Ep 15: How to Vet a Homebirth Midwife

All midwives are not created equal. In this brief episode, Alex and Lacey were inspired to discuss things families might want to look out for when vetting a homebirth midwife to help you find the right person to support you. Questions about training, experience, equipment and how they handle the unexpected or most serious situations are all discussed. 

Transcript

SPEAKER_01 0:04

Welcome to Doolets Unhinged, the podcast where we tell the unfiltered truths and disrupt the accepted view of modern birth and parenting.

SPEAKER_02 0:12

We're your hosts Alex Shaw and Lacey Morgan, here to cut through the noise, share the stories no one else will, and empower you with real talk that's equal parts honest, funny, and unapologetic. Let's get unhinged. Okay, welcome to another episode of Dool is Unhinged.

SPEAKER_00 0:35

Here we are. Hi Lacey. How's it going, Alex? Good. How are you? Good. Living the dream, right? Every day.

SPEAKER_02 0:42

Every minute. Feels good. Well, you want to dive into it? Well, yeah. Um, somebody sent me an article uh that was talking about this um free birth society and uh the um maybe the dangers of people who are calling themselves birthkeepers versus um or or misrepresenting themselves as midwives, maybe. Um and and I want to go on record saying that we fully support the free birth community, that people who want to desire to birth without any support, um, more power to them, right? Like I have zero judgment about people who want to have their babies unassisted. Um, but I think it's it's spurred for me this desire to talk about, well, you know, how do you not get duped if you think you're hiring a midwife? Yeah. Um, you know, how do you make sure that you are actually hiring the person that you think you are?

SPEAKER_00 1:50

Yeah.

SPEAKER_02 1:50

And so we thought we'd come on today and talk about um what are some ways that you can vet your midwives, your potential midwife.

SPEAKER_00 2:00

Yeah. Yeah. Um, I would say the first thing would be, you know, learn what type of midwife you are looking to hire or you are trying to hire. Uh, there are a few different routes to get to be a midwife, right? There are certified nurse midwives, there are certified professional midwives, there are um certified midwives, licensed midwives. There's many different titles and different routes to get there. Um, so I would say learn about them and what um what state you are in and and those state regulations, those legal state regulations.

SPEAKER_02 2:40

Yeah.

SPEAKER_00 2:40

Um, because I know in the state of Pennsylvania, certified professional midwives, right, aren't as regulated.

SPEAKER_02 2:47

Well, they're not regulated at all. There's no laws preventing certified professional midwives, but there's also no laws um creating regulations for them. And so there's um there's no protection for them either. Right. So the only licensed midwives in Pennsylvania are certified nurse midwives.

SPEAKER_00 3:10

Yeah.

SPEAKER_02 3:10

So um certified nurse midwives are people who have nursing degrees and then additional training to go on to be a midwife, a midwife. Uh, what we have a lot of in in our region, particularly, particularly are CPMs or um what might be called a direct entry midwife.

SPEAKER_00 3:31

Yeah.

SPEAKER_02 3:32

So let's talk a little bit about that.

SPEAKER_00 3:34

They go through an apprenticeship. Yeah. Um and may not have any formal schooling. Right. So no nursing background. They might hold a bachelor's degree, maybe. Right. You don't need to necessarily correct. Um, they find a CNM or a CPM or a CPM to train under, um, and then go through a whole what's the word that like a training protocol? Yeah, protocol um to acquire proper training.

SPEAKER_02 4:09

Yeah. And so I would say that that is a formal education, right? Like it's not gone. It's not in school, but I think the value of an apprenticeship is so much more profound than sitting in a classroom for hours on end and not real life in the field. Um, so certified professional midwives can either go through a um approved program where there are required classes and they have to complete certain assignments and certain readings and um learn about topics that um are kind of outlined for them, or they can um just go straight to the apprentice model where they have a certain number of births that they have to attend and a certain type of births that they have to see. Umborn exams, there's yeah, yeah, the prenatal care things that they have to do. Uh so if you're looking at hiring a home birth midwife, you may feel more comfortable with one pathway over another. And so finding out whether your midwife uh which pathway she came to her practice in might be relevant. Uh, for some people, that nursing degree might feel really good and safe. And for other people, they won't necessarily care if you can do an IV because you're at home and you don't want an IV, right? Or um, you know, some states will regulate whether a um a midwife, a direct entry midwife, can bring medications like pitocin or something like that. Um, whereas a certified nurse midwife can administer medication at home, you know, and do the IVs and so on and so forth. Um so another area that I think people might want to look into is um there's uh a group called NARM, which uh, you know, is kind of like a reporting body, right? They're they're a group that makes sure that midwives are staying honest, for lack of a better term. Uh so the North American Registry of Midwives, um which can revoke their practicing privileges, you know, in in terms of like, you know, they would report that this midwife is not safe, right? And so you can go to NARM to check out if your midwife is registered with them and uh what complaints have been filed against her if she's a NARM reporting midwife. But not everybody likes the big um big corporate entities and the oversight um in that regard. And so some more local midwives will do what's called a peer review process. Uh you want to talk about that?

SPEAKER_00 7:04

Yeah, um, and it's similar, right? Like they a group of the group of midwives in your local area will get together um to discuss, you know, what's working, what's not working, um, and help help educate other midwives about their experiences.

SPEAKER_02 7:22

Yeah, especially when they have traumatic experiences or hard experiences or just things that didn't go to plan. Uh, you know, they have a sounding board where they can talk about what happened. And sometimes the elder midwives will draw attention to, well, if we look in your notes, here was a sign that, you know, this was a problem that, you know, you might have wanted to transfer or might have helped you to prepare for that outcome. Um, so I personally, and having had two home births, it mattered to me if my midwife participated in either the NARM process or the peer review. Um, because I wanted to know that that my midwife was someone who was reflective of her practices, but in a public setting.

SPEAKER_00 8:09

Yeah.

SPEAKER_02 8:10

Right. Like it's one thing to reflect freedom itself, but to have have other people, you know, kind of shining a light on areas where you might have a blind spot, I think, is really important. Uh all right. So then we also say that um, you know, it's a good idea to interview your midwife. Uh so what are some of the things that you might uh interview your midwife about?

SPEAKER_00 8:40

Their experience. Yeah, absolutely. Their outcomes and stats. So, like what outcomes and stats? Um their rate, like how many live births? What's your fetal maternal demise statistics? Um, what's your transfer rate?

SPEAKER_02 9:01

Yeah. Yeah, just like how many births did they have they done in their career? How many if you know sometimes midwives will start in a hospital setting or in a birth center setting and then transfer to home birth care. And so you might have somebody who's done a thousand births at a birth center, but only five births at home.

SPEAKER_00 9:23

Yeah.

SPEAKER_02 9:24

Right.

SPEAKER_00 9:25

And that might matter to you.

SPEAKER_02 9:26

Yeah, absolutely. Um, and then looking at like emergencies, right? Like for me, it mattered that my midwife had seen difficult situations. Like I didn't hire my midwife. Sometimes people are like, you know, oh, I want like to feel good around her and like, you know, have that motherly, you know, warm blanket wrapped around me. I didn't need that. I needed somebody who I could trust in an emergency to keep me and my baby alive. Yeah. And the midwife that I hired, she to this day, I trust her more than anyone else in an urgent situation. Like I know that she would, she would do everything she could to take care of my baby. Yeah. Right. Um, yeah. I also like I want to know like when do they transfer, right? Like what what are the reasons that they would transfer care? Um the most common reasons that I see as Adula are that the the mom is tired or dehydrated, right? It's like she just wants to go and get therapeutic rests, yeah. Or an IV for fluids.

SPEAKER_00 10:44

Yeah.

SPEAKER_02 10:45

I can't think of, I mean, there's a handful of times that we've transferred for what felt like urgent situations and only one emergency transfer that I can think of. Yeah.

unknown 10:58

Yeah.

SPEAKER_02 10:58

So I'd want to know about that. Um, I'd also want to know their philosophy of birth, right? Like some midwives are very, very hands-off. Um, and others are very hands-on. Some of them make it feel like the more like a medicalized experience, whereas others are like, I'm just here to catch the baby, right? Uh, so finding out their philosophy, I think, is really important too.

SPEAKER_00 11:25

Yeah. It's like that article. She said, um, what did she say? Like, you don't need ultrasounds or tests or whatever. And I personally would not be comfortable with that. Like, no, there are certain things that I do want as a pregnant mother if I'm delivering my baby at home. And what do you offer, you know? Right.

SPEAKER_02 11:43

Absolutely. Yeah. For me, my my midwife offered all of the standard things that I would have otherwise gotten at the hospital. Um, you know, I had an ultrasound. Um, she did GBS testing. She sent me for the uh glucose test uh to see if I had gestational diabetes. Uh, so she sent me for all of the standard testing, but had I opted out, she would have supported that too. Yes.

SPEAKER_00 12:10

Yeah.

SPEAKER_02 12:11

Right. Um so I think that that, you know, that asking them what is their standard protocol for you know their patients or their clients is it's important in formulating, you know, your decision about who to hire. Yeah. I think what what struck me in that article was, you know, it was written about a woman in Cape Town, um, was that the woman didn't know to ask the questions. And that's really what spurred us in, you know, talking about this today, because maybe people don't realize that you should be getting your fundal height measured to track the growth of the baby or that you should be getting your blood pressure taken.

SPEAKER_00 12:53

Yeah.

SPEAKER_02 12:53

Um and so, yeah, I mean, if you choose, yeah. It should be offered to you if you choose. I know there are plenty of people who don't feel the need to have those things happen, and that's okay too. Um, so I would ask the the midwife, you know, what is her role and what is your role as the patient? Yeah. Yeah. Um, some other things that are relevant, I would say, are um how many births do they take a month, right? Like some midwives take 10 or 12 clients a month. I don't know how you can be at 10 or 12 births and function. Yeah. Yeah, right. Like even that, I was thinking about splitting yourself to be at multiple births at the same time, but you're just functioning.

SPEAKER_00 13:41

I know how we feel, you know, at X amount of clients a month. Right, right. It's exhausting for a birth. Yeah.

SPEAKER_02 13:50

And then to have to go to the next one and the next one and the next one. Yeah. Um, so finding out how many they take. Most midwives in the area that seem to be doing it in a healthy, balanced way are taking about six. Um, I would want to know who comes with the midwife. Um who's the backup. Yeah. So a birth assistant um is most often attending with the midwife, right? Um, I would want to know that there's an assistant who comes and I would want to know who that is and meet her. Um, yeah, absolutely. Because she comes to your house in your space.

SPEAKER_00 14:28

Yeah. Yeah.

SPEAKER_02 14:29

I'd want to meet her. Uh and then the backup, right? Like who who else in the community, what other midwives is she connected with that she would be able to draw on if she weren't able to be there, right? Um, at the beginning of 2020, um, we had a situation where one of the local home birth midwives uh her appendix ruptured. That's not something that she could have planned for, right? And so all of those people who were so supported by her had to transfer care, yeah, either two OBs or two other midwives. And you know, the community, I believe, rallied around, you know, her clients and and took them in and took care of them, but knowing who the backup is, whether she's sick, injured at another birth, it's important. That's very important, and having the phone numbers in case you can't get a hold of her. Yeah, I agree. Right. Um, they're trained. Uh, I I mean, I've never met a midwife who wasn't trained in neonatal resuscitative practices. Yeah. Um, so finding out when was the last time they were trained, whether they're certified in that, because you know, I think that's one of the scariest things for families considering home births is you know, what happens if something's wrong with the baby when they come out?

SPEAKER_00 15:52

What are you going to do?

SPEAKER_02 15:54

Right. Uh, I remember this story about one of our local home birth midwives where the EMTs were called for some reason, and I don't really know what it was. I think the baby was a preemie. And um, you know, she the midwife was doing uh NRP neonatal resuscitative practices for the baby. And um the the EMT said to the midwife, if you weren't here, we wouldn't have known what to do with such a small baby. Yeah, right. Yeah. 911 is not prepared to help you through your labor and delivery of your baby. Like they have such minimal training and the equipment they have appropriate.

SPEAKER_00 16:36

Yeah, and it's faulty. Yeah, and it's faulty. Like, why? What are we doing? Well, because it's not designed for any bitty babies, right? Yeah, it's designed for adults, right?

SPEAKER_02 16:50

Or kids are very pediatrics, but not neonates. Yeah, um, yeah. So I'd I'd want to know, you know, what is what kind of scary situations has my midwife been through? Um and what did you do? Yes. Yeah, how do you handle it, right? I think sometimes people shy away from those conversations because like la la if I don't hear it, they don't want to know it doesn't happen. Uh, but for me, I wanted to hear what scary situation she has encountered and how she managed it. And I wanted to watch her face as she recounted the stories. I wanted to see how her body responded, you know, both to see how she what kind of work she does to release the trauma, but also, you know, was it is it lingering as a trauma in her? Is she you know prepared to to navigate that or was it overwhelming for her? Yeah. Um equipment.

SPEAKER_00 17:49

Yeah. What kind of equipment have you seen at home birds? Um, I mean, tubs, that's a big one. That's like a big space sucker. Yeah. It's like, where are we gonna put this tub?

SPEAKER_02 18:00

Yeah, and most people rent them. Um, that's like an add-on for your home birth. Yeah. Um so tubs, I I've seen oxygen tanks if the baby or mom needs oxygen.

SPEAKER_00 18:15

Um I've seen pitocin. I have too. Methrogen. Yeah, metrogen. Yeah. I've seen IVs. Sort of the certified nurse midwives um who are practicing in a home birth setting. I have seen that.

SPEAKER_02 18:30

Yeah, that they did IVs. Um, I see a lot of homeopathy. Uh so either to spur labor on or uh help with the bleeding, or sometimes to help with babies when they're you know trying to figure out how to come into their bodies. Um, they have blood pressure cuffs. Girl, we're going the same places. Yeah, we are uh scales to weigh the baby when they're born, tape measure. Yeah. What else? They they have a whole bag of equipment. And so if you're uh if you're interviewing a midwife and that equipment matters to you, then ask for a detailed list of what comes in their Mary Poppins bag because um you might be surprised. You know, most of the midwives really they come with everything they need to keep you safe until they can get you to a hospital.

SPEAKER_00 19:25

Yeah, they come with snacks for themselves a lot of the times, yeah. Because they need to fuel and they have you as the person not hosting, but yeah, hosting, sort of ish, ish, and you're not ever hosting like you are the birth and mother, never hosting, but sometimes I've definitely lots of coffee, yeah. Lots of coffee.

SPEAKER_02 19:49

Yeah. Uh and then I'd want to know, you know, what do they do in uh the three big scary things, right? Hemorrhaging, uh, shoulder distos, uh, and if a baby needs help adjusting. Resuscitation. Yeah. Yeah. Um, you know, there's a whole host of questions that you could develop to ask your midwife, uh, but we thought that this gave just an overview of some topics to start the conversation. Um, I think that whether you're hiring a doula or a midwife, it is important that you interview somebody and make sure that you feel like they make you feel comfortable. Right. Um, because these are the the women who are going to be entering into your birth space. Um, and you have to feel good and safe with them. So don't just hire a midwife because your girlfriend or your sister.

SPEAKER_00 20:46

I was just about to say, yeah, like talk to many people, right? The the article that was in Cape Town, it sounded like she had heard from one person about one quote unquote midwife, whether she was one or not, I don't know.

SPEAKER_02 21:00

Yeah. Um the lawsuit will reveal.

SPEAKER_00 21:03

Yeah, the lawsuit will tell. But we live in a time where where we have access to so many people in an instant. So it's like reach out on Facebook or Instagram to all of those virtual communities of home birth midwives and and find, you know, enter in a name. Jane Dell, what do you guys think of her? Who's had her at, you know, for a home birth midwife?

SPEAKER_02 21:27

Well, and Google the midwife's name along with lawsuit, baby death, maternal death, right? Like use your keywords to really search, right? And and ask them directly about their outcomes. Yeah. Right. Um, we're in Pennsylvania, we have uh the Pennsylvania Midwife Review on Facebook uh where families can go and post their stories about their midwives. Uh, and it's not supposed to have any professionals in that. Uh space so that families can speak very openly about uh their experiences. Yeah, yeah. Um ask around, yeah. Yeah, absolutely, and interview multiple midwives.

SPEAKER_00 22:12

Yeah, don't just do one, multiple.

SPEAKER_02 22:14

Yeah, yeah. Well, if you're planning a home birth, we hope that this is helpful to you. Uh, if you have questions about hiring a midwife or what a home birth looks like, or if you want to know more from the dual perspective on the home birth, feel free to reach out. Until next time. Bye. Thanks for getting unhinged with us today. We hope this conversation challenged you, validated you, or made you laugh out loud. Birth and parenting aren't meant to be perfect or polished, and neither are we.

SPEAKER_01 22:46

If you love this episode, share it with someone who needs real and raw truths. Leave us a review and make sure you're subscribed so you don't miss what we're unraveling next. We're Alex Shaw and Lacey Morgan reminding you that your voice matters, your experience is valid, and you're allowed to do this your own way.

SPEAKER_02 23:01

Until next time, stay unhinged.