midwife was very intimidating for me. Not because the midwife herself is intimidating- really, all three of the midwives that I have interviewed have been very warm and sweet. It was the process that is intimidating. Everyone knows how an OB works. You call the office, tell them you are pregnant, and they set up an appointment. You show up for the appointment and hand them your insurance card and pay a co-pay. When the baby is delivered, you go to the hospital and have the baby, and fill out a form, and they take care of the birth certificate. With Jonah's hospital birth, the hospital even took care of sending a birth announcement to the local newspaper for us.

With homebirths, it is a little different. There is a lot that was a mystery to me. The whole process from interviewing to making the insurance claims has been a learning experience. When I went in for the first interview, I did not even know what to ask. Since then, several questions have come up that I wish I had known to ask upon that first meeting. So I have compiled these questions that have come up, for anyone else who is thinking of having a midwife attend their birth. I've also included the reasons that I wish I would have asked these questions during the initial interview.
1. What is your reason for becoming a midwife? This is just kind of a "feeler" question. It gives you insight into the midwife's birthing philosophies as well as lets you know her past experiences.
2. What are your views on prenatal scanning such as ultrasounds and gestastional diabetes testing? You want to make sure that you are on the same page as far as screenings go. If you want minimal screening, you don't want to have a midwife that is going to pressure you into the procedures. On the other end, if you would like to have these screenings, you don't want to feel that your midwife is judging you for doing what you feel is the best for your health and the baby's health.
3. How will my insurance be billed, and what happens if they don't cover the costs of a midwife assisted birth? Some midwifes have a sliding scale that can be adjusted to your income if insurance won't cover the bills. It may seem taboo, but it is important to talk about money up front and find out what the payment options are. Be prepared to battle with the insurance company yourself, and if the midwife requires you to file your own claims ask for any paper work and phone numbers that you will need.
4.What do you expect of me during pregnancy and labor? and what duties will I have to fulfill regarding the pregnancy and birth? My current midwife expects mothers that she is attending to exercise regularly, keep track of her diet, and attend birthing classes. She also encourages attending classes and events at her birthing center. This is different from a typical OB, who would probably answer this question by saying "be on time for appointments" (at least my past OB would) It is also important to know what paperwork you will be responsible for. Some midwives require you to file for the birth certificate and social security yourself. These are things that were handled for me in my hospital birth, but need extra attention for this homebirth.
5. What do you expect of my partner during pregnancy and labor? Remember that there are two of you that the midwife will have to work with. If your partner is kind of hands off and skittish, and your midwife is expecting him to be more active than he wishes to be, then you may have a problem. Be up front about your partner's desired level of participation.
6. In the event of a hospital transfer, what hospital will I be taken to? Through casual conversation with my husband last night, I realized that our insurance only covers Toledo City Hospital. If we are transported to an out of system hospital, we may have to pay quite a bit of money or even be refused care. Make sure that the hospital that you will be transported to is covered by your insurance.
7. In the event of a hospital transfer, can I see the physician of my choice? Many women have a "back up" OBGYN in case they need to be transferred to a hospital during the pregnancy or labor. They visit this OB regularly throughout the pregnancy so that the OB is familiar with the mother and the circumstances. Others feel that the on-call OB is just fine. It is important to know how your midwife feels about a backup OB, and if she will transfer you to that OB or one of her consultants.
8. How do you feel about other children being present during labor or birth? What about other family members? If you have other children, it is important to know how the midwife feels about them being present. My midwife allows them, but requires one person to be there who is designated to watch the children. If you are birthing in a birth center, it is important to know if there is a room that your child can play in or take a nap, or eat if necessary. Also, if you want furthur support during your labor, it is important to know how the midwife will handle having extra people such as your mother or sister. This question will also force you to really think about whether or not you want these people present at the most intimate moment of your family's life. Having my mother there seemed like a sentimental thought, but when I really dwelled on it I am not sure if I could handle having her there, as much as I love my mother.
9. What would you consider grounds to transfer me to a hospital? You want to make sure that the midwife will be able to recognize an actual emergency that requires a hospital transfer, and make sure that her opinions are in line with what you believe to be something that warrents going to the hospital. If they are not, ask her why she would not transfer to a hospital for such things.
10. What are my labor and delivery options with you? You'll want to know if you can labor in a tub, or if your partner can assist in catching the baby. Your midwife may be able to tell you of options you've not heard of before. Can you eat during labor? How will she monitor the baby? In general, ask her what your options are for how your labor can be managed.

This is not a complete list. There are other very important questions that you should ask your midwife before choosing her to assist in your birth. But if you google "questions for midwife" every list will have those same questions. These questions above are questions that I have encountered while doing paper work, setting up appointments, and planning my birth. I did not have these questions on my list the first time I met my midwife, because I was not prepared for any of them to come up. No matter what questions you choose to ask during the interview, it is important to make sure that the midwife you select will be compassionate towards the views of you and your partner, and that she is properly trained and prepared to safely deliver your new miracle into the world.

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