Choosing a VBAC care provider: OB or midwife?

I’ve decided that I’m going with a midwife. For those of you that know me, you know this wasn’t a tough decision based on my first birth experience. For those of you that don’t know about it, check out my birth story. Experiencing a vaginal birth is important to me (although I know it’s not for all women). I am aware of the risks associated with having a VBAC and with repeat c-sections (I’ll post those stats next week!) and have put plenty of thought into it. If I continue seeing OBs, especially in my region of the U.S., I may never get to experience the vaginal birth that is so important to me.

Let me explain… even classified as a low-risk birth, I would have a nearly 90% chance of having a repeat cesarean section. That’s just based on the national averages. My city and state are statistically and legislatively more anti-VBAC, anti-homebirth and anti-midwife than most. When I asked my nurse while getting prepped for my first cesarean if I’d ever have a vaginal birth, she said “nope.” When I was in recovery and I inquired about it again, I was told there was only one clinic in my city that had doctors that would even consider it.

My OB and the rest of her clinic? They don’t allow VBAC patients. Not that I’d go back there anyway…

If I wanted an OB for my VBAC, sure I could find one that says they’ll let me try, but 1) my options would be slim and 2) odds are against me that when it finally came time for birth, I’d be pressured for another surgery.

So……. midwife it is.

For having all the VBAC fears that I do, using a midwife is not one of them. I’m happy to say that I am 100% confident in that choice. However… I need to find one!

Recently, the Illinois legislature sadly shot down the Home Birth Safety Act which would have legalized CPMs (certified professional midwives). There are CNMs (certified nurse midwives) that can legally perform homebirths, however. The main difference is training: CNMs train for birth in a hospital setting; CPMs train in a home setting. CPMs do exist illegally in Illinois (not covered by insurance), so if I hired one of them, I’d be having an “under the table, off the books” birth. But I’m not counting it out. If I fall in love with a CPM, I’ve gotta have her. The same goes for a legal CNM… if I find one I fall in love with, who shares my philosophy about birth and will help me experience a natural, vaginal birth… then I gotta have her! Another option is Wisconsin: CPMs are legal there and I’m only 30 minutes from the border. SO MANY CHOICES!

The decision has been made: vaginal birth with a midwife. When interviewing midwives, what questions do I need to ask? HELP?!

Here are the few I have in mind:

1) How long have you been attending births/how many births?

2) What’s your transfer rate? Under what situations do you transfer?

3) What do you think about internal checks? How often do you do them?

4) Will you be the one attending my birth? What if you’re sick?

5) Do you bring assistants to the birth? Who?

6) If we transfer, will you come to the hospital with us?

7) Do you put time limits on how late pregnancy can go, how long I can push, how long I can go after my water has broken?

8 ) Episiotomies–rate? prevention?

9) What is your philosophy on pregnancy and birth?

10) Do you offer prenatal care throughout the whole pregnancy?

11) Do you have kids, how were they born?

And of course questions about fees and payment plans. But I know I’m missing about a MILLION other questions. Have you interviewed a midwife? Have you had a VBAC or homebirth? What else do I need to be asking about?

11 comments to Choosing a VBAC care provider: OB or midwife?

  • Allie Sakowicz

    Hi Emily,
    I’m @futuredoctor19 on Twitter. Just thought I’d pop in and let you know you are more than welcome to contact me if you want my list of midwives in the Chicago area. I know you aren’t extremely close to here, but I also have the names of a few CPMs in Wisconsin near the border and such.


    babydickey Reply:

    Yes!!! Going to tweet you right now 🙂


  • I’ve had two births, both with midwives, but two very different experiences. I think the two biggest things to consider once you’ve decided to work with a midwife(wives) are a) what environment will they deliver you in (hospital, birthing center or home?) and b) who will be supporting them? (nurse, another midwife, doula, etc.) For me, those factors made the biggest difference in both of my births. Even if you choose to work with a midwife but you birth in a hospital you will be working with a team of nurses who are use to working with OBs and are going to be more supportive of “traditional” methods and will ultimately effect your outcome. A few additional questions that I would add to your list include:

    – Under what circumstances will they refuse to deliver you? (breech, etc.)
    – How long will they let you go past your due date?
    – If you are past your due date, will they try natural methods to help induce labor?
    – Will they encourage you to try different positions, etc. if the birth isn’t moving along as they would like?
    – What methods will they employ to help ensure you have the VBAC delivery?
    – Under what circumstances will they transfer you (to a hospital)? What is their transfer rate?
    – Can they provide any references? Do they have any successful VBAC clients who would be willing to provide a reference?

    Remember, YOU are your own best advocate and no one will fight for what you want and know is right better than you can. I think one of the biggest keys to having the birth that you want (natural and/or VBAC) is removing the hospital element. Working with a midwife does not guarantee that you will end up with a natural birth. However, I do think that having your birth in an environment (birth center or home) and with care providers that are supportive of your decisions and wishes your chances of having a successful VBAC or natural birth will be significantly higher.


    babydickey Reply:

    Thank you! Yes, that is so so so important–having a provider that is supportive and has the same philosophy about birth that I do. Your list is very helpful, thank you!


  • Paula

    Hi Emily –

    Great blog entry! I stumbled across it on my google reader for homebirth (good to set up if you want to read as much as there is out there on the internet on homebirth) and your questions look pretty good. Add Tamara’s and you’re doing even better. I’ve also been searching for the right homebirth midwife for my vbac so I’m right there with you.

    These are my personal tips, having been on the phone and interviewing midwives these last two weeks straight:

    -Phone interview as many as you’d like and then set up in home interviews with your top matches. They should offer to come to your house – to make sure the drive is OK for them, if all visits and the birth will take place at your home. They will want to see your space.

    -Pick your top, most important questions to ask in the phone interview and then ask the rest in person. Judging their personality over the phone and in person, how they interact with you, your personality, are key. Listen to if they’re paying attention to you or if they’ve got other things going on in the background. You want someone who can devote their time to you and deal with distractions/personal things/work issues after they are finished on the phone with you. Also, it is important that your partner and child be involved and make a connection with the midwife too. The midwife should want to meet you and your partner and your child at your home, to get a feel for you and your family.

    -Be sure to ask how many clients they take on per month. You’d like to find someone who will be 100% there for you, not juggling 3 people due every single month until you’re due, and then you’ll have to worry if another lady goes into labor when you do!

    -When you ask their fee, or fee range, what their deposit is, sliding scale or not, etc, be sure to ask if they use a billing service or if not, do they handle insurance or would you have to do all the legwork yourself.

    -If you’re looking for someone that will help you be calm and mellow, look for someone that gives you that good vibe. If you need a direct, coaching type, look for those qualities.

    -Ask if they are comfortable with whatever type of birth support you think you’ll need and if they’re flexible to change. You’re also going to have to pick between older, more experienced versus younger, less experienced.

    -Ask how many births they attend as primary each year and how many they act as second, or support.

    -Ask them if they recommend any books or videos. You can tell a lot about their philosphy, if it matches up with yours or not if they recommend Hynobirthing, Birthing from Within, Ina May’s books, etc.

    -Ask if they do any other work besides midwifery, from teaching prenatal yoga, to birth classes, etc.

    -Ask them if they have any questions for you.

    -While they are answering, it is good to judge them on what questions they do ask you. The good midwives, in my opinion, ask you everything about why you had a c-section the first time, ask to see your records if you choose them, ask you what you’re hoping for with your upcoming birth, why you’re choosing to have a (I assume, a healing, natural) homebirth, about yourself, your concerns, fears, hopes, family. Etc!

    If you become aware of what you really think is important for your birth and who you think will fit you best and help you achieve your goal, you will find the perfect match. Best of luck in your search!



    babydickey Reply:

    Hi Paula, thank you so so so much for taking the time to comment. Your list made me breathe a sigh of relief–I feel so much more prepared now! I love everything on the list. Many of them I never would have thought of and I could just see myself looking back and WISHING I had asked that. I really appreciate it. And best of luck to you on your provider search and your future HBAC!!


  • Warning: you may have a hard time finding a CNM who will do a homebirth if you haven’t VBAC’d before. I know Gina from The Feminist Breeder did. They’re trying to reduce their risks, because they’re pretty threatened there in Illinois. See if you can get recommendations from moms in your area, especially any VBAC-ers. (Here’s where Twitter can be your friend!)


  • Angela

    I am an Ob/Gyn resident and I have delivered 2 of my 3 children naturally with a midwife. I defiinitely recommend CNMs! However, I felt compelled when reading this to encourage you to deliver in a hospital setting. Although the risk of uterine rupture after 1 prior cesarean is low, the results are catastrophic. I think you can get everything you want out of the birth experience without compromising the safety of your unborn child or your own safety – find a CNM, be open about your hopes, and then remain flexible because labor/delivery is often unpredictable. Any provider who offers to deliver you at home is not invested in your best interests – a home birth can be amazing, but should be reserved for a very carefully selected patient without risk factors for complications. A 1% chance of uterine rupture doesn’t sound like much, but what a tragedy that would be for you and your famliy if it happened at home. Best of luck to you in this wonderful endeavor!


  • amanda

    i live in conway ar i resently went to see a v-bac doc in little rock and he refused to let me have my baby naturally because he says they do not do v-bac after the 3rd c-section i just feel thats not right because i am not being given a choice in the matter of having a c-section can someone please help me find someone who will deliver me naturally?????HELP!!..PLEASE


    babydickey Reply:

    Just emailed you, Amanda!!


  • […] This post was mentioned on Twitter by Sheri Wallace and Baby Dickey, said: Choosing a VBAC care provider: OB or midwife? […]

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