The Fourth Trimester

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photo credit: Birthing Beautiful Communities

When a newborn emerges from the womb, it leaves behind a warm, dark, and physically stimulating environment that includes the mother’s heartbeat, the sounds of children or other adult voices, and the rocking, jostling, and rhythmic steps of the mother moving about. Upon birth, a baby will turn toward the familiar sound of its mother’s voice. We teach new parents to lay the baby down in quiet rooms, away from noise and the hustle and bustle of life, away from the mother’s familiar heartbeat, but what if what they really need is more of what they experienced in the womb?

The concept of a fourth trimester was first communicated by British childbirth educator and author, Sheila Kitzinger, in 1975: “There is a fourth trimester to pregnancy, and we neglect it at our peril. It is a transitional period of approximately three months after birth, particularly marked after first babies, when many women are emotionally highly vulnerable, when they experience confusion and recurrent despair, and during which anxiety is normal and states of reactive depression commonplace.” And other anthropologists like Jean Liedloff, author of The Continuum Concept, have studied multiple cultures or indigenous populations, looking for answers for problems faced by mothers and babies during the fourth trimester and beyond.

The fourth trimester concept embraces the idea that human babies are born three to four months earlier than developmentally ready. With evolution, the human brain has grown larger, but the woman’s pelvis has not. Thus, babies are born when their skulls are approximately eleven centimeters and before they have the muscle control to hold up their heads or roll over.

A friend who recently had her first baby remarked that while she had probably over-prepared for the birth, she hadn’t prepared at all for the first three months. Women no longer live and work in the same environments; we don’t see parenting up close with our communities or do as much caring for younger children as we once did when families were larger and life was more communal. We’ve moved into the workplace, attending college at large numbers, and waiting until our thirties (on average) to have children.

The transition from baby-in-the-womb to baby in the room can be just as jarring for today’s new mother as for the baby.

Buzzwords and parenting trends come and go, but the needs of the baby and new mother remain constant. During the fourth trimester, the mother faces: changing hormones, physical and sometimes emotional recovery from the birth, an initial unusually heavy period, soreness, moodiness, sleep deprivation, feeding and caring challenges with the baby, and, frankly, a world turned topsy-turvy. First time mothers are adjusting to the fact that every decision they make—even slipping into the bathroom to shower—impacts another person. Essentially, her life is no longer focused on her own wants and desires. More than men, women’s lives are greatly disrupted and reshaped by the arrival of a child, especially in the first months after the baby’s birth.

Both mom and baby are thrust into a new world, requiring adjustments, time, and a steep learning curve. If it’s a first baby, the learning curve is steep, but even consecutive babies create a learning curve, given personality and developmental differences baby to baby.

didymos-baby-sling-baby-carrier-baby-brightThe concept of the fourth trimester helps during this vulnerable time of change—looking at the early months through the eyes of the newborn, with empathy, helps the new parents in terms of setting expectations and making decisions. For instance, babywearing, especially with cloth wraps, can soothe even the fussiest of babies. The baby returns to the familiar warmth, heartbeats, and movement of its mother in the wrap. Wrapped securely, mothers can grocery shop, take care of older children, walk around the house, prepare food, or rest on the couch while the baby naps in its familiar cocoon. Some physicians and development specialists recommend swaddling to achieve a similar sense of security, but it remains more controversial in terms of neurological and motor development, especially if done for extended periods of time. One of my favorite wraps is the Didymos, but there are many types and styles of wraps on the market today and a mother might find that different styles are better for certain situations. For instance, for a quick errand at the store, a ring style sling might be easier to use. And babywearing can be a lifesaver with colicky babies.

Looking through the lens of the fourth trimester, it’s easy to see why a baby might nurse at uneven intervals; in the womb, the baby received nutrition continuously and in synch with the baby’s development. In the same way, a baby will nurse more when it’s making big developmental leaps, cutting teeth, or going through a growth spurt—as well as when it’s upset, scared, or angry. The media (books, TV shows, movies) often portrays sleep as something to be managed, when in reality, the baby knows what it needs and the sooner the new mother (and father) accept a more flexible approach to feeding/nursing, the easier the fourth trimester becomes. Full nights of sleep WILL return, but to expect full nights of sleep when the baby is young is contrary to its needs and development.

In the meantime, what makes sleep easier? Many families find that co-sleeping or using a side basinet works well. If breastfeeding, the mother gets more sleep when the baby is close by. And regular sleep/arousal cycles are healthy for infants and decrease the risk of SIDS. Every baby will sleep on its own when it’s ready. Managing expectations about sleep is just as important as managing the baby’s care. Attitudes should match development, not external schedules or sleep rules. These guidelines for safe co-sleeping can be helpful. Never sleep with an infant if the accompanying parent(s) have been using drugs or alcohol, as they may impair instincts and awareness. Dr. McKenna, an anthropologist and infant sleep researcher, cautions against co-sleeping when the mother is unable to breastfeed. In that instance, having the infant in the room in the early days will allow the parents to respond quickly to the baby’s needs. To learn more, check out McKenna’s Behavioral Sleep Laboratory at Notre Dame.

More and more research, as well as community programs, is focused on the concept of the fourth trimester. The University of North Carolina has a team of investigators looking at ways to improve outcomes during the first months of motherhood and infancy. Mothers and babies need support during those tender first months and health professionals are beginning to realize the importance of timely health encounters to reduce the incidents of post-partum depression, breastfeeding problems, and other maternal health issues. As women, we no longer live communally, but we can create a sense of community and support with our care providers, support groups (La Leche League or new parent groups for example), extended family, and friends who are already mothers.

Midwives see the care of the mother from a holistic perspective. From pregnancy to birth to postpartum, the midwife educates and supports the mother. It’s just as important that a new mother reach out to her midwife or care provider when feeling overwhelmed or unsure. Like the baby, the new mother is going from a constant environment—one in which she did things a certain way—to a completely changed environment. Support from other seasoned mothers and from health providers can be crucial to moving successfully through the final trimester and first months of motherhood.

(Locally, check out the Premier Birth Center postpartum support group, which meets every month in Winchester).

The Shaming Has to Stop

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Get ready for a major soapbox post.

I get it. Those of us who choose to birth outside the box are different. We make choices that don’t necessarily follow mainstream society norms. Our choices may not be in alignment with what is embraced by the obstetrical model of care. Our choices may make medical professionals feel uncomfortable, challenged, exposed. I get it, really I do.

But…

That doesn’t give a healthcare professional the right to deny care in order to shame women and midwives, to bully us, or to punish us into submission because a laboring woman didn’t choose what the medical professional thinks we should do for ourselves, for our children, or for our clients.

Yes, this really happens. All. The. Time.

And, it never should. Ever.

For the most part, people who choose to give birth outside of the hospital feel that giving birth in a hospital is like using a sledgehammer push a thumbtack into a cork board—way too much fuss for something that most people can do on their own—and that a healthy woman having a normal birth in a hospital is asking for trouble. It isn’t that doctors have bad intentions. Most of the time, doctors and nurses have the very best of intentions. But, once a woman walks into a hospital, she will need to be “treated.” And, once a normal labor is “treated” (read, “interfere with”), risk is introduced.

People who choose to give birth outside of the hospital view the medical community as a necessary resource if the normal process doesn’t go normally. Most of us don’t hesitate to seek medical care if there is a need. Yet, why would a woman hesitate? Why do so many of home birthers/birth center birthers distrust the medical community? The lack of trust in the medical community exists because women have been burned many times, and women share their stories with each other.

As a midwife, I’ve personally seen patients yelled at, forced to have vaginal exams despite an explicit refusal, and verbally abused (put down, shamed, coerced, threatened). Doctors have yelled at me, attempted to discredit me in front of my clients, and threatened me with complaints. Why? Is it because something was done wrong? No, quite the contrary. All of these things happened because of a hospital transfer when a mom needed non-emergency help. Yes, these examples occurred during non-emergency transfer situations.

You might think, “Well, during a birth, the hospital staff acts this way because they worry about liability.” OK, let’s assume a medical professional was upset about that. Does that warrant abusive treatment of women and midwives? Quite honestly, does their bias or fear of liability even matter? Their job is to treat whoever comes through the doors of the hospital. Federal EMTALA laws protect a woman’s right to be treated in labor. ACOG supports patient autonomy even if the provider feels the woman’s choices are in conflict with the provider’s belief that her choices are unwise. A practitioner’s unprofessional behavior actually increases the provider’s liability by failing to respect patient autonomy and by refusing to provide the same level of care they would give to any other patient they serve.

This lack of professionalism experienced in the hospital sometimes extends beyond the birth. This is where I feel like the treatment is almost entirely punitive. While I can understand the frustration and stress of a provider who receives an in-labor hospital transfer, this type of post-birth discrimination seems like coercion and punishment for a family making choices that a provider does not personally support.

After a normal, healthy birth, the midwife’s scope of practice is normal newborn care throughout the first 6 weeks. The midwife conducts all of the usual assessments and then recommends the family see a pediatrician for a normal well baby visit at the end of the six-week period. The family calls to make an appointment.

Hold the phone! Wait a second, they won’t see the baby? Why not? Some practices won’t see the baby because the baby was born at home. Say what? They won’t see the baby for 6 months because they didn’t get the vitamin K shot? You’ve got to be kidding me!

Do physicians have the right to deny those people care because they disagree with their choices? For instance, is it OK for a pediatrician to refuse to accept a patient into care because the mother doesn’t breastfeed her baby? Would it be OK if a pediatrician refused care for families who homeschool? No, of course not. Yet, in many cases, with the population of families we serve, if a family has refused for their newborn anything from the mainstream model (such as a Vitamin K shot or erythromycin eye ointment or hepatitis B vaccine), they encounter judgment, fear, or a refusal of service.

It is unethical to refuse care in an attempt to coerce or bully a patient into consenting to care they have refused. It is unethical to refuse care as a way to punish families for their choice to give birth in a way that you do not agree with. It’s morally wrong.

The shame that is heaped on families who’ve chosen a path outside of the mainstream standards has created a culture of resistance and distrust, and that’s not good for anyone. Women and their families should be able to count on a multi-tiered model of care. If a woman plans to give birth at home and the labor takes a turn, she should be given a high quality of care during her transfer, and when she becomes a patient at a hospital. What if instead of shaming, a medical professional chose compassion? Understanding? And what if the medical professional were trained to see themselves as an important part of the picture for women who choose to birth at a birth center or at home?

The shaming has to stop. The punishment has to stop. Is it any wonder we don’t trust you? The distrust has been built on years of mistreatment. It rests on the shoulders of those in the medical community who lack professionalism, who don’t separate their own personal choices and/or training from the choices of the women and midwives who come to them in good faith and in order to see a labor to a successful and safe conclusion.

This dynamic needs to change. Show women that you can treat them with the same respect their midwives show them. Help women to make informed choices, and then respect their right to informed refusal (without trying to make them feel bad about the final decisions). Welcome us—the birth team and the laboring women—so we feel we can come to you for help when it’s needed. Welcome us, so we don’t feel like we want to wait a little longer to see if things get better because we’re scared of how we’ll be received when we arrive at the hospital. Welcome us, so we know we can share our stories fully and honestly with you, without fear of mocking or teasing—or retaliation against our clients.

If the goal is truly to provide good care and not to punish people whose views differ from your own, it’s time to do something to make a change for the good. Every time we interact with you, you have a golden opportunity to let the medical profession shine. Don’t blow it. Help us walk towards you instead of away from you.

If you’re a doctor or a nurse and you support families who make choices that aren’t in alignment with your protocols, this post is not about you. Or, maybe it is. Maybe this is a love story about you. You are the people who give me that glimmer of hope that change is possible and that midwives, consumers, and the medical community can work together to make outcomes better for mothers and babies, and make the experience better for all of us.

20 Interview Questions to Help You Find the Right Midwife for You

Chances are, if you’re reading this blog, you’re probably already thinking about hiring a midwife.  You know all about the Midwives Model of Care and you’re ready to find the perfect midwife for your family. There’s a midwife for every woman. What’s right for one woman may not be right for another. So, how do you choose the right midwife for you?

What’s most important to you? What personality traits are most important to you? What type of practice style suits you?

Baby SleepStart with the big decision first. Where do you want to give birth?

This topic may require a whole other blog post, but let’s assume you’ve made up your mind about whether you want a hospital birth, birth center birth, or home birth; your decision about the birth setting will largely determine care provider options. For instance, if you want a hospital birth and you want a midwife to attend, you will hire a Certified Nurse Midwife (CNM). If you want an out-of-hospital birth, you can choose a CNM or a Certified Professional Midwife (CPM). Some women choose other options, such as unlicensed midwives and unassisted birth, but the focus in this blog post is on licensed care providers in a variety of birth settings.

Make a list of questions.

Before you meet the midwife, come up with a list of interview questions. If you don’t have a list, the midwife will likely still be able to give you a good overview of her philosophy and the care she provides, but if you have a list of questions, you’ll be more likely to come away from the experience feeling as if you have all of the information you need to make a decision. After meeting with hundreds of families over the years, these are some questions that I’ve heard:

image6 (1)1. How many births have you attended? How did you become a midwife?

There is no right answer here. New midwives bring new energy and up-to-date knowledge to their care. What they don’t have in experience, they make up for in resourcefulness. They tend to be very well-connected to a wide community of student midwives and experienced midwives, and they know where to turn when they encounter a non-emergency situation that requires further research.

Experienced midwives tend to have the gift of having seen a lot of births, of having helped a lot of different types of families, and having seen wide variations in what’s normal. Their knowledge and experience is vast. Where others might be nervous, the experienced midwife has “been there, done that.” Experienced midwives work hard to stay current in their field, attending continuing education classes and conferences, and participating in midwifery associations, although some are very busy in their practices and may find it difficult to find the time to participate in activities other than helping mothers and babies in their care. An experienced midwife is a gift to her community.

Fireandrescue2. What happens if there’s an emergency? What is your role if I transfer? Do you stay with me until my baby is born? What about postpartum visits for moms who transfer?

Every midwife has a plan for hospital transfer. If you’re planning a home birth, the midwife will come up with a plan customized to your particular needs and based on your location. As a client, it’s good for you to understand what happens when there is a transfer. If you go by ambulance, does the midwife ride with you? Who goes with the baby? What hospital do you go to? What have her experiences been like there? How long does the midwife stay?

12439120_10208534688063276_3445913896829134711_n3. How many postpartum visits do you provide? Are those provided in-home or in-office?

There’s significant variation from practice to practice with regards to postpartum care. Most practices provide a postpartum visit within 24-48 hours after the birth and again at 6 weeks postpartum. There’s usually at least one other visit between those two visits. Some practices see you for a few more postpartum visits than that, and some keep in touch by phone between visits.

4. What is your fee and what’s included? Do you bill insurance? How does that process work?

Finances can get complicated. Often, if you’re a healthy person, this is the first time you will have had a major medical expense covered by insurance. The billing process is often not straightforward. Ask the midwife to explain how she handles it. Who does her billing? Will you be dealing directly with the biller or with the midwife? Is there an insurance billing fee? Is she in-network or out-of-network? Does she offer insurance benefit verification? How much is required as a prepayment towards what she bills insurance? What payment options are available? How does the reimbursement process work?

vaccine5. What labs do you require? Will you draw labs for me or will I need to go to the patient service center for that? Do you require ultrasounds? How many? Do you offer them in-house or will I need to go to an imaging center? What if I decline certain labs or ultrasounds?

How your midwife answers these questions is important. If she launches into “I require____” that tells you something about how much she values your opinion and right to make informed choices about your care. Some women want the midwife, as “the expert,” to make such decisions and have clear rules, and she may be the right midwife for you. If, on the other hand, the midwife says something like “there are certain tests I recommend, some tests are required by law in this state, and others may be worth considering depending on your history. I generally recommend ____, but I also recommend you do your research and that we discuss your options before you make a decision…” this shows a respect for you as the ultimate decision maker for your care and the expert on your own body, your right to make informed choices, as well as a commitment to a shared decision making process. For many women, this is an important characteristic in the care they seek.

6. What is your policy about postdates?

There are various factors that may affect a midwife’s postdates policies, such as hospital rules, laws in your state, physician supervision, or experience with postdates. “Postdates” means different things to different providers. To some providers, postdates means after 41 weeks. To others, it means pregnancy after 42 weeks. Does she have a firm cut-off date for you to go into labor? What happens if you go past that date? Explore the possibility of a postdate pregnancy and how the two of you would navigate such a situation. For instance, the midwife may work with an acupuncturist or chiropractor who specializes in postdate care. She may be able to offer herbal or homeopathic options for labor stimulation. The midwife may prefer that you have an ultrasound at 41 weeks to check on the baby’s well-being, or she may simply want you to count the baby’s movements.

7. What is your policy on prolonged rupture/release of membranes (PROM/ROM)? How does that change if I test positive for GBS (Group Beta Strep)?

Ruptured membranes (water breaking, release of waters) can happen before or during labor. Once it happens, there can be additional concerns about increased risk of infection. Some providers have very firm guidelines about transferring to the hospital after a certain point after ROM. Some providers have the option of IV antibiotics at an out-of-hospital birth, which can provide additional options to help reduce the need for hospital transfer for prolonged ROM.

8. Do you attend breech, twins, or VBAC births? If so, under what circumstances?

Contemporary recommendations continually fluctuate on the best practices for breech, twins, or VBAC (vaginal birth after cesarean). There is ample evidence pointing to the long-term risk of cesarean births for the mother, but there is also evidence that the risks for vaginal birth are higher for the baby. Each mother needs to evaluate her own situation to decide whether a vaginal breech birth is something she would want, as well as whether she would want that option in an out-of-hospital setting. Current training practices for obstetricians have focused solely on surgical solutions, so vaginal breech birth in a hospital setting is a rare option. It’s important to know how a midwife would handle a breech birth, and, if she doesn’t attend breech births, what practitioners she recommends.

Some midwives have experience with attending twins births and feel comfortable handling the birth on their own. Some prefer that you consult with the back-up practitioner.

VBAC recommendations continue to fluctuate, but many women who have previously had cesareans seek midwifery care for a VBAC, and most are successful. In my own experience with VBAC, the cesarean rate for the clients attempting VBAC is roughly the same as all of my other clients (5-8%). Hospital VBAC success is lower. ACOG estimates that about 60-80% of women who attempt VBAC should be able to have a vaginal birth, but only about 4-22% actually do. Virginia’s VBAC rate is 10.2%

2013vbacmapAscertaining your midwife’s skill level and experience with each of these situations is important. And if she is not comfortable with any of the three types of births, what is her referral practice?

9. What medications do you carry?

This will vary state to state based upon the state’s regulations for the midwife. In states where midwives are not allowed to carry medications, the midwives sometimes work with physicians who can assist with access to medications.

10. Do you use herbs, essential oils, and homeopathics?

Each midwife will have her own philosophy about herbs, oils, and homeopathic remedies. Some midwives have a lot of knowledge, skill, and experience with these modalities, while other midwives do not. Depending on the relative importance of this to you, it may be good to know your midwife’s experience with these options.

AdobeStock_79081005.jpeg11. What is your relationship like with the medical community?

As midwifery care continues to grow, medical communities are finding ways to work with midwives in terms of transfers, back-up care, and supplemental care. Some midwives require that the mom finds her own back up care and some midwives have long standing relationships with physicians and hospitals. Regardless of your feelings or your midwife’s feelings about hospital birth, the fact is that out-of-hospital birth is safest with the option for a smooth hospital transfer when needed. Having a good relationship with the medical community can go far to facilitate a coordinated and efficient hospital transfer.

12. Have you ever lost a mom or a baby or come close to losing a mom or baby? What did you learn from that experience? How do you support moms through a traumatic birth, miscarriage, or stillbirth?

This is a difficult topic. No one wants to consider that a pregnancy may result in a stillbirth or other medical emergency. And yet it sometimes happens, in hospitals, at home, and in birth centers. It’s an unfortunate reality in rare situations, although it is more common that women can experience an early pregnancy loss (miscarriage). What kind of support would your midwife offer you if you were to miscarry? If you were to lose a baby, or face a life-threatening situation yourself, it’s important to know that how the midwife would handle the situation best matches what you would want.

13. Are you on a call schedule? Who will be on call for me? Who covers for you if you are not able to be at my birth?

The bigger the practice, the more chance of a call schedule for the midwife. Typically you will have at least one appointment with an alternate midwife. If there is a call schedule, how many midwives are in the call rotation? If it’s just two, you may be able to get to know both of the midwives pretty well. If it’s more like 4-6 midwives, it may be more of a challenge to feel a continuity of care.

AdobeStock_80039918.jpeg14. Who assists you at births? What kind of training do they have? How long have they worked with the midwife?

Some midwives train birth assistants, apprentice-style, to serve with them at births. Others hire registered nurses (RNs) to serve as birth assistants, which is the case at the Premier Birth Center, where I practice. Other midwives allow you to shop around and choose your own birth assistant, and typically the midwife will have a list of birth assistants she has worked with in the past. It’s important that they have experience working together.

15. Do you have practice guidelines, protocols, and informed choice documents that I can see? What’s your typical prenatal care like? What would make me “risk out?”

Most midwives have practice protocols and informed choice forms. Some states require midwives to hand out certain informed choice forms. NARM requires all CPMs have practice guidelines and an informed disclosure for home birth. If you are considering hiring a CPM, she should be able to give you those documents on the spot. If you are planning a birth center birth, the birth center (especially a CABC accredited birth center) should have a Policies & Procedures Manual that details the care they provide. Seeing a midwife’s practice guidelines, protocols, and informed choice documents can give you insight into the care you would receive with that practice.

16. Do you keep practice statistics? How often do your clients transfer to the hospital and why do they transfer?

Some states also have this data available online. Contact your state department of health. These statistics will give you a good sense of how often a mother has to transfer from the birth center or from the home. Some midwives are more conservative than others in terms of deciding to transfer, so it’s good to have a discussion with the midwife to find out why she most often has made the decision to transfer.

17. How would you describe your care?

This will give the midwife a chance to share her perspective on what kind of care she offers. You can probably get a feel for her practice style just from the answers to her other questions, but asking her to describe her care gives her a moment to pause and really think about her style and what she’d like you to know about her.

18. What does birth look like with your practice?

Ask the midwife about her protocols for monitoring you and the baby. Out-of-hospital providers almost always use a Doppler or a fetoscope for monitoring your baby’s heartbeat. Hospital-based providers are more likely to prefer continuous electronic fetal monitoring, although some will be able to offer intermittent electronic fetal monitoring. Some midwives rarely do cervical exams, while some will usually do an initial cervical exam when they arrive at your birth, and then may check periodically during your labor. Some midwives offer warm compresses and oils for perineal support, while other midwives prefer a more “hands-off” approach. Some midwives encourage the parents to catch their own baby, while others are not as comfortable with that idea.

19. Do you offer water birth?

Many, but not all out-of-hospital midwives attend water births. Hospital-based providers will often support the use of water for pain relief during labor, while not supporting the actual birth of the baby in water or not supporting water labor after rupture of membranes. If the midwife does support water birth or water labor, does she offer birth tub rentals? If you’re giving birth at a birth center, be sure to ask about their birth tubs. How are they cleaned? How do they verify cleanliness (taking laboratory cultures on a regular basis, for example)?

20. Do you offer other services besides midwifery care?

Some midwives offer birth pool rentals for moms who want a water birth. Childbirth education classes, lending libraries, and a selection of supplements or teas might be offered through the midwife as well. Some midwives also offer placenta encapsulation or work with local encapsulation providers, if that is a service you would want.

Trust your instincts and trust the midwife’s instincts.

I’ve been interviewed by hundreds of women. Sometimes, we’re a good fit and sometimes, we’re not a good fit. If someone doesn’t want to move forward with my practice, I don’t take offense. I trust that a woman knows her own needs and will find the right midwife to serve her.

Sometimes, I meet someone and know instantly of a midwife who would serve her better than I, and I recommend she contact that midwife for an interview. During the interview, the midwife is interviewing you as well. It should be a good fit for you both. Don’t take offense if a midwife says to you, “I just don’t think we’re a good fit,” and refers you to another midwife. She does this because she wants you to receive the best individualized care, and she knows that the quality of the care depends on the quality of the relationship between the client and the midwife.

Do some soul searching.

The midwife you choose will become a big part of your pregnancy, birth, and postpartum experience. Before you start looking for a midwife, step away from the computer and really think about the type of person you want to have caring for you during this process.

There’s a Midwife for Every Woman

It’s been said there’s a midwife for every woman, and I truly believe that to be true. I’ve been to many midwifery conferences and other midwifery gatherings, and while we all share that common bond of midwifery, it is clear that there can be big differences between us. To generalize, there are “hippie midwives,” Christian midwives, parteras – Spanish for midwives, young or old midwives, male midwives, married midwives, single midwives, Amish midwives… the list goes on. Midwifery is what we share. At the core, we agree on the value of serving women selflessly, helping women through the life journey of womanhood into motherhood, honoring women and their families in the ways that only the midwifery model of care can offer.

Yet, there are differences, even within the same community. So, when considering your options, how do you know which midwife is the right midwife for you?

Create a clear picture of who you want to serve you at your birth, before you begin your search.

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It’s easy to get caught up in the excitement of creating the plan to have your baby at home or at a birth center, but, be sure to take a moment to consider what you truly want from a midwife before starting your search. What is your personal birth philosophy? How do you feel about laboratory testing and ultrasounds? Do you want all of your visits at home, or are you OK with going to an office? Do you need someone with a strong, authoritarian personality or someone with a more cooperative and gentle personality? Visualize what would make you most comfortable. Sit with that image awhile. This exercise is akin to creating a mission statement for a company. When there is clarity around what you want, everything else will fall into place.

Do your homework before you interview a care provider.

Lucky for you, in the Internet age, researching a midwife is not terribly difficult. You can start with Googling her name. If your midwife has been practicing for awhile, chances are that people will have written something about her online. Most midwives have at least some sort of online presence. Just about all have a website or Facebook page. Some have blogs (like me!).

Birth Partners, and Mothers Naturally are great online directories of midwives. You can do a Google search for your zip code and midwife, and you should be able to come up with midwives who are local to you.

Look on FacebookYelp or Health Grades for reviews from people who have used her services.There will likely be blog and message board posts, as well as reviews on Healthgrades, Facebook, and her Google Business page.

Check with the state corporation commission to see if the midwife’s practice has registered with the state. The state midwifery board (for CPMs) and state nursing board (for CNMs) will have information about the status of a licensed midwife’s license (CPM) or status of a licensed nurse practitioner (CNM), including any complaints against her or disciplinary actions from the appropriate regulatory board. Keep in mind though, there’s always more to the story than what you see online. A midwife who has been in practice for many years is more likely to have come under scrutiny than someone who is newly licensed, and the birth culture of your state can have an impact on such scrutiny . Read the information ahead of time to give you a starting point for the discussion. The way she responds about the information you found will tell you a lot about her character and professionalism.

Ask friends for recommendations.

Many will say, “I just loved my midwife!” All midwives hope for that response to their care from clients. But be sure to dig deeper and ask, “What was it that you loved most about your midwife?” The aspects one person loves may be the aspects that another person would not like. Be specific and ask about the things that you’ve already identified as important to you. Maybe your friend liked that her midwife was opposed to using a Doppler to listen to the baby’s heartbeat and prefers to use a fetoscope, but you really want to use a Doppler. Or, perhaps your friend liked that her midwife was very “hands-on,” and you want someone who is very “hands-off.”

Ask the birth workers.

The birth world is a small world. Doulas, childbirth educators, and your friends probably know a lot about the local midwives. Ask them about the midwives you’re considering – someone may have first-hand experience with them.

Look to the mom groups in your community.

Just about every community has a birth circle or La Leche League group or some sort of birth advocacy group. These groups can be a great way to meet women who have used the services of local midwives and can give you feedback about their experiences with them. And many midwives offer meet and greet sessions at birth circles or attend the meetings as members of the community.

Contacting a midwife

Most important is the “click” factor. Many moms report knowing that a midwife was right for her because they just “clicked.” Follow your intuition to make the best decision for you and your baby.

If you’re not sure which midwife to hire, consider interviewing several midwives until you find the one who is the right fit. Set up an appointment and prepare for the interview with a list of specific questions, concerns, and wishes.

Up Next… 20 Interview Questions to Help You Find the Right Midwife for You

 

 

Kim Pekin newborn exam

The Whispered Calling to Midwifery

Kim Pekin newborn exam

I think I always wanted to be a midwife, but I just didn’t know what that was until much later in my life. After I became a midwife, I found out my great-grandmother was a midwife, so maybe the calling is something I knew at a cellular level somehow. When I was a little girl, I was fascinated with birth and babies, and just absolutely amazed by pregnancy. All of my Barbie dolls were continuously pregnant or nursing their little babies. I always had a Baby Alive baby doll with me. I dreamed of the day that I’d somehow become a mother myself. I remember my mother bought a copy of Lennart Nilsson’s A Child Is Born back in 1974, when I was 8 years old, and I read it over and over again. I felt so full of awe by seeing the progression of how two individual cells could somehow manage to form a complete human being. It still boggles my mind to this day. Such an amazing miracle!

When I was a teenager, I thought I wanted to be an obstetrician. I didn’t know anything about midwives. It was 1980 at the time, and we were a really mainstream family. I didn’t know anyone who had given birth at home, and I thought that midwives had gone out of existence long ago. My mother quickly talked me out of the idea of becoming an obstetrician saying, “Oh, you don’t want to do that, Kim! You’d be on call all the time and would have to get up in the middle of the night to go to births!” I laugh about it now, because, well, that’s my life, and I wouldn’t have it any other way!

I had my first child in 1989. I was very excited to finally get to experience this miracle of pregnancy and birth myself! I wanted the best possible care, of course, which to me at the time meant hiring an OB/GYN and having a hospital birth. There was no Internet back then, and I knew of no other way. I read a lot of books. Unfortunately, the books I read weren’t the most helpful ones for preparing to have a natural birth, rather they were much more helpful in preparing me to be a compliant patient. I was very naive and thought that if I wanted a natural birth, all I had to do was tell the hospital staff and doctor that’s what I wanted, and they would support my choice. I had no idea that hospitals weren’t really set up that way for birth. I ended up having a very interventive hospital birth, but somehow escaped a c-section. Looking back, it’s truly a miracle that I ended up with a vaginal birth with my first child. I credit a lack of health insurance and a patient doctor with my outcome.

My next two births were highly interventive hospital births, as well. There was a lot of trauma I had to work through with those births. By the time I had my third baby, I had gotten to the point where I felt like my body was broken somehow. I felt like I needed all of those medical interventions in order to give birth. I lacked confidence as a mother, and I lacked confidence in myself and my ability to make good choices for my care. That idealistic young woman who thought having a natural birth was just a choice and not something I’d have to work for, had quietly dissolved into a compliant, timid, defeated person. The joy I had hoped would come from birth was replaced with fear.

I decided with my fourth baby things would be very different. By that time, I had become a La Leche League Leader, and many of my friends had been choosing to give birth at home with midwives. I wondered if I could be “strong enough” to do that too. Could I do it? Did I have it in me? My friends encouraged me to talk with a midwife and learn more.

After that first meeting, I felt like I’d come home. For the first time as a pregnant woman, I felt like my provider had actually listened and heard what I said. I spent over an hour with the midwife, sharing about my previous births, discussing my hopes and fears, and learning more about what midwifery care was all about. She accepted me into her care, and I was on my way!

I worked really hard. My husband and I attended our 12-week Bradley Method Childbirth classes, we read all sorts of books, practiced our relaxation exercises, ate really well, prepared our home, and did everything our midwives recommended we do to prepare ourselves for our home birth. In the end, I had a beautiful, wonderful home birth, with all of my older children, my mother, and my husband in attendance. Afterwards, my midwife whispered in my ear, “See, your body knows just what to do.” She was absolutely right, and it transformed my life. It took a whisper to hear the calling to midwifery.

That home birth was the impetus for great change in my life. I went on to start my own business. I was fearless! I built my own home-based business and had over 500 people selling for me around the country. I published a catalog several times each year. I created my own line of personal care products. None of these things were things I knew how to do before, but I knew that if I could give birth naturally after feeling as defeated as I had felt, I could figure out how to do all of the rest of these things somehow.

My true love was midwifery, though. Midwifery is what helped me to have the confidence in myself to become the person I was meant to be, and I needed to make that my life’s work. The timing was right. I made the decision to close my business, go back to school, and devote my attention full time to becoming a midwife.

Being a midwife allows me to be part of an incredibly transformative journey for a woman and for her whole family. I love seeing women grow in confidence in their ability to grow and birth their babies, and I feel so deeply touched to witness how couples and entire families strengthen their relationship with each other by working together during this special time. Midwives speak of feeling honored and privileged to be part of this, and those are not just words for us. I know, from my own experience, just how meaningful this experience is. I appreciate so much when someone asks me to help them on their journey, and feel deeply honored to be given the opportunity to serve their family. I feel a certain reverence knowing the impact the experience can have upon their life.