What Questions for Independent Midwife?

[Kess]

I've got an independent midwife coming round to "interview" tonight, and I was wondering what questions anyone might suggest I ask to see if she's "the one"?

I'm going to ask about her success rate on keeping perineums intact (I'm terrified of tearing or being cut) and how many of her first-timers transfer to hospital, as well as about any postnatal support she offers. Does anyone have any other suggestions, ways to make sure she's the best match for me, or ways to ferret out if she isn't? I'm going to try and see another one or two midwives this week before we pick.

 

[Bournefree]

Hi I haven't used an independant MW but these are some of the things I would ask, just off the top of my head!

How many booking does she take in each month, some look after 2 or 3 a month.
How many Anti-natal appointments will you have with her; how long will they last, where would they be?
How long has she been trained?
Where did she train?
How many HB's does she think she does in a year.
Where she lives? - time travelling to you?
What equipment does she bring. Both for you and for baby?
Will there be a second MW for the end of stage 2.
If there is anything in your Pregnancy notes that she is concerned about, and if so how would she treat it?
What are her thoughts on your birth plan, if you have one.
Is she a lead from the front type of person, or will she take a back seat, and not coach you through labour?
Can she give you some refferences from women that have used her serivces that you can contact?
What are her experiences with, TENS, Hypnobirthing, meditation, water births?
What alternative ways would she use to make you more comfortable. Positions and movement etc.
If you did transfer, would she stay with you?
and Costs?!?!?

If I think of anymore.. I'll let you know.

 

[NaturalMomma]

I like to print this sheet out and give it to my clients when interviewing a MW

https://www.mothersownbirth.com/questions for midwives.pdf

 

[Kess]

Hi I haven't used an independant MW but these are some of the things I would ask, just off the top of my head!

How many booking does she take in each month, some look after 2 or 3 a month.
How many Anti-natal appointments will you have with her; how long will they last, where would they be?
How long has she been trained?
Where did she train?
How many HB's does she think she does in a year.
Where she lives? - time travelling to you?
What equipment does she bring. Both for you and for baby?
Will there be a second MW for the end of stage 2.
If there is anything in your Pregnancy notes that she is concerned about, and if so how would she treat it?
What are her thoughts on your birth plan, if you have one.
Is she a lead from the front type of person, or will she take a back seat, and not coach you through labour?
Can she give you some refferences from women that have used her serivces that you can contact?
What are her experiences with, TENS, Hypnobirthing, meditation, water births?
What alternative ways would she use to make you more comfortable. Positions and movement etc.
If you did transfer, would she stay with you?
and Costs?!?!?

If I think of anymore.. I'll let you know.

I've already asked all of the stuff in green on the phone - I wouldn't be having her visit without knowing how much she costs and how much experience she has - she's actually been practising for as long as I've been alive! I'll be sure to add the others to my list.

 

[Jenniflower]

Those are some great questions Bourne and that's a great print out NaturalMomma. I think I'll save that on my computer for when we move to America and look into an independent.

 

[Bournefree]

she's actually been practising for as long as I've been alive! I'll be sure to add the others to my list.

Amazing! I love the MWs who are alittle long in the tooth, and have a natural air of confidence and ease about them.

Let us know what you thought of her?
Xxx

 

[Kess]

Well I'm not sure what to think. We waited and waited and then phoned her - she'd forgotten she was supposed to come today. She apologised a lot, and said something had happened with her parents which put it totally out of her head, and we've arranged another visit for Wednesday. But I'm not sure if it's a one-off, or something that might be a problem long-term.

I've also found another midwife that does the option of a slightly different package of care, with only a couple of "get to know you" antenatal visits rather than the full works, for £500 less, which is very tempting. The important bits for me are the birth and some postnatal support, I have no problem with the NHS for the antenatal visits. She's less experienced though. But £500 is a lot of money to save. This second midwife charges for the initial consultation, though, before we even decide whether to go with her or not, which rubs me up the wrong way. I don't think the first midwife charges for this initial "interview" type session, though the phone was playing up so she might have said it and I may not have heard! I'm going to have to ring to make sure tomorrow I think.

 

[Jenniflower]

I appreciate you might already know this, but do you know you're covered under NHS for a homebirth? I thought when you were first asking that you were from the US. I understand though you may have your reasons for wanting an independent MW so don't feel like you have to answer why.

Does the second midwife put the cost of the initial meeting towards her over all price in the end if you do choose her? I suppose you can appreciate having to charge something as it is her time you're taking up, but when a lot of business or independent workers do this they tend to say that cost will go towards the £1000 or so that is charged in the end. I remember a lot of my Hypno practitioners I looked up were like this.

 

[Kess]

Yes, I know the NHS would sort of cover me for a homebirth, but only sort of, unfortunately. I spoke with my midwife about it and she has said that as long as they have someone free, they'll send someone, but if they're short staffed (and my local team always are, they have one team member on long-term sick leave and are all trying to pick up her slack) they'll insist on me coming into hospital. If I refuse to go in, they'll consider me to have "refused care" amd leave me alone at home.

A smaller, but still important issue is that the team is 15 strong, and covers a large area, so I also won't have a clue who will attend me in labour or their feelings on home birth, it depends on who is on duty at the time, and if my labour goes over a change of shift, the midwife I've gotten to know in some small way in labour till that point is going to up and leave and a new one (also who I've probably never met) will come.

 

[Jenniflower]

I completely understand the second part. But as for the first part it's not your responsibility for the midwives to have someone at your birth. It is THEIR responsibility and they can get in big trouble if they don't send someone out. A lot of midwives tend to use this excuse but it's not actually allowed! This is from the AIMS.org.uk website:

Many women expecting to give birth at home are subjected to a variety of tactics to persuade them into hospital, such as: 'we are short of midwives' or 'if you go into labour at the weekend/between 6pm and 8am' or 'midwife Bloggs will be on holiday' (and any number of similar alternatives). The following is not an unusual experience:

Dear AIMS,

I've planned a home birth with my midwife but I have just been told (at 37 weeks) that there are 5 other women due at the same time wanting home births and there is only one midwife on call. I've been told that if more than one of us goes into labour at the same time, it's on a "first come, first served" basis and there is a likelihood I will have to go into hospital.

I thought that I had a right to a home birth, and feel very upset to be told at this stage it may not be possible. They have suggested that I book an independent midwife but I really cannot afford this, and should I have to pay for this service?

I am really worried that if I go into labour I won't get the services of an NHS midwife anyway! What I can do?

This kind of tactic is very common. Women have a right to a home birth, the Government suppports a home birth service and the Trust has a responsibility to provide the service.

This is the only area in our consumer society where an increasing demand for a particular service is not met by increasing production (i.e. providing more midwives) but by telling the customers that they have to use a different service!

If you are faced with this dilemma we recommend that you send a letter to the Chief Executive of the Maternity Unit along these lines:

Dear

I have been informed that you have a shortage of midwives and when I call in labour the Trust may not be able to send one and I shall, therefore, have to come into hospital. I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'.

Your midwives have been aware of my intention to give birth at home since ...(insert date). I have no intention of taking the additional risk of a hospital birth in order to alleviate your staff shortages, although I am prepared to transfer to hospital should a medical complication arise. I suggest that, if your hospital is short of midwives, you contact the Independent Midwives Association and arrange an extra-contractual referral.

I expect a midwife to attend when I call her in labour. Should a midwife not arrive and any untoward event occur that is related to your failure to respond to my needs and those of my baby, my family will take appropriate action and we shall hold you and the Director of Midwifery personally responsible for this failure.

 

[Kess]

I completely understand the second part. But as for the first part it's not your responsibility for the midwives to have someone at your birth. It is THEIR responsibility and they can get in big trouble if they don't send someone out. A lot of midwives tend to use this excuse but it's not actually allowed! This is from the AIMS.org.uk website:

Many women expecting to give birth at home are subjected to a variety of tactics to persuade them into hospital, such as: 'we are short of midwives' or 'if you go into labour at the weekend/between 6pm and 8am' or 'midwife Bloggs will be on holiday' (and any number of similar alternatives). The following is not an unusual experience:

Dear AIMS,

I've planned a home birth with my midwife but I have just been told (at 37 weeks) that there are 5 other women due at the same time wanting home births and there is only one midwife on call. I've been told that if more than one of us goes into labour at the same time, it's on a "first come, first served" basis and there is a likelihood I will have to go into hospital.

I thought that I had a right to a home birth, and feel very upset to be told at this stage it may not be possible. They have suggested that I book an independent midwife but I really cannot afford this, and should I have to pay for this service?

I am really worried that if I go into labour I won't get the services of an NHS midwife anyway! What I can do?

This kind of tactic is very common. Women have a right to a home birth, the Government suppports a home birth service and the Trust has a responsibility to provide the service.

This is the only area in our consumer society where an increasing demand for a particular service is not met by increasing production (i.e. providing more midwives) but by telling the customers that they have to use a different service!

If you are faced with this dilemma we recommend that you send a letter to the Chief Executive of the Maternity Unit along these lines:

Dear

I have been informed that you have a shortage of midwives and when I call in labour the Trust may not be able to send one and I shall, therefore, have to come into hospital. I understand that it is Government policy that the NHS should support women who intend to birth at home. In a House of Commons debate (20 Dec, 2000) Lord Hunt of King's Heath stated: 'The Government want (sic) to ensure that, where it is clinically appropriate, if a woman wishes to have a home birth she should receive the appropriate support from the health service. At the end of the day, it must be the woman's choice'.

Your midwives have been aware of my intention to give birth at home since ...(insert date). I have no intention of taking the additional risk of a hospital birth in order to alleviate your staff shortages, although I am prepared to transfer to hospital should a medical complication arise. I suggest that, if your hospital is short of midwives, you contact the Independent Midwives Association and arrange an extra-contractual referral.

I expect a midwife to attend when I call her in labour. Should a midwife not arrive and any untoward event occur that is related to your failure to respond to my needs and those of my baby, my family will take appropriate action and we shall hold you and the Director of Midwifery personally responsible for this failure.

Do you know how up to date that is? I was told by my midwife that that used to be the case, but that now their rules have changed, and that I could speak with the head midwife if I wanted but she'd tell me the same.

 

[Jenniflower]

The problem is that technically it's unclear

Around 1995 the Trusts realised that they had no clear legal obligation to provide midwives when called by a woman in labour. The midwives' registration body, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (now called the Nursing and Midwifery Council), despite considerable lobbying by AIMS and other concerned childbirth groups, gave contradictory advice on the subject. On the one hand it stated:

'While the employed midwife has a contractual duty to her employer, she also has a professional duty to provide midwifery care for women and would not wish to leave a woman in labour at home unattended, thus placing her at risk at a time when competent midwifery care is essential'.'

While, on the other hand, it also stated:

'The Council has been advised that it is the employed midwife's primary contractual duty to carry out the wishes of her employer, although the employer could not expect an employee to do anything illegal, including anything which contravenes the midwives rules. A midwife would not be in breach of her professional duty if unable to attend a woman requesting a home birth by reason of her employer's decision not to provide such a service. In an emergency, the midwife has a professional responsibility to provide midwifery care to the best of her ability.'(our emphasis) (UKCC, 2001) (Note: A woman telephoning the labour ward informing them that she is in labour at home IS AN EMERGENCY.

In AIMS' experience women who are determined to give birth at home, who make it absolutely clear (preferably in writing) that they have no intention of going into hospital to solve the Trust's staffing problems, are eventually provided with a midwife. To do otherwise, would leave the Trust in an indefensible position were a disaster to occur as a result of their failure to provide a midwife.

I've recently been through an issue with my community midwives about when they would allow my home birth. They started off saying on-call starts at 39 weeks, then they said they could give me 38. But I knew 37 was full term and so it was my right to have my on-call start then. I wrote to the Head of midwifery, I also CCed my MP and AIMS on the letter and in the end I was allowed my on-call at 37 weeks. Just because they have rules that are not right, and just because they may not have enough midwives to be on call was not my problem. The problem is every other woman here has just given in and allowed them to keep this silly rule. Even though it goes against our rights! The trust will never know there's a need for more training and/or midwives if nothing is ever done about it.

Again I really do understand if you want continuous care that an independent midwife would be your best option, but if it's really just because this is what they told you it's not really something you should just take. Speaking to the Head midwife won't do you any good, more times than not they will never put into WRITING what they're saying. Writing a letter is the best way to get them to speak the truth.

 

[Bournefree]

Awesome posts Jenni! Everyone should know where rights are where this is concerned, as it is so routine practice for the Trust to apparently warn they may not have enough MWs available.. and try to coax you in. I had that with my last pregnancy. Also I have just had a MW appointment this morning, and my MW has confirmed that even though in a different area from were DD was born, we will be having a meeting closer to my due date to go through any potential risks.. and get the same standard letter afterwards.
My MW really knows my views on this practice, so knows that I won't be going anywhere. I've even said with my first baby, if I ring and you tell me no one is available, I'm saying put, and you find someone, OR I will be calling out a paramedic to attend me. I was assured that hook or by crook they would get someone to me.. Think they were slightly offended at the idea of me getting a paramedic to attend!
In the area I live in now, my community MW (who I see for all my AN appointments), isn't part of the birthing team, so won't be on-call for my birth (big shame.. they split the teams here) However, what she DID say was that she has been called at all times of the day and night when they are short staffed to go into the BC, hospital, or to homebirths. So at least there is a big enough stand-by pool of MWs available.
I think that phoning in early labour is one of the best tricks to making sure they know you are in labour, then they can organise staff to come to you, assess you and solve any staffing issues in time.

I totally appreciate the ease of having an independent who you know, and any potential problems with availability will be reduced.. .and also knowing who is going to attend you for your labour and birth. My experience with this baby might be quite different from the last in that respect - as I have my community MW attend my labour and birth.. And it was hugely reassuring to have someone that knew me so well at my side.
xXx

 

[Bournefree]

Sorry Kess, we have moved off topic a bit.. but I'm really fascinated to find out if you booked another meeting with the MW who didn't turn up, or if you are interviewed any more.. and how it is all going?
Xxx

 

[Kess]

She's due this evening, Bournefree. I'm going to get some referrences, if I can, to check with them if she has timekeeping/memory problems in general or if Monday was a one-off.

 

[Bournefree]

She's due this evening, Bournefree. I'm going to get some referrences, if I can, to check with them if she has timekeeping/memory problems in general or if Monday was a one-off.

hahahaha!! yeah fingers crossed she's not getting early Alzheimer’s!!
XxX

 

[Kess]

She was great! Her philosophy of birth seems to really gel with what I want for my birth, and her outcomes for first time mothers and with avoiding tearing etc are much better than the average, as is her number of clients breastfeeding (100% for the whole month postpartum that she visits, and a lot that she keeps in touch with are still feeding two years later!). She does a lot of work with her mothers throughout the pregnancy on getting rid of fear and getting into a positive mindset (we had a big talk about the cervix and how to think of it etc), as well as massage and things to help get baby into the perfect position. She will lend me a Birth Pool in a Box, a Hypnobirthing CD, a TENS machine, a bean bag with a hole in it which is supposed to be great for backache and positioning, and a couple of books.

Still wincing at the cost, but she's about average tbh and as long as nothing bad happens with our finances we should be able to save the money back up again afterwards, so it's only a temporary setback.

 

[Bournefree]

Oh that is brilliant! I love that she is establishing the mindset of dispelling fear in childbirth. I believe that is so important to achieving a great birth. I have read Dr Dick Grantly-Read's book "childbirth without fear" and it made total sense to me that being relaxed reduces muscle tension, and in turn alleviates pain so it isn’t even there or an issue.
Also with all the things she is lending you, she is saving you a small fortune.
You only get one go at this birth and although I’m going to fight for my NHS Trust to provide the service they are meant to be.. I totally understand your choice. I do wish that we had the means to be able to do this ourselves or to hirer a Doula.
XxX

 

[Kess]

Oh that is brilliant! I love that she is establishing the mindset of dispelling fear in childbirth. I believe that is so important to achieving a great birth. I have read Dr Dick Grantly-Read's book "childbirth without fear" and it made total sense to me that being relaxed reduces muscle tension, and in turn alleviates pain so it isn’t even there or an issue.
Also with all the things she is lending you, she is saving you a small fortune.
You only get one go at this birth and although I’m going to fight for my NHS Trust to provide the service they are meant to be.. I totally understand your choice. I do wish that we had the means to be able to do this ourselves or to hirer a Doula.
XxX

Normally I'd be all up for fighting lol, I'm the one my husband gets to "deal" with pushy salesmen or issues with bad customer service after he's tried the nice guy approach. But I don't want to spend the entire rest of my pregnancy worrying if they'll show up or not, or if they'll be horrible midwives who don't support how I want to do things etc. It doesn't help that an old friend of mine from school is a qualified midwife, and knowing how she is, the idea of not meeting my midwife and pre-approving them to attend me is a scary thought!

It's my first baby, and I have panic attacks and depression anyway, I really need this to go well in order to bond properly with my baby. I know myself well enough to know that a "traumatic" birth (for me, anything where I felt too out of control) would hamper that so I need to do all I can to give myself the best chance. Hubby, bless him, has said although it's a lot of money he'll leave it to me to decide as I know best what I need for the birth etc. I can't work because of a disability and he's only at an early phase in his career so our income is quite a bit below average for a couple, but we're frugal and save a large proportion of our income each month. Times like now, that comes in handy! Future babies, I'm more likely to fight, or at least to have a birth-only package with an independent which is about 1/3 the price of the all-inclusive.

She listened in to the heartbeat with a doppler too, and it was there, strong and regular. I was scared about letting her try, as the NHS midwife warned me they don't try before 16 weeks as they mght not find it and then I'd worry, but she said the reason they say that is they don't have time in a typical appointment to look extensively. She said, "We've got the patience and the time to keep looking, we'll find it" and she did. It was so nice .