|Choosing a Midwife
Below are some suggested questions for interviewing prospective midwives, along with Catharine Miller's responses. The first four questions are particularly important.
Q: How many years have you been practicing and how many births have you attended?
A: I have been practicing for twenty years and I have attended approximately 750 births.
Q: How were your birth experiences? Did you have a spontaneous, natural birth? At home, or in the hospital?
A: Yes, I had a natural home birth with my son Eli.
Q: Do you have a midwife to back you up if you are at another birth when I go into labor?
A: Absolutely! Myself and 2 other midwives support each other whenever we need help.
I also provide an opportunity for my clients to meet the other midwives that back me up at a monthly ‘open house’. This is also a wonderful opportunity to meet other home birth couples and form a community of like-minded families.
Q: Have you ever missed a birth because two of your moms have birthed at the same time?
A: No, I have never missed a birth due to two births happening at the same time. This is because I do not take on a heavy birth load. The more clients a midwife takes on each month, the greater her chance of missing your birth!
Q: What is your philosophy about childbirth?
A: Nature cannot be improved upon. Women are designed perfectly to birth their babies, and if left to follow their own instincts, and are uninterrupted by outside interventions, most births will evolve just as nature intended. I believe in following a womans cues in childbirth, and giving as much support as she desires, or as little as she wants.
Q: Why did you become a midwife?
A: The home birth of my son was such a transformational experience, I felt called to safeguard this option for the future, and assist other woman in this rite of passage.
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Q: How did you receive your training?
A: I received my midwifery training through the traditional apprenticeship model, which is hands-on learning with experienced midwives.
Q: Do you have a state license?
A: Yes. I was one of the first pioneergroup of 26 midwives to get licensed in California.
Q: Do you have ay additional certificates of competency from other organizations?
A: Yes, the California Association of Midwives (CAM) and the Midwives Alliance of North America (MANA), which issues the Certified Professional Midwife (CPM), the midwives' national certfication.
Q: What emergency equipment and medicinal do you bring?
A: First Breath has available a variety of herbs, homeopathy, bach flower essences, aromatherapy, and essential oils. I also carry oxygen, resuscitation equipment for baby, and emergency meds for mom immediate postpartum.
Q: What happens if the birth is so fast you miss the birth?
A: I have missed only 2 births due to precipitous labor. Both times the mom had a very long first birth, and didnt even realize she was in labor the 2nd time until the very end. So even though I raced to their home as soon as I was called, those babies did not wait for me. I talked the Dad through catching the baby on my cell phone, arrived soon after the baby was born and helped deliver the placenta.
Q: What situations, should they occur, would be too high risk for a home birth?
A: Conditions such as insulin-dependent diabetes, preclampsia, and other chronic diseases that require regular use of certain prescription drugs.
Q: What about prenatal testing and lab work?
A: All labs and cultures are available through First Breath. Sonograghy and amniocentesis are provided by excellent referrals to various centers in San Diego County.
Q: Do you do a home visit? How many?
A: I come to your home before and after the birth. The prenatal home visit allows my birth team and I to get familiar with your home: how to get there, where you are keeping your birth supplies, discuss possible areas to birth, use of the labor tub, etc. Postpartum home visits are to help with breastfeeding, check Moms bleeding, check the baby and make sure everyone is adjusting well.
Q: Are you trained in CPR and Neonatal Resuscitation?
A: Yes. First Breaths birth team are all trained in adult CPR and Advanced Neonatal Resuscitation (the course the respiratory therapists take at Childrens Hospital)
Q: How many babies do you attend per month?
A: I attend between an average of one to three babies a month.
Q: How long do you spend with each woman at a prenatal visit? What is done?
A: I spend between an average of 45 minutes to one hour with each woman, with as much extra time as needed depending on the situation. Vitals are checked, I feel the baby for position (and fun), measure the babys growth, listen to the babys heartbeat. The rest of the time is to address any other issues, needs, or problems that may come up, and just to get to know each other, and develop a bond, and trusting relationship.
Q: What is your transfer rate to the hospital? For what reasons? What were the outcomes?
A: Transfer rate is to hospital is between 5 and 10%, most often for lack of progress, or meconium in the amniotic fluid.
Q: Do you do episiotomies? If so, why and when? What is you rate of doing them?
A: I will do episiotomies only if absolutely necessary for the health of the baby. This may occur if the baby is in distress due to being stuck in the birth canal and the other means of releasing her/him have failed. I have only had to perform under a dozen episiotomies in almost 20 years.
Q: Will you bring anyone with you to my birth? What are their qualifications?
A: I will have one fully-trained birth assistant with me, either another midwife or midwife in training. Not only are they trained as assistants in home birth midwifery they are also certified in neonatal resuscitation and CPR.
Q: Which means of treatment if necessary, do you prefer?
A: First Breath offers a variety of natural therapies including homeopathy, herbs, essential oils, and aromatherapy. Also available are relaxation techniques, breath work, exercise/movement/yoga, and prenatal massage and acupuncture. We offer excellent referrals all over the county for chiropractic, cranial sacral work and much more.
Q: Do you attend water births? Do you have labor / birth tubs available? How do you see water used in birth and labor?
A: Yes. Two labor tubs are available. Floating in warm water is very comforting and relaxing, provides pain relief, and promotes smoother labors.
Q: How is medical back-up handled? What about pediatric back-up?
A: Referrals for pediatricians are given, and medical back up is determined on an individual basis.
Q: Do you participate in peer review -- having other midwives review your services? Do you participate in continuing education?
A: I have participated in regular peer review and continuing education through out my midwifery career,
Q: What role do you see yourself playing in my (our) birth? What role do you see my partner playing?
A: Its your birth and I follow your cues. The role I play is determined by what you desire. You and your partner determine what roles you play.
Q: What happens if either the baby or myself are transferred to the hospital?
A: I help facilitate a smooth transfer from home and dialogue with the hospital staff to create an atmosphere of cooperation. I provide continuity of care by staying with you throughout the birth and the post partum period until both you and the baby are comfortable.