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Revamping the Midwife Interview

The Interview

Ah, the old midwife interview. If you are searching for a midwife, you will soon see there are tons of lists all over the internet of all the questions you should ask during the midwife interview. As providers, we can tell you that these questions are sometimes awkwardly written or won’t provide you with the information you are actually seeking…. or they are asking questions the provider can’t actually answer without violating another woman’s medical privacy. It is time for these questions to be rewritten!

Keep in mind that if the provider you are interested in holds informational meetings about their practice (such as a “Meet the Midwife” night), you may not need to ask any questions as they may provide you with all of this information right away.

When interviewing a provider (midwife OR physician), it is also perfectly acceptable to skip questions. Why ask about VBAC rates if you are uncertain what a VBAC is? Asking questions about policies regarding advanced maternal age when you are only 21 years old may simply be a waste of time. You should ask questions in which the answers matter to you.

Time to take on the old and awkward questions!

Old question: “What made you become a midwife?”

We recommend, “What fuels your desire to continue in midwifery?” The provider you are speaking to may have come into this profession a long time ago and for a wide variety of reasons. What makes them tick? What makes them stay? You will learn a lot more about the provider by asking them about their current thoughts and passions.

 

Old question: “What is your philosophy of care?”

We recommend questions such as, “What model of care do you generally practice under?” or “Do you practice according to the local standards of care? Why or why not?” If it is a group practice, “Do all of the providers here practice according to the same policies? Will my birth options change depending on who is on call when I go into labor?” These questions will simply get you a lot more information than the practiced answer about philosophy. What is likely more important to you is how the general philosophy of the provider plays out in actual practice.

 

Old question: “Have you ever missed a birth?”

We recommend, “How do you ensure adequate coverage for the women in your practice?” or, “Has a woman ever birthed without a provider due to lack of provider availability?” Doctors and midwives will miss births. Some women have very rapid labors. Some women wait too long to call. Sometimes there are blizzards or flooded roads that make the commutes take longer. If a midwife doesn’t have anyone she uses for back-up services, what happens if she has a family emergency? If she has a community of midwives she uses, how often has that been needed? If it is a group practice, how do they manage their call schedule? This is what you actually want to know!

Old question: “Have you ever lost a baby?”

Ugh. I hate this question. According to the March of Dimes, stillbirth affects approximately 1 in every 160 pregnancies. Then, there are babies who are born with health complications who may not survive the first year of life. Helping women through miscarriages during the first trimester is extremely common and sometimes we also help women who have had a miscarriage in the second trimester. If a provider hasn’t had a loss in their practice, it is only a matter of time and statistics. It is heartbreaking to walk with families through losses. It is absolutely the hardest part of this job.

We recommend, “Have there ever been any formal complaints filed against you?” or “Have there ever been restrictions placed on you/your license?” or “Has your license or certification ever been revoked?” or “Have you ever been accused of negligence or malpractice?” or “Has a mother or baby ever suffered injury or death in your practice due to negligence?” These are the things you really want to know, right? My guess is that people don’t want to know if a provider helped with the loss of a baby out of morbid curiosity, but they want to know if the provider has ever been responsible for a bad outcome.

 

Old question: “What is your religion?”

We recommend, “Can you offer care that is sensitive to my culture/religion?” If you want to feel free to pray during birth or there are specific practices to your religion or culture, what you need to know is that your provider will do everything in their power to be respectful. They do not need to match your beliefs to be respectful and sensitive. Also, keep in mind that in group practices, we cannot ask about religion during interviews and so while I know my own beliefs, I cannot make any promises about the beliefs of anyone else in the practice.

 

Old question: “Do you have children? How did you birth them? Vaginally or c-section? Did you have them at home?”

Instead…. just don’t. Not as part of the interview. One’s ability to provide excellent care has everything to do with their professional experience and education and really nothing to do with their physical abilities to get pregnant or give birth. The provider you may be interviewing may be struggling with infertility. They may have medical needs that do not allow for them to have an out-of-hospital birth. I am not saying it is never appropriate to chat with your provider about their family or personal life, but it shouldn’t be part of the interview and it shouldn’t be part of your decision making about who to hire.

 

Old question: “What makes you better than the provider we interviewed in the next town?”

Yeah…. no. We won’t answer that one. That other provider in the next town (or in our case it would at least 4 counties away)?  That midwife is likely to be a friend and colleague. It is likely that she is amazing and provides great care. This is why you interview, so that YOU can decide which practice/style/personality is the best fit for you. Don’t ask us to throw someone under the bus to win you over because we just won’t do it.

 

Old question: “How many births have you attended?”

There isn’t actually anything wrong with this question, but I put it here for clarity. Compare apples to apples if you are basing some of your decision on the number. Some midwives will answer to include every birth they have ever attended in any capacity. Others may only tell you the number of times they were actually the primary provider. Being the doula at 1000 births is different from being the midwife at 1000 births.

 

Old question: “What is the most beautiful birth you have attended?”

Births are beautiful and miraculous, all of them. This question feels unanswerable.

 

There are good, solid questions worth keeping around.

There are plenty of other good questions you can ask as well:

  • What is your practice transport rate? Emergency transport rate? Then, ask more questions if the numbers seems unusually high or unusually low… a higher transport rate might be a more conservative practice or it might be a practice that is very popular with first time mothers. If a midwife has an extremely low transport rate, it might be that the midwife is taking risks or it also may mean the practice serves a community that tends to be low-risk and healthy with very little need to transfer care. Ask a few more questions if the number feels off to you.
  • Do you have a preferred non-emergency transfer hospital? What do you like about that location? Is this different than your emergency transfer hospital?
  • What is your training and experience? Are you certified by any organization? Are you licensed? What are your exact credentials (CNM, CPM, LM, DEM, TM, etc)?
  • Do you participate in local professional organizations? Peer review? CEUs? NRP/CPR up to date?
  • How many people from your team attend each birth? Do you have enough people to feel you are able to adequately handle a resuscitation or other emergency?
  • Anything else that you want to share with me or that I should know?

 

Keep in mind there are no perfect answers. These are jumping off points to get a sense of the practice. Happy interviewing!

 

2 Responses to “Revamping the Midwife Interview”


  • Stacy Vandenput, CPM / / Reply

    Wow Erika! This is an excellent article, AND it rattles me a little. Many of the “old questions” are built in to my consent documents. I don’t want to have to rewrite them! (DAUNTING!) Thankfully, many of the “new questions” are built in to my consent docs too.

    Times are changing (changed), and the professional midwife role is much better represented by your new questions. Coming from traditional midwifery to professional midwifery, I feel reluctance to give up some of the language and interview methods that shaped midwifery in the earlier days. There was purpose in sharing our personal childbearing journey and “midwifery philosophy” with potential clients. Part of that purpose is to level the power dynamic with clients, and part of it was to establish that we midwives were not practicing medicine. We no longer have to dance around the subject of practicing medicine without a license, but I like what happens when clients feel the sense of personal strength that comes from not holding the midwife in superior esteem to themselves.

    It feels complex. It WAS complex! Essentially we had to show capability without hinting at medical authority. Thus we discussed philosophies and personal experiences instead of policies and negligence. I’m going to have to ruminate on this a bit! How do I maintain the equality of personhood that the old way engendered (and the benefits of it) while embracing the good things about professionalism that the new way commands? I love the new questions! But I’m an old dog!


  • Erika Urban / / Reply

    Stacy,
    I would never presume to tell midwives what they should or should not include in their informed consent documents or as part of their consultation. If you feel strongly it is important for you to discuss your childbearing or religion or anything else, then you should continue to do so! It is your practice and the consultation is a representation of you!

    What I am trying to assist with is families who ask questions without really knowing why they are asking. They print a list off the internet and go down the list. I have had the experience of attempting to answer really awkwardly worded questions and when I ask, “What do you mean?” often families will shrug and say, “I don’t know, I thought I was supposed to ask that.”

    I don’t feel it is an issue of traditional vs. professional. I think this is more about clarification. Does a person really want to know if a midwife has ever missed a birth? Or are they really asking if the midwife answers her calls and provides back-up if she can’t make it for some reason?

    I have spent years explaining my philosophy of care (which sounds pretty much like the philosophy of every other midwife I know), but how does that philosophy actually play out? How does it guide my providing of informed consent? How does it guide decision making?

    I find that the best way to maintain equality between myself and women who are coming to me for care is in how informed consent discussions are presented. I like to make sure that I use language and a style that ensures women feel they are free to make the decisions that are right for them.

    Again, I am not saying in this post that midwives shouldn’t include any of the above questions or information. I am saying that if families ask questions written like the “old questions” they may not get the information they are actually seeking.


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