Choosing a Midwife
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 the person with whom you choose to birth. 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 all primary care practitioners
before you decide to hire one of them. 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. One way to learn if there are any midwives practicing at your local hospitals is to call the labor and delivery wards and ask the nurse managers. They will know if any midwives have hospital privileges at their facilities. 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 cannot simply assume that you will get the kind of birth you are looking for. You must carefully screen midwives by asking direct questions related to the way they practice. What kind of procedures do they use during a usual 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 midwives must follow the rules of the hospital where they practice.
Some hospitals have special rooms on the labor and delivery floor called an Alternative Birth Center. These rooms are generally more relaxed than the regular labor ward. They may offer water birth, with a much greater chance of you 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. Any or all of these may make a significant difference in your pain levels and comfort. The expectation of the practitioner in the Alternative Birth Center 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 freestanding 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. A freestanding birth center is a small, more homelike facility with more autonomy and fewer restrictions than a hospital. Parents like the fact that there is access to more medical equipment, if needed. Facilities and midwives can vary a great deal in practice philosophy. You must tour the facility and see for yourself if it is a place where you will be comfortable giving birth.
When investigating your options, also consider 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 is a great way to find the home birth practitioners in your area. They will also have opinions about how each of them practices. 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 are used to determine if a transfer is necessary. If at any time you decide that you want to change practitioners, it is your legal right to do so.
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. Having a well- qualified practitioner is very important and for many mothers with low risk pregnancies, midwives are an excellent choice.