Every Question You Need to Ask Your Homebirth Midwife

Every Question You Need to Ask Your Homebirth Midwife

45+ GOOD QUESTIONS — for you home birth midwife

This is a list of every question we could think to ask your homebirth midwife. It’s another freaking huge list of questions, guys. You won’t need all of them at first. In fact, most of them you will most likely use as a reference for your choices and options and an understanding of how your midwife practices along the way. We *starred the ones that might be most useful during an interview, but feel free to use this guide as a way to jog your brain to ask the questions that are most important to you.

We suggest you ask open-ended, rather than yes/no questions, wherever possible. “How often do you see…?” “What do families who birth with you usually choose…?” “How will you support us during…?” “What are your policies regarding XXX procedure or situation…?” Home- and birth center-based care tends to be far more flexible and personalized than hospital-based so these may give you a better understanding of where your midwife’s experience lies.

1. *How long have you been in practice? How many births have you attended? How many of those births were you the primary midwife?

2. *What is your training and certification (CNM, CPM, PM or Lay-midwife)? What professional associations are you a member of? If you are a CNM how long were you a nurse before becoming a midwife? Did you do other birth or pregnancy work before becoming a midwife? What other services do you provide?

3. *Are you licensed to deliver in my state? If no, why not? Does your status affect your transfer protocol? (Midwives have different reasons for choosing to be licensed or not, make sure their priorities align with yours)

4. *What is the cost of care and what is included? How often are clients reimbursed the full fee by their insurance? Do you work with a billing agency? Do you offer payment plans or discounts for early payment in full?

5. *How do I contact you for questions and concerns during pregnancy? How do I contact you during labor?

6. *How many clients do you take per month on average? Do you have a cap on how many you will take? When do you consider yourself “on-call” for me? What do you do if two families are in labor at the same time?

7. *Do you work with other midwives? Who is your back-up? Who are your assistants and what is their training? Can I provide my own birth assistant? Do you work with a student? How many people can I expect to be on my birth team?

8. *Are you and your team neonatal resuscitation certified? Have you ever had to resuscitate a baby? Are you and your team CPR certified? Have you ever had to resuscitate a birthing person? How recently have you recertified?

9. *Do you recommend doulas? Do you recommend childbirth education classes? Do you work with birth photographers?

10. How often do you recommend acupuncturists, chiropractors and massage therapists?

11. Do you attend VBAC/ VBA2C/ VBA3C / Multiples/ Breech births? How many have you attended? Have you completed extra trainings for those scenarios?

12. *Do you offer water birth? How often do your clients deliver in the water? Does a tub rental come as part of my package? Do you have a recommendation for where to rent or buy your favorite pool? Are you comfortable delivering in my bathtub?

13. *What are your prenatal visits like? How long are they? Where do they take place? How often are they scheduled? May I invite friends and family members to attend?

14. What are your policies or recommendations regarding urine dips, basic blood tests and labs, genetic testing, routine ultrasounds and growth scans, gestational diabetes testing, group beta strep testing, iron levels testing? Are there any you don’t recommend declining? Can you draw blood or will we need to use an outside lab?

15. What is your philosophy on weight gain, nutrition, prenatal supplements, and exercise? We will receive counseling or education on those topics?

16. *Do you provide our birth kit? If not, do you have a preferred supplier? What else will we need to provide?

17. Are there any induction methods that you are comfortable using (stretch and sweep, foley bulb, castor oil, black and blue cohosh, breaking waters) and when might you suggest them? How often do you transfer care for postdates induction?

18. *What is the most common reason that your clients transfer to the hospital? What is your transfer rate?

19. *What is your relationship with area hospitals? Have you been to my nearest hospital before? Are there any local hospitals that you are not comfortable transferring to, and why? Will you remain present if we transfer, and if no, why not? How would my medical records be transferred (digital, on paper, faxed, hand delivered)? Do you have an OB or practice that you refer to for transfers when complications arise during pregnancy?

20. *What do you consider “high-risk”? Under what conditions would you absolutely transfer care? What conditions would make you consider transferring care during pregnancy? During labor? After birth?

21. To what gestation are you comfortable waiting? What is your standard protocol for clients going over 40 weeks?

22. When can I expect you to join me in labor? Will you ever leave a labor? How will you provide support during early labor?

23. How often do you monitor the baby during labor? Is your doppler waterproof? What do you consider a non-reassuring heart tone? How often do you take the birthing person’s vitals?

24. How often do you perform vaginal exams during pregnancy? During labor? What would you say if I refused a check?

25. What tools do you use to help families through the intensity of labor? What would you say if I asked you for pain relief or to be transferred to the hospital for pain relief?

26. Do you carry and administer any herbs and in what situations? Do you carry and administer any medications (Pitocin Cytotec, Methergine) and in what situations? Do you carry and administer IVs and in what situations? What other tools do you bring to births (birth stool, rebozo)? How do you handle a hemorrhage?

27. Do you have any additional training in herbs, homeopathics, essential oils or acupressure for labor and birth?

28. How do you handle a very long labor? How do you handle a precipitous labor?

29. How do you coach families through pushing? What do you do to help minimize tearing? Do you ever let the birthing person or another member of the birth team catch the baby?

30. How long do you usually leave the cord intact? How long are you comfortable waiting for a placenta?

31. What is your philosophy on placenta encapsulation?

32. *Are you comfortable suturing? Under what conditions would you feel a repair requires a hospital transfer?

33. What would it look like to transfer a baby to the hospital if needed after birth? What would it look like to transfer a birthing person to the hospital after birth?

34.  Have you ever lost a baby or birthing person and what were the circumstances?

35. *How long do you stay after birth? Will you help my family clean up/break down the birth pool?

36. *How many postpartum visits can I expect? Will all of those take place in my home? What changes if I transfer and deliver in a hospital? Does your visit include care for the baby? Will you be available for well-woman visits?

37. What other postpartum resources do you offer your clients?

38. Can you administer Vitamin K and Erythromycin if we want? Can you administer the PKU test or will we need to see our pediatrician? Will you administer Rhogam if needed? Can you provide us with a hearing screening, and if not, where do you recommend clients go?

39. Is there anything you will need from us to file the birth certificate?

40. What kind of breastfeeding support do you offer? Do you have any extra breastfeeding training or certifications? Do you have local IBCLCs that you recommend?

41. *How would you describe your style of midwifery?

42. *What inspired you to become a midwife?

43. How do your personal birth experiences inform your midwifery work? (Great midwives don’t need to have had children)

44. *What is your philosophy on continuing education?

45. *What are your expectations for your clients?

Questions to ask yourself:

  • How does a visit with this midwife make you feel?
  • Is the midwife able to fully address any concerns you have? How about the concerns of your partner?
  • Do you feel comfortable in their presence? With them in your home?

I also like this list of questions to ask yourself to discern if homebirth is the right choice for your family.

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If you think we missed anything please drop us a line and let us know what to add!

If you aren’t planning a homebirth, or you are doing co-care with an OB or just want to be prepared in case of a hospital transfer you might enjoy this post on Every Question You Need to Ask on Your Hospital Tour

Photo: Bergen Howlett Photography

Every Question You Need to Ask on your Hospital Tour

Every Question You Need to Ask on your Hospital Tour

35+ GOOD QUESTIONS — for a hospital or birth center tour

This is a list of every question we could think to ask during a birth facilities tour. It’s a freaking lot of questions, guys. You won’t need all of them. In fact, most of them will be answered by your tour guide along the way. And some answers won’t affect your unique birth vision, anyway. So, feel free to use this guide as a way to jog your brain to ask the questions that are most important to you.

We suggest you to ask open-ended, rather than yes/no questions, wherever possible. “How often do you see…?” “What do families who birth here usually choose…?” “How will you support us during…?” “What are the policies regarding XXX procedure or situation…?”

Many of these questions can also be asked of your doctor or midwife during prenatal visits. Sometimes, what a care provider is comfortable with and what hospital policy allows don’t match. It never hurts to double check.

 

  1. How many births take place here on an average day? How many of those are caesarean births? How many are VBACs? How many are unmedicated? How many are induced? What induction methods are used most often?

 

  1. How often do you see doulas or birth photographers attending births? How do you feel about their presence? 

 

  1. How many people can be in the delivery room at once? Does that number change during Flu Season? Is there a place for my partner or birth team to rest? Are my older children welcome during labor and birth? Are my older children welcome? Do you have policies in place for unwanted visitors? (Make sure to assess the rooms. Do you feel comfortable there?)

 

  1. Are there any situations that may take me away from my birth partner and/or doula? (epidural administration, cesarean birth prep, triage, etc.)

 

  1. What are the facility’s policies around birth photography and videography? What are the facility’s policies around doulas? Is there any paperwork that either will need to sign?

 

  1. How often are students or residents present during labor? Can I decline their presence if I change my mind about their attendance? Who should I contact if we need to explore a staff change?

 

  1. How many nurses/midwives/OBs are on during a shift? How long are shifts and at what times do they end?

 

  1. Will I be in the same room for birth and recovery? Will I ever share a room with another family? Are TVs and internet access available?

 

  1. What does triage look like — is there a special triage area or a will a private labor room be used? Will my partner and doula be allowed to stay with me? Under what circumstances would I NOT be admitted (i.e, would I be encouraged to leave at under 4 or 6 cm dilation, or a certain contraction pattern like 4-1-1)? How often is there a significant wait for an open labor room? How often are families turned away because there are no free labor rooms?

 

  1. Can I decline an IV? Can I opt for a Hep-lock instead of an IV? Can fluids be administered intermittently? Can the IV be disconnected after a course of fluids, antibiotics or Pitocin are finished, or turned off? Will I still be able to use water therapy with an IV placed?

 

  1. What is the typical protocol regarding Group B Strep? Is a rapid test available? If I test positive, how often will antibiotics be administered? Will a positive test affect any other part of my labor care or progress?

 

  1. Am I encouraged to eat and drink during labor? Under what circumstances would I not be permitted to eat (with an epidural)?

 

  1. What is the typical protocol for fetal monitoring and how often will you do it? How many wireless telemetry, wireless patch systems (like the Monica Novii) or handheld doppler systems are available and are they waterproof? How often do you use internal monitoring and under what circumstances?

 

  1. How often are vaginal checks usually performed? When is a vaginal check not recommended (i.e.ruptured membranes)? What would you say if I declined a check?

 

  1. Will a shower be available to me, and if so where is it located? How many birth tubs are available and where are they located? How often and how long may I use the tub? Will I have to leave for fetal monitoring? How long does it take to set up and/or clean the tub between uses? Will I need to call dibs early? What are the circumstances where I wouldn’t be able to labor in the tub (ruptured membranes, fast labor, none available)? Am I able to birth in the tub?

 

  1. What options, aside from the epidural, do you offer for pain management (narcotics, nitrous oxide, sterile water injections)? What options do families choose the most often? Is one method suggested over the others? Are there wait times to be considered? What are some of the most common side effects you see for mother or baby (Will baby need special observation if narcotics are administered less than 4 hours before birth?)

 

  1. What is the average wait time for an epidural? Does that change during the night, weekends or holidays? Can my epidural be turned up or down at any point? Does that require my anesthesiologist or OB, or can the nurses do so? What are the most common side effects you see for mother or baby?

 

  1. What birthing tools are available (birth ball, peanut ball, squat bar, mirror, birthing stool, labor sling)? Which tools are requested most often? How often do you see families bringing their own tools (such as a TENS unit, essential oils, rebozos, birth balls, heating pads)?

 

  1. Will I be encouraged to move freely throughout labor (walking, squatting, lunging, using birth balls/ stools)? Will I need to stay in my room, on the L&D floor, or may I use the facility grounds?

 

  1. How will you support me during pushing? Will I be encouraged to “labor down” during the latent part of the pushing stage of labor? How long do first-time families usually push and is there a standard time-limit for pushing? How often do care providers give perineal support or counter pressure with warm compresses during crowning? What is typically used for lubricant (baby soap, Astrogilde/KY)? May I provide the lubricant of my choice? How often are episiotomies performed? How often do you see families experience vaginal tearing significant enough to require repair?

 

  1. In what positions do you see families giving birth most often (on their back, on their side, on all fours, kneeling, squatting, upright, on a birth stool, in the tub)? In which positions do you see the least instance of tearing? The most tearing? Will I be able to give birth anywhere but in the bed?

 

  1. How long do you usually leave the cord intact after birth? How often do families choose to wait longer than 4 or 5 minutes? What are the policies for the third stage of labor and what techniques are usually used to encourage the placenta to detach? Is immediate postpartum Pitocin administration standard policy? After how long is a placenta considered “retained”?

 

  1. Will my baby be placed skin-to-skin immediately after birth? How soon will we be encouraged to begin breastfeeding? 

 

  1. In the event we experience a cesarean birth, how many support people can be present? Are doulas/photographers welcome in the OR? Can they be on standby to swap out if my support person leaves with the baby? Is skin-to-skin and breastfeeding encouraged in the OR? May I have at least one arm free to hold my baby? What does a “gentle” or “family-centered” cesarean birth look like here?

 

  1. What is the typical protocol for baby care immediately after birth? If my baby needs to be checked, weighed or placed on a warmer will he leave my room? How long are you comfortable waiting for examinations after birth? How long are you comfortable delaying baby’s first bath? How often do families decline HepB, vitamin K or Erythromycin administration?

 

  1. Is there a release form to sign should I choose to take my placenta home with me? If any tests need to be performed can just a small piece be sent to pathology instead of the entire placenta?

 

  1. How will I be supported in the first days of breastfeeding? Who will be there to guide me shortly after my baby is born? Is lactation support offered 7 days a week? Under what circumstances will formula or pacifiers be given? Will I be asked first? What kind of follow-up resources are available for breastfeeding concerns after discharge?

 

  1. Will my baby be encouraged to stay in my room? On average how much time will a baby spend in the nursery? Are there any tests or procedures that would be required to be done anywhere other than my room (hearing screenings, circumcision)? Are there any options for baby care if I desire?

 

  1. Is there a NICU at this facility? What level is it and what’s the youngest gestation accepted? Where would we be transferred should we need a higher level NICU? What are the typical protocols for NICU transfers? Are there any circumstances where I might need to be transferred to another facility? What, if any, lodging is available to us if our baby has a significant NICU stay?

 

  1. Are there specific visiting hours? Are there limits to how many people can visit at once? Do you allow young siblings to visit? Does a birth during Flu Season change anything? 

 

  1. What security measures are in place? Will a device be placed so that my baby is unable to leave the floor? Do visitors need to be buzzed in and are there security guards present?

 

  1. What kind of meal resources are available to me and my partner? What are the cafeteria hours?

 

  1. What time does discharge typically occur? How long do families usually stay after an uncomplicated vaginal delivery or cesarean delivery?

 

  1. What follow-up resources do you offer for new parents? How and when can I reach out for questions, concerns or emotional support?

 

  1. What can we do to help make this a good experience for everyone involved?

 

* BONUS #1: Good Questions when planning a VBAC: http://vbacfacts.com/2009/06/06/interviewing-care-providers-questions-to-ask/

 

* BONUS #2: Add “does any of this change with multiples?” to any question if you are expecting more than one baby.

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If you are planning an out-of-hospital or homebirth you may find this list more helpful

If we missed anything please drop us a line and let us know what to add!

Acupuncture in the Childbearing Year with Evan Howlett

Acupuncture in the Childbearing Year with Evan Howlett

Written by Evan Howlett of Howlett Acupuncture:

Traditional Chinese medical theory, which includes acupuncture, is thousands of years old and an amazing lens with which to diagnose and treat a spectrum of issues during the childbearing year from easing painful menstrual cycles to helping breech babies turn themselves to facilitating the onset of labor to recovery postpartum. Supporting the hopes and soothing the physical and emotional stresses that come with welcoming a new person into this world is definitely the most exciting and joyful part of my practice.

Acupuncture is slowly becoming more well known as a powerful tool for fertility support and during the childbearing year. From my extensive studies and conversations with fertility, pregnancy and postpartum care specialists in my field, I put together a brief outline to help families understand when, where and how acupuncture is most effective, what to expect during treatment, and an “ideal” time frame for treatment during a healthy pregnancy.

What Acupuncture Can Treat:

FERTILITY

  • maternal and paternal
  • IVF support
  • aiding conception and implantation

PREGNANCY

  • nausea/hyperemesis
  • heart burn
  • sciatica and back pain
  • other pain
  • breast discomfort
  • anxiety
  • insomnia
  • leg cramps
  • constipation and hemorrhoids
  • hypertension and preeclampsia support
  • edema
  • premature labor
  • preparing for labor
  • breech presentation
  • beginning labor

POSTPARTUM

  • scar healing (tears and Cesarean incisions)
  • diastasis recti support
  • postpartum mood adjustment
  • breastfeeding support and mastitis
  • urinary problems
  • future reproductive health
  • pain

Through the childbearing year acupuncture is a wonderful tool
for supporting mental and emotional health, too.

What an Acupuncture Appointment Involves

At your first appointment:

  • identifying and diagnosing issues in a visit of about 1.5-2 hours
  • conversation and history taking
  • pulse taking
  • a look at your tongue
  • a closer look at any areas with pain which may include your abdomen, arms or legs
  • assessment of any joint pain or pain with moving

Treatment in subsequent visits of 45-60 minutes-may include:

  • acupuncture with needles
  • cupping
  • moxibustion
  • tuia (like acupressure or massage)
  • traditional Chinese herbs
  • conversation about diet and lifestyle changes to support whole health

Schedule for Treatment in the Childbearing Year

Below are turning points in pregnancy and times when your acupuncturist can support a healthy mother and child and check on you and your little one to see if any issues need more attention.

Treatment starting three months or more prior to planned pregnancy will set the stage for a smooth and healthy pregnancy. Especially for those who have had a history of miscarriage or trouble conceiving, this is the time to build qi and blood and save up jing (your fundamental essence). Acupuncture is shown to help those with irregular or painful cycles for up to a year after a cycle of treatment.

DURING PREGNANCY

  • At 4 weeks, if you know or suspect you are pregnant to support the first large jing transfer
  • At 6 weeks to support transfer of jing
  • At 8 weeks to support the third initial transfer of jing
  • Between 12 and 13 weeks to check up and support mom where needed
  • Between 26 and 28 weeks
  • At 36 weeks to begin preparing for labor, treatment may be more or less frequent in the last few weeks

BREECH PRESENTATION – Ideally treated at 34-36 weeks. Bring your partner so they can be shown how to do moxibustion at home. Treatment should be for three consecutive days and then continued at home with moxa for the next 7 days or until the baby turns.

FACILITATING THE START OF LABOR – After consulting with midwife or primary care provider, acupuncture can help to start the labor process, usually this treatment is done around 40 weeks and may be done for a few days in a row. Acupuncture is shown to facilitate the start of labor within 3-60 hours.

DURING LABOR – while few acupuncturists will attend labor, acupuncture and acupressure can help labor be smoother, less traumatic, and give the birthing person more stamina. Some of these points are easy to access, can be stimulated with fingers or a pencil and can be used during labor if recommended by your acupuncturist.

ST36 for endurance and strength – on the outside of the knee, about three or four fingers down
LI4 to smooth out contractions – on the top of the foot
GB21 to help move baby down – in the middle of the trapezius muscle
KI3 for power especially if afraid – on the back of the ankle
PC6 for nausea – three or four fingers up the arm from the wrist

POSTPARTUM HEALTH – Pregnancy and birth draw on fundamental resources and it is vitally important to health the guard and build qi and blood postpartum to promote a health, physical, mental, and spiritual. while our busy culture makes carving out time for new moms difficult, acupuncture, and especially moxibustion, are amazing tools to build qi and blood and smooth emotions postpartum.

  • See your acupuncturist for mother roasting around day 5-7 (7-12 for cesarean birth) or earlier if they will do a home or hospital visit
  • Then once a week for next three months is ideal and takes full advantage of this time to set the stage for vitality and reproductive health through the next life stage.

POSTPARTUM REPRODUCTIVE HEALTH – Because pregnancy and birth open the channels, especially the heart-uterine channel, the postpartum period is an important time to protect and set the stage for reproductive health going forward. A skilled practitioner can help express toxins that have been held deep, clearing the body of pathogens that could bring future fertility difficulties and prepare for a smooth menopause.

You can find Evan Howlett and more information about acupuncture in the childbearing year at HowlettAcupuncture.com