So you want to hire a homebirth midwife?
That’s a great choice! There are many great midwives that serve women all across the world. They usually serve in a more natural minded manor and know more about physiological birth than their obstetrician counterparts.
When you go about hiring a midwife, it is important to be aware that they are not one size fits all. They are each very different, all will practice differently, all will have different views on what physiological birth is, and not all midwives are attending for YOU.
When choosing a midwife, be aware that most are limited in how they can serve you due to state laws. Most licensed midwives will not serve you completely autonomously with out risking losing their license. Which is sad – but important to be aware of. This is something many women are unaware of when hiring midwives. There are also midwives that are not bound by legalities and can serve you completely autonomously. These women are often considered Traditional or underground midwives. There are also licensed midwives who are willing to bend rules and fudge numbers to ensure a safe, out of facility delivery, making you the number one priority. Be sure you know who you have along for your journey before hiring!
A few questions you may want to ask a potential midwife would be:
1. What does a physiological home birth look like to you?
Some may have a more medical version of home birth in mind with monitoring vitals, checking the cervix, and so on. Some will have a more natural flowing version where medical monitoring/assisting only occurs when needed.
2. How often do you need to monitor baby?
In some states licensed Midwives are required to monitor baby every few minutes. This can be an unnecessary bother during labor. If this is something you’d like to avoid, be sure your midwife is able to support your choice of limited monitoring.
3. Are cervical checks ever required, if so, how many?
Most women do not enjoy cervical checks during labor. They can be hindering during labor and are 100% unnecessary. If your birth plan is to avoid cervical checks, be sure to discuss this as some may require them.
4. What all might risk me out of your care?
Closer to the end of pregnancy, many women are shocked when their provider says they “risked out” of care. This means you are no longer a client and they will no longer serve you. Some midwives will risk you out for silly reasons such as baby being breech, solely to protect their license. Be sure you are aware of every situation that could risk you out of their care before signing a contract.
5. What would necessitate a transfer during labor?
During labor, your midwife can choose to transfer you. Transfer is necessary in some situations! Unfortunately, some will choose to do so for unnecessary reasons, with out warning. Of course, you can refuse transfer, but they may be required to call 911 before they leave – this then becomes your issue to deal with while you are vulnerable. Some will transfer for silly reasons such as two slightly elevated blood pressure readings, baby being breech, or “failure to progress”. Be sure you are aware of all scenarios your provider will transfer for, before labor. It is important to also discuss what you will do in the case of a suggested unnecessary transfer. Will you stay home and continue with delivery or will you do as she suggests? This should all be discussed prior to laboring day.
It’s comforting to believe that all home birth midwives have your best interest at heart, but this unfortunately is not always the case. Those are a few questions that might be able to help you decipher if she is more concerned about you or licensure. A few things you could do to protect yourself if your midwife drops you or suggests unnecessary transfer would be:
1. Do not pay in full until the deadline of payment.
2. Be informed on your states midwifery laws and the legalities surrounding.
3. Have a plan of what you will do in the case she drops you out of care.
4. Discuss each unnecessary transfer scenario and what you and your partner would do if she made the suggestion to transfer.
5. Discuss with your midwife prior to labor what you will do if she feels she needs to leave your birth to protect her license. Discuss each situation and scenario.
6. Make sure there is a refund policy in your contract, be sure you agree with it.
7. Be sure your partner and/or Doula are in the loop with all of the above because they will be the ones you look to for support if your midwife drops you or suggests transfer. Everyone involved should know what would “risk out” of care as well as what might necessitate a transfer. No need for surprises on laboring day!
I’ve heard too many stories where a home birth midwife left a woman hanging, mostly for unnecessary reasons. Most times, the woman was unaware that their midwife could abandon them like they did. Most did not get any amount of refund, and many were left with traumatic births. This is what drove me to create this article. Women in their childbearing years need to be aware that this can happen. They need to know what questions to ask and how to decipher if the potential midwife is a good fit, prior to signing a contract and paying in full. She can be a sweetheart and say she supports, you but there is more to it than that.
Again, not all midwives are the same. It’s important to acknowledge that there are a few snakes in the grass. Many midwives will have your best interest at heart, will bend silly rules for you, and put you before themselves – be sure the woman you hire is one! There are amazing midwives out there, you just have to look! Keep in mind, if your midwife is driven by the law, that is exactly what she will deliver.