Interview Questions

•  Why are you a midwife?
•  What is your training? Are you certified? If yes, with whom and why? If no, why not?
•  Are you licensed in the state of _____?
•  What is your scope of practice?
•  Are there any circumstances (physical, emotional, and/or spiritual) would you not take a woman as a patient?
•  When would you risk out a patient?
•  What is your style of practice (laid back, hands on, managing)?
•  How much time will be spent with me during each appointment? Do you come to my home or do I come to your office?
•  At what intervals will you see me during pregnancy?
•  What can I expect at a prenatal visit?
•  What routine tests are utilized during pregnancy? What if I decline these tests?
•  What herbs or supplements do you like your patients taking during pregnancy?
• At what point in labor do you normally arrive?
• What positions are you comfortable catching in? Birth stool? Hand/Knees? Squatting? Standing? Water?
• What does your cord clamping protocol look like?
•  What do you do in the event a complication arises during labor or birth?
• When would you transfer a patient?
• What percentage of your patients do you transfer to the hospital? Cesarean rate?
•  How are post-dates (post-42 weeks) handled in your practice?
•  Do you ever encourage induction by pharmaceutical, herbal, AROM or other natural means? If yes, please describe.
• What does postpartum care look like for me and my baby?
• Do you have a midwifery student or an assistant that attends births with you? If so, what is her role?
•  Who would attend me if you are ill, had an emergency or are at another birth?
•  Briefly please describe the types of births you are most and least experienced with.
• What if I hire a doula? Are there restrictions on the doula I may hire? If yes, why? What is your perception of the role of a doula at a home birth?
• Do you have a back-up physician?
• What do your fees cover?
• Do you take any insurances?
• Should I take childbirth education classes? Do you recommend any? What do you cover?

Points to ponder afterward:

• Did you feel immediately comfortable and heard at the interview?
• Was MW willing to answer questions in detail without being annoyed?
• Are you comfortable with her scope of practice?
• Are her expectations of you reasonable?
• Are your expectations of her reasonable?
• Are you able to take full responsibility for your decisions with this midwife?

All Rights Reserved Desirre Andrews Preparing For Birth 2011

Many times over I have heard something similar to “If only my insurance would cover the childbirth class, doula, that provider or birth location. Then I could have the birth I really want for me and my baby.” That statement sadly says to me that women are settling for a provider, birth location, type of birth even that would not otherwise be chosen.  Even so far as having a repeat cesarean because the insurance covered location or provider does not “allow” VBAC.

So practically how is someone going to get the desired provider, location or birth? First think of appealing to the insurance company to add a specific location (even home) or provider (even a  home birth provider) to the plan. This may or may not come to fruition, but unless the process is undertaken it isn’t even a possibility. Second, think outside the insurance box.  Be creative. I am a believer that almost 100% of the time there is a way. It may not be easy, simple, or lack stress but likely possible.

Here are some of my ideas for paying for the birth location, care provider, education, or doula support really desired.

Ask for family, friends, co-workers to donate to fund(s) in lieu of routine shower gifts (you will likely not use most of that “stuff” anyway no matter how much you think you will).

Trimming Down = Money Savings

• Satellite/Cable tv – Lower or cancel service.
• Cell phone – lower minutes, negotiate new fee structure, change plans.
• Household utilities – Lower thermostat, take short showers, heat or cold proof home.
• House phone – Get rid of all extras on phone that you don’t need or go VoIP. Even set-up answering machine.
• Food – Grocery shop sales only (no impulse buying), use coupons, eat at home, brown bag to work, no more fancy coffee drinks.
• Entertainment – Get Netflix instead of going out to the movies, visit with friends or family in their homes or yours.
• Shopping – Cut back on extras you do not need to live.
• Vehicle – Car pool whenever possible, only run multiple errands together, walk if possible, use public transportation is available.
• Housing – Move to a lower rent area or to a smaller home. Even consider moving in with family to maximize savings.

Extra Cashflow

• Sell any unneeded items via yard sale or something akin to Craig’s List. This can apply to second vehicle as well.
• Take on a second job that can be done from home or even with a multi-level company.
• Ask husband or partner to temporarily take on a second job.
• Do you gourmet cook,  write, musically talented, sew, knit, paint or craft? You may be able to sell your creations or services.

Miscellaneous

• Barter
• Ask for payment plan.
• Look for less expensive supplies such as a “fishy pool” versus renting an AquaDoula.
• Choose a birth center or a home birth as the cost is significantly less than even a no-intervention natural hospital birth. Also your prenatal care is included in the fee unlike a planned hospital delivery.
• Hire a training doula. Often a lower fee.
• Start a savings account before you are pregnant.
• Plan ahead and pay down any existing debt prior to getting pregnant or in early pregnancy.

I hope some “light bulb” moments are had and there is encouragement in the ideas. There is almost always a way.

If I have left anything off the lists, please feel free to leave a comment and I will add.

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

• Take the ICAN webinar on cesarean prevention.
• Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
• Interview both midwives and OB’s.
• Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
• Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
• Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
• Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
• Turn off your TV – stop watching the dramatic birth shows.  They are not real.
• Use mobility in labor.
• Drink and snack in labor.
• Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
• Say no the the epidural completely or at the earliest at 6 cm’s dilated.
• Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
• Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
• Study yourself for what comforts, assures, and adds to your feeling of safety.
• Eat healthy and exercise during pregnancy.
• Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
• For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
• Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.

I have been invited to share with you an intimate and challenging (and graphic) journey of a mother from an unexpected primary cesarean, physician decided repeat cesarean and a home water birth after those two cesareans.

Before you watch it, take a deep breath and have an open mind. A box of tissues may be in order as well.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Watch how a baby is delivered in a cesarean birth and see the dramatic difference of what both the mother and baby experience in a home water birth after cesarean.

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Thank you Alex for allowing me to share your story!  Many blessings to you and yours.

For more information on cesarean recovery, support, prevention and VBAC information go to www.ican-online.org.