Hellobee

Some Hellobee readers have been asking about how to find a midwife and what questions to ask a potential midwife. Jenna of the very popular That Wife blog had some incredible posts on her natural birth experience, so I asked her to share her search for a midwife with our readers.

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My hunt for a midwife was long and difficult. From what I understand, when most women are pregnant they talk to their girlfriends and find out who people liked, find out if the provider is covered by their insurance, and begin their prenatal care. I found the search for the right midwife to be much more involved than that.

In my search, I considered two different types of midwives. One is known as a Certified Nurse Midwife (CNM) and the other a Certified Professional Midwife (CPM). I searched around for what I consider to be an unbiased opinion about the difference between the two types, and I really like this PDF provided by the website Safe Birth Ohio. Safe Birth Ohio tells that a person with the credential CNM or CPM has earned a nationally recognized credential. CNMs are required to have a nursing background and practice primarily in hospitals. CPMs practice primarily in out-of-hospital settings.

According to the American College of Nurse Midwives, CNMs are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) (formerly the American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA)), and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the U.S. since the 1920s. To learn more about what it takes to become a CNM, click here.

According to The North American Registry of Midwives, a Certified Professional Midwife (CPM) is a knowledgeable, skilled professional midwife who has been educated through a variety of routes. Candidates eligible to apply for the Certified Professional Midwife (CPM) credential include:

• Graduates of programs accredited by the Midwifery Education Accreditation Council (MEAC);
• Midwives certified by the ACNM Certification Council (ACC), Inc. as CNMs or CMs; and
• Candidates who have completed NARM’s competency-based Portfolio Evaluation Process, the PEP Program.

An excellent PDF about CPMs and the training they receive can be found here.

I believe that comfort plays a huge role in determining who the right care giver is for each person, and I am personally comfortable with both CPM and CNMs. My husband and I had a very large incentive to seek out a Certified Nurse Midwife as our insurance provider at the time only covered 80% of the costs, a difference that would mean thousands of dollars. Our insurance (BCBS), as well as most other insurance companies, offer out-of-network coverage for home/birth-center births done with CNMs, but absolutely nothing for home/birth center births done with CPMs. Based on the Dallas averages we knew would be looking at paying somewhere around $1500 for prenatal care, tests, and birth with a CNM, but that the cost with a CPM would be somewhere between $3500-$4000. The actual cost for us, with ultrasound fees, labs, and vitamin supplements was actually closer to $5000.

Unfortunately CNMs that do out of hospital births are difficult to find and there aren’t very many of them. The home birth CNM who came most highly recommended to me by some women in my church didn’t have any availability by the time I contacted her.

Once I had a baseline understanding of the pregnancy and labor process, I felt ready to start interviewing potential caregivers to find the right fit. I sent out a list of 12 questions to midwives I found through a website (I’m sorry, I can’t remember what it was, although I did later find this fantastic list on the American Texas Midwives page), and then responded back to those who answered my questions in ways that showed our opinions on things were similar.

I consulted with three different midwives in person before making my final choice. Below you will find the list of questions I took with me to my last appointment (with a CNM). Please note that although I referred to other lists found across the internet to make sure I wasn’t missing anything, this list represents my actual concerns, not just questions someone else said I should ask. Do your research and know what terms mean, risks, alternative options, etc.

My questions:

1. How many births have you attended as a primary caregiver?
2. How many births do you attend per month?
3. How long is the average prenatal appointment?
4. Do you let us do whatever we want during labor? (Food, positions, water, privacy for intimate time with my husband, etc.)
5. Do you have guidelines or restrictions about who can give birth at home?
6. Non-emergency transfer rate?
7. If I transfer, how long will you stay with me at the hospital?
8. C-Section Rate?
9. Episiotomy rate?
10. Do you attend breech births?
11. Augmentations used to intitiate or during labor?
12. Do you wait until the cord has stopped pulsating before it gets cut?
13. How much time do you allow for the delivery of the placenta? What methods do you use to encourage delivery of the placenta if there is a delay?
14. How many attendants will be at the birth?
15, How long do you stay after the birth? What cleanup do you do?
16. Belief about postdates?
17. What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?
18. Do you provide nutritional counseling?
19. Opinion on gestational diabetes?
20. Require any tests?
21. Have you ever had to resuscitate a baby?
22. Experience with mothers who have had a breast reduction?
23. Experience with hypnobabies?
24. Does the birthing center provide birth/breastfeeding classes?
25. Postpartum visit after birth?
26. What organizations do you belong to?
27. Do those organizations have any requirements that you must follow in relation to my care?

My husband sent me with a few questions of his own. He couldn’t attend this consultation with me because he had to work.

1. What are the most common complications during home/birth center birth?
2. How do you handle each of these complications? Is there an additional risk of having the birth at home vs. birth center?
3. What drugs/instruments do you bring with you to a home birth? Are there any drugs/instruments that would be available at a birth center birth that won’t be available at a home birth?
4. Which birth complications is a CNM better prepared to handle than a CPM?

After many, many, many conversations with my husband (and several instances of me changing my mind back and forth based on guilt about the cost), we decided on a really wonderful CPM with both the personality and the belief system about birth that would serve our needs. The birth of my son ended up being everything I wanted it to be. I labored in my own space (baking the baby a birthday cake just a few hours before labor ramped up!), gave birth in a birth tub set up in our living room, and only a few minutes after we met our son for the first time we all curled up in the master bedroom for some peace, quiet, and a nap or two.

Image via Kelli Nicole Photography