Questions To Ask A Potential Midwife

Recently I have seen a rise in people claiming to be a home-birth midwife that are not trained or equipped to provide the services they offer – all across the US. This has resulted in multiple fetal deaths, maternal deaths/harm, and unnecessary birth trauma. These ‘midwives’ are something to shy away from – here is how you can avoid them for your own birth.

Midwives are not interchangeable; no two are the same. Most serve with a heart of true passion and care; some serve solely with a wallet to fill or ego to boost. Some will walk with women throughout their entire journey, and some will bail on them for various reasons. Some midwives undergo years of training/attending/learning/practicing. Some claim to be a midwife but has nowhere near enough training to do so. It is crucial to interview properly to make sure your midwife is a good fit for you. Don’t hire a woman who will be ‘a deer in the head lights’ when you or your baby needs assistance.

Keep in mind, a licensed midwife does NOT mean a well-trained and educated one. More often than not, it only limits how they can serve you. In my experience, it is the licensed midwives who can be fear ridden, as taught in their medicalized schooling – not all though! Again, none are the same. It should never be a degree or license you are looking for. You want one who is there to serve YOU, not serving the state or medicalized model of birth.

Here are a few questions that would be great to ask a possible Midwife. Be sure she has answers, if you have questions that go unanswered – you should not take this lightly. She should not be hired. Never ‘settle’ on a Midwife.

  1. What training have you had? Schools, degrees, certificates, preceptorships, internships, etc.?
    (You can look up their schooling history, degree, and certificates online. Do not take anything for face value. Do your research before signing a contract. Again, some midwives do lie about qualifications. If they attended internships/preceptorships, ask to reach out to their preceptors. Some are fired or let go before completion and choose not to disclose this information. You may want to know why.)
  2. Are you trained/certified in neonatal resuscitation? (You can ask to see their NRP certification card as proof. Yes, many birth workers do lie about their trainings!)
  3. How many times have you had to resuscitate in your career?
  4. How many births have you attended?
  5. Where can I find reviews for your services? (You want to be sure you hire someone who is backed by past clients. If she does not have reviews, this could be a red flag)
  6. How long have you been attending births as a primary midwife? (This asks how long they have been attending on their own, without a preceptor – someone guiding them)
  7. How many births do you attend per month?
  8. Do you have a backup midwife? Will I meet her? (Every midwife should have a backup. You should ask to meet this backup prior to labor if you do not want a stranger possibly walking into your home on birthing day)
  9. Do you have an assistant or will you be attending alone? (Some bring an assistant and some charge more for the assistant)
  10. How many times have you had to transfer during labor? (A midwife’s transfer rate says a great deal about her ability to serve women)
  11. Do you stay with mom once she is transferred? (Many midwives will transfer mom to the hospital then leave once she is admitted. This likely isn’t something you want, be sure it will not occur)
  12. How many times have you had to transfer mom/baby postpartum?
  13. Will you attend twin, breech, and VBAC births? Why or why not?
  14. What complications and emergencies have you seen and how were they handled? (i.e. prematurity, prolonged labor, fetal distress, breech, bleeding, dystocia)
  15. What circumstances/conditions would rule out your attendance? (In many states, especially with licensed midwives, they are required to drop you from their care for many unnecessary reasons. Do not get to 37 weeks and find out she is dropping you because your baby chooses to present breech. If she is not competent, or holds her license above your births wellbeing – she might be a MEDwife and might leave you hanging with no care or reimbursement.)
  16. Can you list each scenario that could possibly risk me out of your care?(Know ahead of time EVERY reason you could be released from her care. Depending on state, the midwife’s knowledge, her licensing, and her competence, there are many reasons they can drop you from care. Things that are not in your control Be aware of EVERY possibility before signing a contract)
  17. What complications/emergencies are you prepared to handle?
  18. Under what circumstances do you transfer to a hospital? (Some midwives are known to transfer women for silly reasons that are not science based. Be sure your midwife will not bail on you when you are vulnerable.)
  19. What percentage/exactly how many clients have had cesareans in your practice?
  20. Will you accompany us through a hospital birth if one was necessary?
  21. Do you offer prenatal care? What is your schedule for visits?
  22. What is included in prenatal care? (i.e. lab work, urine checks, blood pressure, fetal heart tones, fundal measurement, baby’s positioning, & vaginal exams & PAP)
  23. What type of nutrition counseling do you provide?
  24. Do you visit the home at any time before the birth?
  25. Am I required to complete any kind of testing? (Some Midwives require specific testings or they will drop you from care. This is not autonomy and likely not something you want to sign up for. You should have complete control and say over your prenatal care)
  26. Am I required to attend a certain amount of prenatal appointments?
  27. What happens if I refuse appointments, procedures, or suggested medications? (If they have an issue with your having say over your pregnancy and refusing XYZ, run the other way)
  28. When do you like to be called once labor has begun?
  29. When do you come to the home once labor has begun?
  30. What equipment do you bring and what must we provide? (You can tell a great deal about a midwife and the care she supplies by what she carries in her bag. Does she carry herbs and tinctures or does she simply carry Pitocin and oxygen. Know what she will be showing up with! Know what you are comfortable with being used.)
  31. What emergency equipment do you provide?
  32. How do you view the father’s role?
  33. What is your role during labor? birth?
  34. How do you feel about sibling participation in birth?
  35. What non-drug measures do you suggest for pain relief?
  36. How often do you listen to the baby’s heart rate during labor?
  37. How often do you check the mother’s blood pressure?
  38. Do you require vaginal checks at all, ever? (Vaginal checks can be harmful and mean nothing in regards to progression during labor. If she requires vaginal checks, she might not be a good fit. That would be a red flag that she does not support autonomy.)
  39. What is considered fetal distress in your opinion?
  40. What do you consider prolonged labor/birth pushing?
  41. Do you have preferences for labor/ birth positions? (This answer should always be “It’s the mother’s choice”. If she requires you to lay in a certain position, this is a concern.)
  42. How do you feel about water-birth? Have you attended any?
  43. What measures do you take to prevent tearing?
  44. Will you allow partner to “catch the baby” instead of you?
  45. Do you check for tears after delivery?
  46. Do you have local anesthetic & suturing equipment for this repair to be done without going to the hospital? Do you suture all tears or only major?
  47. How do you prevent/treat excessive postpartum bleeding?
  48. How do you handle the baby immediately after birth?
  49. How long do you stay after the birth? What do you check at this time?
  50. What is your schedule for follow-up care?
  51. Do you do the newborn screening tests?
  52. What are your thoughts regarding circumcision?
  53. How is the filing of the birth certificate handled?
  54. Do you routinely give me a copy of all my records after the birth?
  55. How much do you charge for your services?
  56. What services are not included in this fee?
  57. Do insurance plans cover your fee? Do you accept direct payment?
  58. When do you want the full fee paid?
  59. Are there any refunds if I risk out of care? (I see it occur so often that a mom “risks out” of care and mom is left with no midwife and no refund. 7K+ down the drain at no fault of her own, and no home birth to show for it. Know about her refund policy and make sure you agree before signing!)

Final Thoughts

Determine the midwife’s willingness to be open to communicate, explain things that you don’t understand, and willingness to let you make your own decisions. If she is unable to answer all questions without hesitation, be wary.

Be sure to reach out to your local birth community and ask around. Some providers will present themselves to be something they are not. Their abilities will reflect in their past client’s experiences. Read all reviews, ask questions.

Hiring a midwife is not a simple choice, this plays a HUGE role on birth outcome. Knowing the difference between a CNM, CPM, and traditional midwife is also helpful in making a midwife selection. Again, Midwives are not interchangeable – none are the same. Do not settle, find one that is a perfect fit for you!!

LGBTQ+ Baby Making Options

This article is inspired by Tampa Bay Birth Network! You can find more information about the organization at their website: Tampa Bay Birth Network

Some people view not being able to get pregnant while in an LGBT relationship as a positive thing. Natural birth control right?! We must reconsider our words, as some LGBT couples really struggle through the fact that they cannot accidentally conceive or easily begin to try doing so, like a lot of heterosexual couples can. But, there ARE options!!

Choices Beyond Adoption

LGBT couples are four times more likely than heterosexual couples to adopt, likely many due to this challenge or by preferred choice, but what if your family simply does not want to adopt, but wants to have biological children? Your feelings are valid and there are choices beyond adoption!

First, it is very important to make a game plan when trying to conceive as an LGBT couple. What are the realistic options? What are the most cost-effective options? If the cost-effective options do not work, what will be the next step, and can you afford the more expensive treatments? How much money do you need to start saving for the treatments? Set goals for when you or your partner would ideally like to be pregnant! Start eating healthy, whether you are the partner contributing sperm to a carrier, you are the partner getting pregnant, or you just want to be extra healthy for that brand new baby that is going to be coming into your life.

Sperm Banks

If you will be using a sperm bank, there are a lot of different options, and a plethora of things to be looking for. Check the pricing! Is it affordable? What does the initial fee cover? What extra fees are there to view potential donors and once you have decided on one, what are the legal fees involved? What are the sperm shipping costs? How is their matching process? Do they have facial matching options? (This is where you can put a picture of anyone you want, including your spouse, and get matched up with donors that look like that person). Do you want the donor to be completely anonymous, have their contact information released when the child turns 18 (known as an Open-Identity Donor), semi-involved (in their life, but not as a parental figure), or do you want to co-parent with the donor? Do you know someone who will be a donor for you PERSONALLY? Most sperm banks have very strict qualifications as far as medical history, including relatives, luckily! Not all sperm banks are LGBT friendly though. Biogenetics, California Cryobank, Cryobiology, Idant Laboratories, Pacific Reproductive Services, Rainbow Flag Health Services and Fairfax Cryobank are known to be LGBTQ friendly.

Fun fact, there are also such things as Donor Sibling matching sites, where families that used the same donor, can talk about their kids and meet, if they would like to!

Types of Insemination

IVI – This is intravaginal insemination, meaning that donor sperm is placed in the vagina, as close to the cervix as possible, to travel up through the cervix, into the uterus, to meet an egg! This can be done at home with the right equipment, or in-clinic. A midwife, if they are willing, may also assist you, if you feel you want a professional alongside you, depending on state laws. IVI typically has a 10-30% success rate, depending on whether the sperm is washed or not (washed sperm increases chances, but this will have to be done in-clinic and can be more costly).

ICI– Intracervical insemination. This involves the use of a speculum, catheter and syringe to place sperm into the cervix, and then placing a sponge under the cervix to prevent mucus and sperm from leaking out, then is removed a couple hours later. ICI has a 5-30% success rate.

IUI– An intrauterine insemination also consists of a speculum, catheter and syringe, but the catheter will go a bit further, into the uterus for the best chance at sperm meeting an egg, and a sponge is again placed, and later removed. IUI success rates range from 2-40%.

IVF – In-vitro Fertilization is a bit more complex than any of the above listed methods. It requires eggs to be extracted from a donor or the intended carrier, whichever is best for your family, then matching those eggs with sperm from a donor or from one, or both, fathers! Embryos will develop to approximately 3-7 days old, and then be transferred into the carrier’s uterus. This is relatively the same process as surrogacy and involves a protocol of medications and lots of monitoring. It is certainly the most expensive but is sometimes the only option. IVF typically has a 40% success rate, but it truly varies per clinic and their different protocols.

Surrogacy

If you are considering surrogacy to grow your family, here are the things you should be considering!

Traditional Surrogate VS Gestational Carrier

  • Traditional Surrogacy involves using the carrier’s egg, so she would be biologically related to the baby. This may involve home insemination, in clinic insemination, IUI, or the full IVF process (extracting her eggs, creating an embryo or multiple embryos, and transferring the embryo(s) into her uterus).
  • A gestational carrier is simply hosting the embryo(s) and they are not directly biologically related to her; though if it is a a cousin, sister, daughter or any other relative, they will be distantly related. This involves basically the second half of IVF where ovulation is suppressed, lining is thickened, and embryo(s) are transferred. Progesterone and estrogen are supplemented to sustain pregnancy.

Review the laws of surrogacy in the SURROGATE’S home state, as those will be the laws that apply, not your home state. Read laws state by state here.

The process leading up to becoming an intended parent are as follows:

  • Decide on an Agency or Choose to go Independent (aka “INDY”)
  • Medical Evaluation
  • Disease/Drug Screening
  • Psychological Screening
  • Match With Your Surrogate of Choice & Pay for her to go through her process
  • Build up an escrow account for surrogate compensation, medical expenses and a little extra to cover bases
  • Decide on a lawyer to do your contracts
  • Provide sperm and/or eggs to clinic of choice to make into embryos to freeze or use fresh

You might be wondering, what is the process that the surrogate goes through?

  • Requirements: Must be between 21 and 50 (generally), not be on any type of government financial assistance (food stamps, WIC, or any variety of that), have had at least one healthy, complication-free and term pregnancy and be raising said child. People who have had gestational diabetes, pre-eclampsia, antenatal depression, pre-term delivery, hyperemesis gravidarum, placenta accreta, or any other complication may not qualify.
  • Background Check
  • Medical Evaluation (includes hysteroscopy, pap smear, pelvic exam, blood work)
  • Drug/Disease Tests
  • Psychological Screening
  • Follow all steps necessary to complete all necessary evaluations, contracts and follow RE protocol to raise chance of pregnancy

Contracts are so very important, so be sure to discuss these and more, in-depth, when considering matching with a surrogate.

  • Place of Birth (Hospital, birth center, home?)
  • Compensation (plus lost wages, gas, transfer fee, complication fees, any other fees that may need to be considered.. How will it be broken up, monthly, bimonthly, lump sum, etc?)
  • SET or DET (This is how many embryos you will transfer)
  • What circumstances is termination requested?
  • Involvement & Contact
  • Medical Decisions
  • Surrogate Providing Breastmilk
  • Placenta?
  • Ask questions if you are confused, make sure you and the surrogate are in AGREEMENT before either of you sign, or this may cause future conflict. Do not rush!
  • Contracts must be notarized

Once the surrogate gives birth, you will work out any final payments or paperwork that needs to be done, and you will take home your baby/babies!

Interested in Adoption?

If you decide that adoption IS for you, after considering these options, be sure to check out the laws in your state! You can find a state-by-state guide here.

Final Thoughts

A note about pronouns, respect and understanding for LGBT families in pregnancy, birth and postpartum: Please be sure you use a provider that respects you and your family enough to use proper pronouns. If you prefer non-binary or alternative pronouns, or non-gender specific references as opposed to ‘mom’ and ‘dad’ for example. If they cannot respect you enough to make this simple change, they will likely not respect you in birth, either!

Enjoy building your family!

With all our love and support, HERBAL.

 

Building The Village For Our Young Mamas

A teenage pregnancy is defined as any pregnancy that occurs in a female under the age of twenty years young! Teen mamas account for 7% of all births in the US. While most of them are unplanned, this does not mean that they are necessarily dangerous or problematic. What IS dangerous and problematic is how healthcare providers are treating teen mothers as walking ignorance, and a living breathing complication. It is disheartening to see how we, as a society are treating these young girls when they become mamas, and need support more than ever.

Proper Sex Education

So let’s talk about prevention first. To best give a teenager the true opportunity to be informed about sex, we have to squash the concept of abstinence-preaching. This does our girls NO JUSTICE, because let’s be real, teenage hormones are surging – especially in public schools where there are “pretty/handsome” teenagers EVERYWHERE, relationships and sexuality are a status symbol, opportunities to hear about a party are abundant, and there are about a thousand ways to sneak out of your parents’ house. Instead, we should be discussing methods of fertility tracking, natural family planning and preventing, safe contraceptives that do not destroy their bodies, and holding young men accountable for prevention and consequences of sex, as well.

YEP, I went there. I have a son and believe me, he will know about cervical mucus, temping, neem oil, and more about a woman’s fertility (and his own). It is crucial that the two that will tango are both knowledgable; it should not solely rest on a young woman to prevent pregnancy. We need to leave an open conversation for teenagers to come and talk to us, as parents, teachers, and advocates in the community, whether it is about STDs, infections, a pregnancy scare, rape/assault, or any other potentially “embarrassing” or “private” subject. And if we cannot have this, what else can we expect to happen but an unplanned pregnancy due to LACK OF WILLINGNESS TO EDUCATE ON OUR PART?? We are adults for goodness sake, and our babies, will not always be babies.

Responding to a Teen Pregnancy

Next, we must address the fact that not all parents are going to be open to the above and that pregnancy is going to happen, so let’s figure out how to handle the scenario of your teenager coming home and sharing with you that she is pregnant, or that he has gotten his girlfriend pregnant. Instead of crying, shaming, yelling, grounding, expressing that their “life is over” and “what have you done” blah blah blah…, why can we not meet them with compassion? They are obviously already feeling all kinds of emotions, and they do not need to carry yours; unload that baggage on someone else, not your child. They need you to be their rock right now, more than ever. Remember, YOU as a parent, are their role model, how would you want them to react to your future grandchild? Look at that sweet teenage face, and remember when they were a baby… that is how fragile they are right now – love them, guide them, do not push them away. Ask them how they are feeling right now, talk with them about their choices, how far along mama is, what can you do to help. Make a game plan! Start with discussing jobs, finances, the home they will live in/raise the child in for the first year at least, how can you arrange childcare, what about transportation, how can they finish school, etc. Not all of this needs to be addressed off the bat, but progressively and productively, all filled with love and positivity, as your children make these tough decisions at such a young age. They will be so grateful for the gentle guidance we can provide to them.

What ARE their choices? We mentioned choices in the above paragraph, but some people truly do not know their options and what all that entails. She has the option to access abortion, pursue closed or open adoption, or choose to raise the baby, either co-parenting with the child’s father, or as a single mother. No woman should EVER be forced, coerced or intimidated into any of these options; she should be presented with non-biased, evidence-based research as well as equal anecdotal experiences on all of the following and make her own decision.

Maintaining a Healthy Teenage Pregnancy

Nutrition is vital once a young mama finds out she is pregnant, just like any other mama! Many teenagers do not know how to eat properly, especially if they are raised in a home that does not exactly model healthy meal plans. Start together. Look into the Dr. Brewers Diet; it is sustainable and nutrition-packed – perfect for a mama to start when she is pregnant.  Proper nutrition reduces the likelihood of complications such as high blood pressure, anemia, premature labor, low birth weight, and more – which teenage pregnancies are stereotypically associated with.

Mental health is also an important aspect to address for a young mama. She may lose all of her peer support and friends from school once she is pregnant, she may even lose her relationship with her boyfriend. Talk to her about visiting a therapist that she can vent to and discuss all the hardships of losing those peers and the social status at her school. Find out what teenage pregnancy resources are available locally to you, and go with her to classes, support groups, so she does not feel so alone!

Preparing for the Birth

Now, discuss the birth plan! A lot of care providers assume that a teenager will not make it through labor without some kind of pain medication, and this stigma needs to stop. Just because you have a first-time mom who is young and does not know much pain, sitting in front of you does not mean that she is any less than a 30-year-old first-time mom. Her body is just as capable, just as strong, do not dare treat her less. Talk to her about her options, provide her with evidence-based research and allow her to decide and compile her birth plan herself. The best thing you can do if you have a daughter aiming for a natural birth is get her a doula! No matter what birth setting she is choosing to birth in – home, birth center, or hospital, a doula is full of great techniques and knowledge to advocate for that mama! Even when she is under-age, she still has the right to choose how her body is treated, what interventions are involved during her birth, and how her baby will be treated. She is still in control! Support her in her choices. First time, young mothers can have a home birth, too! Home births are not just for trendy millennials who have already had a couple of children, but for anyone who grasps the concept of undisturbed, physiological birth.

Supporting the Young Mother

Then, we fall into the fourth trimester. This is a hard one for teen moms. They likely do not have a friend that who was pregnant with them at the same time, that now has a sweet newborn around the same age; someone to vent to, ask questions to, and bond with, as a new mom. Likely, all of their friends are actually getting ready for a school dance like prom or homecoming, attending a football game, on a date with their newest partner, or cramming for finals – and she is learning to breastfeed, doing laundry, changing diapers, and possibly also cramming for finals and doing home work! Being a great support person for a young mama in her postpartum period includes watching for signs of postpartum depression and educating her on those signs as well (The Edinburgh Scale is wonderful for this), take her places (the mall, the beach, outside for a walk), acknowledge that she is still a person and her dreams, goals and wishes are still obtainable and they still matter! Young moms absolutely breastfeed, too, and it will help her get more sleep by dream feeding, not have to stress about bringing bottles, water and formula out and about, and she can start her baby out with an amazing microbiome and immunity. Praise her on her successes and choices, she is blossoming and flourishing as a new mama.

As a society, we can do much better in encouraging the success of young mothers everywhere because like it or not, young motherhood is going to happen and instead of shunning them from schools and workplaces, they deserve to be a functioning and strong representation of what a teen mom looks like. Implementing nursing or pumping rooms in schools, fighting for pumping rights in the workplace for ALL, advocating for teen rights in birth settings, providing resources further than “maybe you should consider adoption”, and overall coming together as a community to ask how we can help young mothers locally to us, will make a MASSIVE difference in our growing generations and the bond between a young mother and her child.

So let’s branch our village out and surround young mamas in love, grace and support, shall we?

 

 

What Makes HERBAL Different From Other Doula Certification Programs

Doula certification organizations are not all the same! It is very important to be sure you know the morals and standards of a certifying program before purchasing. Be sure you can stand behind their beliefs! Many organizations have rules, obligations, additional fees, etc. Be informed before purchasing!

Most all Doula & Birthkeeper certification programs will speak about and cover the following topics:

  • Birth work timeline/ Birth History/ Provider history
  • Antenatal/Prenatal
  • Physiological birth process
  • Assisted birth options and how to assist in each scenario
  • Pain management techniques
  • Post partum/ 4th trimester

The topics directly related to birth and the Doula’s role. We also discuss all of this in full in the HERBAL program.

But How is HERBAL Different?

At HERBAL we cover topics other programs might not discuss. A few of those topics would be:

  • Unassisted birth – how to support those who choose this option (YES, we support unassisted birthing women)
  • Birth emergencies – signs to look for and what to do in these scenarios
  • Fertility – how to track your cycle; the hormone process involved
  • Everything breastfeeding (with no additional cost!)
  • Bereavement and loss – how to support those who experience loss
  • Parenting choices
  • Nutrition
  • Homeopathy & Herbs/tinctures
  • Essential oils through out motherhood
  • Cultural awareness in birth – how to support those in other cultures as well as things to be aware of in how they are treated differently.
  • LGBTQ- how to better serve this community
  • Recognizing Domestic violence – addressing abuse in pregnancy; how to handle clients struggling with domestic violence
  • Self care in birth work – how to keep yourself safe in your work
  • Business guidance – how to get started; business-related pointers

We cover a great deal that is not covered in other programs. We feel this extra amount of information is necessary to better serve our mamas! This is also where Birthkeeping differs from Doula work. HERBAL Birthkeepers hold more holistic knowledge than your average Doula certification program.

What Else Does HERBAL Offer?

We also have a Placenta Encapsulation Specialist certification course as well which is available in the HERBAL program. This would teach the different placenta variations, how to properly examine, handle and prepare a placenta for consumption, and more! The cost of this program is $100. Most other programs do not have this certification option.

A few other added bonuses we have that others might not, are:

  • No additional costs – some require re-certification fees or additional charges, we do not – EVER.
  • Private student forum – We have a forum for our students to reach out and discuss various topics, share stories, ask questions, and fellowship with like minded women. Our students are added to this group upon enrollment and reaching out to one of the founders.
  • Payment plans – we are very flexible. Our main goal is to educate and empower women; revenue is not our purpose. We can make payment plans to help fit your budget, all you have to do is ask!
  • Scholarships – we give away multiple scholarships, to many woman, for many different reasons. Again, we are out to educate and empower. Revenue was never the priority.
  • Hands on workshop trainings across the US – there has been one held so far in our mere 3 months of HERBAL being open. We have 2 more planned for the year of 2019, stay tuned for details! These are optional and not mandatory!
  • Spanish translations- we are in the works of translating all of our course modules into the Spanish language so that we can reach more women, in diverse communities – and we couldn’t be more excited! This opens so many doors!
  • Audio recorded modules – We are also in the works of translating all of our course content into audio videos that can be listened to. We are hoping this opens more doors and makes our course accessible to others who may have disabilities.

We also have far fewer “rules” and “regulations” than your average Doula certification program. We feel women shouldn’t be confined in how they love on and support families. Here are a few examples of how we might differ from another Doula certification program:

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Whichever program you choose to go with, be sure you can agree with their views and morals. There is not a certification program that is perfect for everyone, but there is definitely one out there for anyone who desires to certify! Be sure you pick the right one for YOU!