How to Pick a Midwife

stellasoo

I'm planning a home birth. DH and I narrowed our midwife options down to 2. They're very similar as far as philosophies, how they handle different things, number of pre- and post-natal appointments, cost, distance, positive reviews, etc. The major differences are in experience level and personality.

MW1 has attended significantly more births (1000+ between the 2 MW's in the group). They were both very nice but serious and I don't feel like I could be myself with them. 

MW2 has less experience (about 300 between the 2 MW's in the group) but I feel 100% comfortable personality wise and don't have any qualms about how we would work together. The other pro is that if the baby is breech, they would consult with a MW who has significant experience with breech deliveries and she would possibly take over as the primary MW. I don't know if I would want to try a vaginal breech delivery but it's nice to know it could be an option. It would absolutely not be an option with MW1. 

Do you think 1000 births vs. 300 births would make one MW better than the other? At what number of births does the extra experience not really make a difference? Or should personality weight more than experience? I don't know anyone who has had a home birth or natural birth IRL so I'm hoping to get your thoughts. 

Thanks!

painttheair14

I would go with mw2 because how they make me feel during labor is more important to me than experience and 300 is still a significant amount.

I will say however that my MW only had attended 60 births (I had no other options where I live) and I absolutely loved her!! I felt totally safe with her as well.

painttheair14

You will want to be as relaxed as possible during labor so what makes you more relaxed: knowing they've attended more births or a calming personality?

Remember though that the 300 births is no small number! Just much fewer in comparison.

*LrCg*

I've had several homebirths so I am a supporter of homebirths.  However, right now the big issue in homebirths is qualifications of the provider.  So to me the qualifications would be more important then the number of births attended.  I went with a CNM.  I think some people think CNM are too doctor/medical minded but she is very much in keeping with birth is natural.  She is allowed to bring oxygen and carry certain drugs with her on a birth (for instance I have a blood clotting issue (its controlled and I treat for it so I've never been not eligible for homebirth) & in my last birth I actually needed pitocin after the birth which is the FIRST time I've ever needed that as breastfeeding usually resolves it), if I would have used a lay midwife that would not have been an option for me.  I also admired her relationship with hospitals and doctors.  They respect her and her opinions and sometimes doctors have came to her for advice.  I liked that fact that IF I ever had to transfer she wouldn't be in a shadows of a hospital- she'd be out front directing.  I also agree with PP about asking about her status on transfers, etc.

Lastly, I see you are still in your first trimester, right now you may not feel very compatible with one of the midwives however you have a long time to establish a bond.  The shortest appointment I've ever had with my midwife was 1 hr 20 min (and I'm on baby #4 with her)- and from what I hear that's pretty common with homebirth midwives.  So imagine seeing her every month for at least and hour then going to see her every other week for at least 1 hour.  You will develop a relationship. 

stellasoo

Thank you so much for all this insight. It's incredibly helpful. 

We did talk to both about transfer rates, adverse outcomes, etc. The group that has attended more births has about a 10% transfer rate and 2% of those have gone on to have c-sections. They said the transfer rates have been varied - everything from the mom wanted an epidural, to maternal fatigue to more emergency reasons like the baby needs to get to the NICU. They've never had a mom or baby pass away. They do not carry oxygen but do carry meds to stop hemorrhaging. They've never attended or seen a breech vaginal birth. One of these MW's is a CNM. 

The group that has attended fewer births has had 1 transfer. They said that mom had been on the fence about home birth the entire pregnancy and decided mid way through labor that she wanted to go to a hospital. They had 1 baby who needed CPR - they were able to revive the baby and everything was fine. They have been assistants at 3 breech home births all with good outcomes. They carry oxygen and meds to stop hemorrhaging.

stellasoo

Just wanted to say a quick thank you for all your responses. We decided to go with MW #1. Their experience will put me at ease more than any warm fuzzy feeling they could give. We're talking about having a doula so she can be the calming person.

sschwege

stellasoo said:

Just wanted to say a quick thank you for all your responses. We decided to go with MW #1. Their experience will put me at ease more than any warm fuzzy feeling they could give. We're talking about having a doula so she can be the calming person.

I think that's a good choice.  I had hospital births so different experience, but there were 7 MWs in the practice and only 1 I didn't want.  I remember telling DH anybody but her.  Not that she was rude or inexperienced, I just felt no connection with her.  Of course it figures she was the one on-call the day I went into labor, but she was wonderful!  I remember her sitting on the edge of the bed while I was pushing, she had such a calm, soothing voice, I just knew everything was OK and we were both in good hands.  One and a half years later when I was pregnant with DS I saw her and she still remembered DD's birth so clearly.  Keep an open mind, she might surprise you!