First Contact: Connecting with a Midwife

I just got some wonderful news - a good friend of mine is pregnant! She emailed me to ask some questions about how to approach home birth midwives, how to set up consultations, and the overall protocol of what to do in the early weeks when a home birth is desired. I remember feeling a little confused about how it all worked in the beginning myself, so I thought, of course! I'll share it on le blog. (With permission, of course!)

Her original missive:

I am pregnant! 6 weeks. Ah, I really don't think I have ever been so happy about anything in my entire life. Really, this is a dream come true. As happy as this makes me, I am also well aware that anything is possible at this early stage. So, please do not say a word to anyone. We plan on keeping it to ourselves and immediate families until 10-12 weeks. Thank you.

Since you have been through all this and seem to have an endless supply of information, I would love to ask you a few questions. Please don't feel rushed to reply:

1. How many midwives did you interview?
2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?
4. Should I go to a doctor to get a blood test?
5. Do midwives do blood tests?
6. Any advice on how to approach a midwife?

I already have two/three midwifes that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincents. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???

Thanks, Anne.

Here's my response, with a few embellishments. PLEASE, midwives, doulas, experienced home birthers and others, correct me on anything that I might be mistaken about. Because she lives in New York City, there are some rules and regulations about which I only know the bare minimum. Comment and correct away!

Oh, I am just so tickled. WHEEE!

Ahem - on to your inquiries:

"1. How many midwives did you interview?"

I interviewed two. I honestly really liked both, but it came down to distance, primarily. One was just too far away - we could have made it work if there were no other options, but since I liked Nancy just as much as Vicki, why not go with her? And I'm oh so glad I did, as I just adored Nancy and her apprentice Gengi - though I'm sure I would have had a wonderful experience with Vicki & Co at Birth and Beyond as well. (To think I could have been attended by the great Amy Romano, by chance? I wasn't even reading her mighty Science and Sensibility blog at the time. Ah, close calls with greatness.)

"2. When you called them up, did you ask to meet up with them for an interview? Or, did you make an appointment for an exam? Do you pay them the first time you meet up? Any good websites out there for questions to ask a possible midwife so that we don't forget anything?"

With EACH of them, I called, told them my approximate due date and said I was interested in a home birth and would like to do an consultation. They each met with me for about an HOUR apiece, and I had really great conversations with them both. This consultation is, generally speaking, very much standard among midwives - I would have raised an eyebrow at anyone who wanted to charge me for an initial consultation.

BUT - and this might be a big but - New York State has its own set of laws and regulations regarding midwifery (it does with massage, too - every other state is pretty much the same, but ooooh, special New York has to have its very own system! *affectionate eyeroll*). You're going to be dealing with CNMs (Certified Nurse Midwives) as opposed to CPMs (Certified Professional Midwives), which won't necessarily affect the quality of your care, since these particular women deliberately chose to go into home birth, but it may affect some of their standards of practice in ways that I might not be aware of. Hope that makes sense!

Then you would go home, talk it over with your husband, weigh the pros and cons of the various contenders, and once you've decided, THEN make the first Official Prenatal Appointment.

As for payment, this varies from midwife to midwife no matter where you are. I'm sure most would absolutely LOVE it if you paid it all right up front, but I know that many will work out a payment plan as well, usually to be completed before or at least by your guess date (I will confess, it took me a a bit longer to pay off my remaining balance after Lily was born, but we did it! Thanks again for your flexibility and understanding, Nancy!)

[I will address the Questions to Ask in my next post, as that is a whole topic unto itself!]

(Was there a number 3? Or was that just Pregnancy Brain?) <----- Very much a real syndrome, as I'm sure you're discovering.

"4. Should I go to a doctor to get a blood test?"

Just to confirm pregnancy? Not necessary, unless there are specific personal reasons to do so. For example, if you had a history of miscarriage and wanted to get a series of *quantitative* blood tests done (this is where they measure the levels of hCG to make sure they're increasing appropriately), I could see why this might be something you want to do. But just for confirmation, no.

"5. Do midwives do blood tests?"

I assume we're talking about the overall initial blood workup, not testing to confirm pregnancy. Some midwives can and some can only do a few things, like blood sugar, not the full workup. Now, since you'll be working with CNMs, they most likely will do blood tests - that's one of the perks! If, as in my case, you were working with CPMs, you would "outsource" it by going either to a cooperative OB office, as I did, or going directly to a lab to get them, and would then bring the results back to the CPM.

Urine tests can always be done by either. And my midwives tested my blood sugar around 28 weeks, just, again, not the entire workup. YOURS very well might be able to do it all. I hope that's clear!

6. Any advice on how to approach a midwife?

With an 8x10 B&W glossy, a resume, and a prepared monologue.

Or, just give them a call and say that you just found out you're pregnant and are strongly considering home birth (even though you're already clear in what you want), and would like to do a consultation to find out about her practice and how it works. Like I said, this SHOULD be common courtesy/procedure, I'm just not 100% on NYC. DO ask whether there is any cost for a consultation, just to be sure. And then she'll take it from there! The first official prenatal visit, separate from your consultation, once you've selected a provider, might not happen until 12 weeks, depending (some might meet earlier - I'm just saying, don't be surprised).

"I already have two/three midwives that I want to meet with and then decide who to work with - that is what I should do, right? Both of them are home birth midwives with privileges at St. Vincent's. Both come highly recommended. I just want to make sure I feel comfortable with them before I hire them. I want to call them soon, but I am not sure what to say to them... How does it work???"

Already having a few to choose from is great! I definitely think you should meet with them all. Don't worry about not being far enough along, either - making these calls at this date is common and fine. And bringing your husband with you for the consultations is also very much accepted - some spouses/partners have reservations and meeting with the midwives helps address their concerns.

Okay, I'll give it a rest. PLEASE do not hesitate to ask other questions or just share more info!

Now, as I said, another entire post can and will be written about what to actually discuss in that consultation! Feel free to add your thoughts on that in the comments as well, and stay tuned!

(Man, I wonder if I'll ever run out of things to blog about. I have so many juicy up and coming posts already, and I just keep adding to the list . . . )