Monday, March 15, 2010

Home Birth: Interviewing a Midwife

This should be obvious to anyone in this process, but I didn't think about it until the last minute: Consider carefully what it is that you hope to accomplish as you interview a midwife. About five minutes before she arrived, I realized I had given *no* thought to deliberate organization of my thoughts and questions. This was a rather unfortunate mistake, redeemed only by the presence of my very level-headed husband, who asked all the right questions. I did come up with a few myself, mostly after he got the ball rolling.

Insurance and the Expense of Home Birth
We had read that home birth tends to cost more out of pocket than hospital birth, primarily because a great many insurance companies don't cover midwife services or home birth expenses. There's also the reality that, even if your insurance company *does* cover midwife services, your midwife may not accept your insurance. Insurance aside, we had read that home birth in the United States is *crazy* expensive, and I was gearing up to be disappointed by the reality that we simply couldn't afford to give birth at home.

My fears proved unfounded. There may indeed be places in the U.S. where home birth will cost you your first-born (pardon the expression), but at least in Kentucky, or perhaps just with the midwife we interviewed today, this is not the case. We, at least, will end up paying less out of pocket for a home birth than we would to give birth in a hospital. Unfortunately, we will need to maintain a relationship with our current OB in case I go into labor early again and need to deliver at the hospital (I delivered 12 weeks early with my first pregnancy), and this will mean a bit more expense over all. But if the midwife we choose has a fee as reasonable as the midwife that we interviewed today, this shouldn't be too much of a problem.

Husband as Primary Birthing Partner
My strongest desire regarding labor and delivery is that my husband be allowed to fill as active a roll in the process as we both desire and he can cope with. My husband is my best friend, hands down, and no one knows me as well as he does. Granted, there will be plenty of moments in labor and delivery when a trained professional will know better than my husband what my body needs, but it's not her face I'll be looking for in my moments of distress, and if it's my husband I want (and I foresee that it will be), everyone in the room had darn well be ready to get out of the way and let him through.

Unnecessary Interventions
I want very much to avoid unnecessary interventions--epidural, forceps, suction. This desire is near the top of my list of reasons for wanting a home birth. Specifically, I want to avoid an episiotomy. I'd rather tear naturally. I'd rather not tear at all. I know there are no guarantees, but I've read about (and observed) a great many techniques for avoiding tearing, and I wanted to know that the midwife we choose is versed in these techniques and ready to employ them.

Finding a Relational Fit
The one issue I *had* thought about was how my husband and I would mesh with each of the midwives we interview. What I have been told is that, with a home birth, it is absolutely essential that the midwife and laboring mother have a positive, trusting relationship--not simply a luke warm, I-guess-I-can-live-with-this-person kind of relationship. I assume that it's helpful if the midwife is also a good relational fit with my husband. In this respect, I feel I was very well prepared to interview. It doesn't take long to figure out if I can manage to mesh with someone. We got answers to important questions (most of which were brought up by my husband, God bless him), but I also talked with her about my first experience with labor and delivery, and was able to gauge her responses to my anxieties and desires for my next experience. I felt heard and affirmed, and I think this is one of the most important things (for me, anyway) that came out of the interview.


These were some of our questions and anxieties--the information we considered key in our process of choosing someone to attend us in the birth of our baby. Your questions and concerns may differ from ours, but thinking through them ahead of time--even writing them down--will help you get the most out of your interviewing process.


Laura-Maternity Bliss said...

I'm planning a home birth too :), I'm from The UK. I had a hospital birth with my first daughter, which ended with a ventouse delivery and epsiotomy. My little one was progressing slowly and luckily the OB that was called in to assist the midwives allowed me to push for 2.5 hours, but in the end she did have to perform one.

For my homebirth I am going to be getting an birth pool. I don't know how expensive they are for you guys over there, but here we can get a La Bassine for about $150 (£115-The $ conversion was a wild guess). If you are comfortable with giving birth in water and your midwife is willing to assist you, the chances of perineal tearing are dramatically reduced!

Good luck with your birth :).

Maria said...

The midwife we interviewed yesterday did mention a birthing pool. I wasn't clear on whether she actually owned one that she uses in births, or if she was suggesting that I purchase one. Unfortunately I had had very little sleep the night before while sitting up with a laboring friend in the hospital, and I was wasn't thinking very straight. Quite a few questions which now seem obvious to me were not asked.

Thanks so much for your comments. All the best to you in your next delivery. :-)

Michelle said...

I read this post while searching for midwives in Kentucky... I was beginning to feel discouraged, but I see that you actually interviewed with one! They do exist in Kentucky! hah!

Anyway, I was wondering the general area you are in Kentucky... I'm in Louisville. Also, if you are anywhere near Louisville if you could pass on to me any kind of contact information for the midwife you interviewed or even know exist. I seem to only be finding CNMs that only deliver in hospitals. :/

Maria said...

Michelle--that is exactly why I shared these posts. If you would, please contact me at maria[at]beautyofashes[dot]com. I would be happy to talk with you about my experience interviewing. I can also steer you away from some folks you might want to avoid.


George MacDonald

"Home is ever so far away in the palm of your hand, and how to get there it is of no use to tell you. But you will get there; you must get there; you have to get there. Everybody who is not at home, has to go home."

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