Choosing a Midwife

By Jo Anne Lindberg

Midwives have a wide variety of practice styles. Choosing the right one for you may present some unique challenges. Where you birth goes hand in hand with who you choose to birth with. The first decision is whether you want a home, birth center or hospital birth. The trend toward midwife assisted birth is growing in America. Certified nurse midwives or certified midwives in some states have hospital privileges. They practice in hospitals or birth centers and can do home births. Non nurse or direct entry midwives only do home births. I recommend that you interview any primary care practitioner before you decide to hire them. I always suggest that you make a list of questions to ask and set up an initial visit. Most will give you a one hour free consultation.

Most people elect to have hospital births so we will discuss this option first. Looking in the phone book or asking your insurance company if they list midwives is a good place to start. You can also ask your family or friends if they know of or have used a midwife. If this yields no results it may be because they are practicing with physicians which makes them hard to find. One way to learn if there are any midwives practicing at your local hospital is to call the labor and delivery ward and ask the nurse manager. They will know if any midwives have hospital privileges at that facility. They may also be a good source of information regarding practice styles. You may have to travel a distance to find the person you want to work with. Many first time parents make the mistake of thinking they need to be ten minutes from the hospital.

While hospital based midwives are generally nonintervention oriented you can not assume that you will get the kind of birth you are looking for. You must carefully screen them by asking direct questions related to the way they practice. What kind of procedures do they use during their average birth? Some midwives have a very intervention oriented philosophy. If your goal is to have a natural childbirth or avoid unnecessary interventions you need to fully inform yourself about what questions to ask. Remember that they must follow the rules of the hospital they practice in. How much they can deviate depends on their political standing in the institution. It also depends on how much they are willing to challenge the system. How the rules are enforced has a great deal to do with the nursing staff too.

Some hospitals have special rooms on the labor and delivery floor that have unique rules or protocols to follow. They are called an Alternative Birth Center. These are more relaxed than the regular labor ward. They may offer waterbirth with a much greater chance of actually getting in the tub. They can do intermittent fetal monitoring which allows you greater freedom of movement. They may also allow you to eat and drink lightly. You may not be required to have an IV. All of these things are important factors in allowing your body to do what it needs to do. They also make a significant difference in your pain levels and comfort. The expectation of the practitioner is that you will be having a natural birth. The nurses also receive special instruction. They will use many non medical forms of pain relief.

Out of hospital births include free standing birth centers and home births. Generally speaking a freestanding birth center will have even more relaxed rules or protocols than an in hospital Alternative Birth Center. Not all states have this option. It is a small more home like facility with more autonomy and fewer restrictions. Parents like the fact that they have access to more medical equipment if needed. Both facilities and midwives can vary a great deal in practice philosophy. You must tour the facility and see how practitioners are allowed to practice.

When investigating the option of a home birth. Both certified nurse midwives and non nurse midwives provide assistance at home. Checking with your local birth network, at the local health food stores, with La Leche League leaders, childbirth educators or doulas are great ways to find the home birth practitioners in your area. They will also have opinions about how each of them practices. If you live in a state where home birth is illegal or the laws are ambiguous there may still be some practitioners practicing underground. You must decide what the differences are between individual midwives and this may have little to do with their training. One major issue is backup in the case of a transfer to the hospital. It is also good to find out what guidelines they will use to determine if a transfer if necessary. If at any time you decide that you want to change practitioners it is your legal right to do so. This is more easily done up to thirty-two weeks.

Choosing a midwife that you are comfortable with is a learning process. In order to make informed decisions you must take the time to educate yourself no matter where or with whom you choose to give birth. Having a well qualified practitioner is very important and for most mothers, with low risk pregnancies, midwives are the best choice. Midwives also provide routine gyne care.

The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life processes. The Midwives Model of Care includes:

• monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle.

• providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support.

• minimizing technological interventions.

• identifying and referring women to obstetrical care when appropriate.

This woman-centered model of care has been proven to reduce the incidence of birth injury, trauma and cesarean section. This model was developed by The Midwifery Task Force, May 1996.

Jo Anne Lindberg, president and founder of BirthLink since 1996, the Chicagoland Birthing Network, dedicated to non-intervention oriented birth, breastfeeding and bonding, is also a birth consultant, speaker, writer and educator. www.birthlink.com