Thursday, July 22, 2010

How to Interrogate your Birth Professional

For those of you at all interested here are some of the things I asked the midwife during our interview:
  • Tell us about your education, background, and credentials
  • Do you have a back-up? She does, he is a doctor in Brighton who's wife had both their kids at home. So he is supportive of home birth and willing to back her up if needed. We will go to him if I develop any complications before I go into labor. Obviously if there are complications during or after labor we go to the emergency room.
  • Do you work with a partner or apprentice? Our midwife will have an additional midwife to assist and an apprentice. My midwife will be in charge of me, the other one will be in charge of the baby and the apprentice will do whatever they need her to.
  • What prenatal tests do you use?
  • What is the plan if someone else is in labor when I am?
  • Do you carry an oxygen tank to births? FYI the answer to this should be yes.
  • Do you have certification in neonatal resuscitation? As if I need to say it, but this should be a yes too.
  • What happens if transport to the hospital becomes necessary? This should be a complex question. There are many scenarios. If it isn't an emergency and there is time, our midwife will take us to the birthing center at Boulder Health, if it is an emergency we will go to North Suburban which is 5 blocks from our house. There are scenarios where there is more time than others, so she might call an ambulence, or she might drive me there herself. Basically this question lets you know what all this woman can do to ensure that your baby and you will be alright no matter what happens.
  • How long will you stay with us after the baby is born? The whole team will stay for about three hours. They will clean everything up, start the laundry, make us a meal, and tuck the three of us in bed. She said the only sign that they were ever there will be that there will be a kitchen trash bag of trash, a load of laundry in the washing machine, and of course there will be a baby there.
  • How often will you make postpartum visits? She will come on day 1, day 3, day 7, 3 weeks, and 6 weeks. Basically I better make her a key.
  • What will be done with the placenta? PLACENTA WATER! hahaha, had to sneak that one in there for Bret. See if she is paying attention. There is a lot you can do with a placenta. She said it is up to us. We can throw it away, we can plant it in the yard, or she can have it dried and put into capsuls which apparently helps you to recover from birth more quickly. Decisions decisions. I was happy to find out that she not only advocates delayed cord cutting, but she has an even better approach. She said the biggest reason babies are transferred to the NICU is that the cord was cut prematurely. Some doctors will let you wait until the cord stops pulsing, which is about 7 minutes, but studies show that nutrients and blood is still being transferred to the baby even after the cord stops pulsing. She will deliver the placenta, wrap it up and put it in a plastic bag (I am imagining a ziplock) then she will tuck it in with the baby. She said it will stay connected for about an hour. I have to be honest, it kind of grosses me out that my kid will spend an hour with the placenta attached, but I agree with her.
  • How many babies have you delivered? How many were water births? How many have required to be transported to the hospital? I won't go into everything she told me, but her transfer rate is 17%. Most of those were transfers before 36 weeks. The women developed complications and so they moved to her doctor friend. She has had very few emergency transfers. So that makes me feel good.
  • Tell us what will happen during a typical prenatal appointment? First we will all get in a drum circle...just kidding. They are pretty normal, except that they are around 2 hour visits. We will go over everything from diet and exercise to how I am feeling, she'll take urine samples, blood samples for tests if needed, etc.
  • At what point in labor should we call you?
  • Tell us about the birth kit and any other tools/equipment/medications that you will be bringing with you.
  • What problems are you prepared to deal with at home and which ones require hospital transfer?
  • Under what circumstances do you recommend inducing?
  • How do you handle slowly progressing labors?
  • Do you monitor the baby's heart rate during labor?
  • What are the disadvantages of homebirth?
  • Can you accompany us to the hospital if we need to transfer?
  • What prenatal tests do you order?
  • What equipment do we need to provide?
  • Do you check for tears (vaginal, urethral, rectal)? Are you trained to repair them?
  • How do you prevent/treat excessive postpartum bleeding?
  • What are your guidelines for a "normal" vs. "high-risk" pregnancy?
  • What is her recommendation for the use of ultrasound? She advocates them and isn't one of those midwives who thinks they have hidden dangers. She recommends using them and find the 20 week ultrasound very important.
  • How is the filing of the birth certificate handled?
  • What services are not included in your fee?
  • When do you want the full fee paid?
  • Are there some things we should be doing to our house now in preparation for the birth?
  • What things should I avoid during pregnancy? Turns out there isn't much that is off limits as many baby websites will make you believe. The reason pregnant women have an extremely sensitive sense of smell is because it is a safety indicator. If it smells okay to you and you can get it down, then it is probably okay to have it. When I said "I know sushi is off limits" she said that it wasn't. She said with sushi and lunchmeat I should use my decretion. Obviously I should avoid the larger ocean fish that have shown to have higher levels of mercury, but if I am going to a high quality place there is no reason to avoid raw fish. Not that I have plans to go eat sushi now, considering I have a hard time getting anything down that isn't an orange or string cheese, but I am excited at the possibility if I ever feel up for it again.
  • What kinds of exercise are okay and which should I avoid? Swimming and Walking are the best. She is all for me continuing to cycle as long as I don't fall. Turns out skiing is not something I have to avoid either. Even with ski season starting close to the end of my second trimester, she said if I am a good skiier and don't hit trees, then it isn't a problem. Hitting trees is generally something I avoid every ski season, but with changing center of gravity I will be sure to take it easier than normal. I think I will stick with downhill and hang up the telemarking skiis for a season, just to be extra cautious. I might be too tired to ski, but if I am up for it, I have the green light! She has had people skiing in their 36th week and longer. Basically after the last two questions, what I got from her is that I know my body better than anyone else. If I listen to what's going on and take care not to push too hard, I can use my decretion. Oh but derby is still out. I can roller skate though!
  • Should I continue with this OB-GYN for the ultrasounds? Again it is up to me, she can order them, or I can stay with this doctor through 20 weeks.
  • Do you have any issues with me using hypnobirthing techniques? She doesn't. She likes their methods, but recommends we also attend other "nuts and bolts" birthing classes if we would like.
  • Do we need to arrange for a pool? For $35 I can get one with big thick sides and a fish on it. Score!
  • I asked her about filing for short-term disability and if this will be something that has to go through a doctor.
  • I asked her about flying for work. I am okay up to 30 weeks, maybe 34 depending on how things are going, but then I will need to stop flying because of the increased risks for clots, and added pressure from less oxygen, and all that business. Great soon it will be time to tell the boss about this stuff.
Okay I am pretty sure that is most of them. Some of them led into others which I didn't have written down. But we spent over two hours with her asking her questions and getting to know her. Anyhoodles, now you know.


  1. wow, you were way more prepared with questions than I ever was! But congratulations! I noticed that you are in the Denver area, and a friend of mine just finished her doula certification and delivered her little boy at home by herself just a few weeks ago. If you are interested in having a doula, I can get you her information.

  2. Wow - great list. I hope I can use it someday to interview a midwife!

    Also, my girlfriend that is 39 weeks pregnant is doing a home waterbirth and her midwife said the same thing about sushi, lunchmeat, etc. She has eaten good quality sushi the entire pregnancy (her husband used to be a sushi chef and they run a ranch with natural meats - - so they're pretty picky about eating quality everything!)... also, she was snowboarding with me through the end of the season (she was about 22 weeks at that point). Definitely her center of gravity was off and she was more careful on moguls, etc, but she was out there! My neighbor was skiing up until 38 weeks I believe. Craziness!