There are many great Web sites out there which can help you figure out which midwife is right for you. The following is my favorite list (it is huge, about 10 pages long).

You may also view a shorter list from Midwifery Today.

And here is another list of interview questions:

These questions will give you so much insight about how a person practices that you will be able to know without a shadow of a doubt what your midwife will do in a given situation. If your midwife dodges a question, or refuses to answer or gives general responses, ask her to be more specific. If she cannot give responses which suit you, find another midwife…It is more than just a question of degree or training; it is a question of how they will treat you and your family during the birth and how they will they manage a birth

Even within the field there are different kinds of midwives in their management of pregnancy birth and postpartum.

We need all kinds of midwives for all kinds of people. Choosing a midwife needs to be as private a matter as choosing a spouse. No midwife is right for all people, no matter what letters she has after her name. More important than choosing CNM, CPM or TBA is choosing a woman who has the experience, protocols and gives you the confidence you can birth your own baby.

Midwives are not just one of these “types.” Like people looking for midwives, midwives are a mix of beliefs and systems of management. These are arbitrary groupings but the wide variety of ‘midwifery care’ needs to be noted so that a person seeking midwifery care can understand that there are many personal choices that each midwife makes, and they might experience in their midwife. Midwives come from so many different backgrounds and points of view that it might be hard to believe that it is the same profession. When you can see a more conservative midwife give one point of view and a more radical midwife give just the opposite point of view on the same subject, it can be confusing.

In the end you must decide for yourself what kind of care is best for you. A midwife must be someone you trust and someone who you believe in, who has answered your questions and has the skills to handle everything that might come up. Its important to note the many differences in style in midwives you might interview, especially when one midwife makes you uncomfortable, yet another makes you feel more comfortable.

This site lists the common protocols that most midwives will adhere to. Your midwife may be different finding this list too restrictive or not limited enough, but this is a fairly standard list of what most midwives will handle at home.

You can find different places there that will define normal, risk factors, reasons for transport etc. Ask midwives you interview for their protocols and discuss them together.

These midwives practice in ways that are very medical. They have a style that errs on the side of caution and uses standards of practice in the medical profession in their area as their gold standard. You will probably see a high level of transport in this population for “midwife dystocia” or things that are happening during the birth outside of the midwife’s comfort zone. Midwives of all certification levels might provide this type of care. You might see a medically styled practice in their attitude toward pregnant women, prenatal appointments, testing requirements or labor and birth management. A large practice may need for there to be a fleet of midwives and you never know who will be on call for delivery, just like an obstetrical practice. Prenatals may be very short, possibly due to volume, without much room for questions and explanations. They may have time limits similar to hospital practice on the length of labor, length of pushing stage or length of time to deliver a placenta. Women may “risk out” of homebirth for relatively minor issues in pregnancy.

Many people will feel more comfortable with women of this practice type. They feel medically supported and have a sense of safety about homebirth because of this level of care. Some midwives may be very conservative on certain points because they have run into trouble with past clients on a certain topic (GBS, VBAC, Grand Multips, emotional issues) and will deal more medically with clients showing similar issues, or refer the clients out to other midwives or physicians.

Some people will feel betrayed by midwives who practice in a more medical style. It can be particularly hard in labor to discover your midwife favors a more medical model when this was not discussed before hand. Yearning for a different form of practice, people will find themselves in a similar predicament to the hospital-too many rules to follow. You can avoid these problems by screening the midwife in the beginning by asking lots of questions about her practice style. Clients must decide for themselves with whom they want to be and find the right type of practitioner. There are always other choices that can be found with dedicated investigation.

These are midwives who practice in ways which are more to the standards of the midwifery community in the area. Midwifery standards tend to be more liberal than hospital-styled standards, however there are still standards within the community of midwives who practice in a given area. Most midwives believe in birth as a normal process, but certain situations will cause consternation and will be likely sources of legal or medical trouble, so these situations are referred out. You will see a longer average prenatal visit and more room for questions in this kind of midwifery. These longer prenatals also offer an opportunity to screen clients. Few midwives will take a client who is very anemic for example, or who has certain medical problems or history, or who exhibits specific problems in pregnancy or in labor.

These midwives have the experience to know the difference between being too conservative and exposing too many clients to transport, as well as the maturity to identify situations that are uncomfortable for them or their clients, or do not they have the supplies or training to handle. Many people feel most comfortable with midwives who practice in this style and it is often what they expect when they look for midwifery care.

With midwives from the more traditional form of midwifery as it is practiced today, you will see a more individualized approach. These midwives will try to create an environment of support on many different levels including nutritional, emotional, spiritual, as well as physical support through positioning or other forms of movement to assist delivery. There is greater emphasis on the length of prenatal appointments, taking up to an hour or more to discuss the many aspects of a woman’s life that might impact her birth, and every effort is made to strengthen the weaker areas and build up areas that are going well.

The birthing environment itself is created to be responsive to the woman’s needs, and the woman’s labor will lead the protocols that need to be followed. These midwives often use herbal and alternative medicines throughout the course of pregnancy and delivery. Clients must be aware that much of their management may use herbal remedies and clients must feel comfortable with these remedies.

However, your particular midwife may have different degrees of herbal knowledge and alternative medicine. Some midwives will use herbs knowledgably and extensively, others will not use discretion in dosing and therapies, and some know very little about herbal or alternative medicine. You must become educated for yourself on what you will and wont use as part of your labor and delivery. Discuss these things with your care provider before hand.

For clients seeking a more holistic approach, midwives who use traditional methods will resonate best. A client seeking a midwife able to handle the various aspects of a birthing woman’s experiences and to see how those experiences effect the birth, Traditionally styled midwives will work best.

These are women who practice outside of the standard protocols of the midwives in a given area. Due to religious conviction, special training, or plain chutzpah these women practice in a manner more free-form than the majority of women in their profession. Often these are midwives who have practiced for more than 15 years, or even 25 years and more in some cases. They have seen so much variation in terms of “normal” and have educated themselves to such an extent, that they are comfortable handling situations that most midwives would refer out to physicians. These midwives will handle all manner of clients, all manner of variations of pregnancy, sometimes including twins and breeches, and are confident in their knowledge of medical interventions, herbs and alternative therapies to handle almost every situation that comes up.

These midwives will often boast a very low transport rate, 2-4% of their clientele at most will need to transport for cesarean section, assisted delivery or postpartum. They also have a loyal and dedicated following. The down side is that occasionally risks do have bad outcomes. While these midwives are popular when they practice, if something happens, the law is not on their side, even when they are not at fault. Sometimes midwives who encounter unavoidable trouble in birth are grouped into this category, even when they are actually very conservative in their practice. Special training may make a midwife a “radical” in some areas (VBACS, twins or breech births) but very conservative in other areas of their practice.

For families who believe fervently in birth at home and believe it is the only option for them, or for those who develop circumstances such as a breech or twin birth, and do not want it handled in the hospital, these midwives are their only option.

For the family:

A birthing family is not in legal danger of prosecution in a homebirth in PA, because it is unconstitutional to be forced to birth anywhere. Accidental birth outside of a hospital is not a crime. There have been cases of bad outcomes (fetal or maternal deaths are the only concern and they are rare) being investigated, however since a family is outside of the hospital system, they cannot be held responsible for the problems.

However, if a mother does seek medical care and is under the care of a physician and THEN chooses to go against medical orders and then has a poor outcome it can be considered criminal because they were in the system and chose to go against it. It is safer from a legal point of view to never enter the medical-legal morass than to try to leave it once the series of involved parties has grown to include a hospital, doctors, their lawyers and a host of others.

The legal rights of parents are being more and more eroded as the birth industry grows stronger. Check with your legal counsel for the most up to date legal advice. Click here to work with legal means

For the Midwife:

Technically, homebirth midwives in PA are alegal. They are tolerated in practice, however if there is an active complaint (a lawsuit) filed, a midwife may receive a cease and desist order. If there is a poor outcome hospital staff at the transporting facility may alert the authorities. While this is not as much of an issue in counties that are heavily Amish and Mennonite, areas with a more suburban and urban population are more likely to have a suspicious view of midwives and their activities.

CPM’s s and TBA’s can still be brought to trial for practice of midwifery without a license; this felony carries approximately a 2-year sentence. Currently, the law only recognizes CNMs as providers of midwifery care, but that has changed recently in 2 states TN and VT and we can only hope PA will join. Currently in PA a woman can have an unassisted labor at any time anywhere, which has a 40% higher chance of problems than an assisted delivery, but if a CPM or TBA shows up to provide skilled care that midwife can go to jail for the practice of midwifery without a license. While it might seem archaic, it is the legal situation. But, the dedicated women who show up to help a woman birth risk their freedom. Hopefully you understand that risk your CPM takes inorder to attend you. CPMs often do their job as a spiritual calling. Click here to help with activism to get that degree recognized in PA.

This lack of legal status in for midwives PA becomes a problem for those who are litigious. If you plan to sue your midwife or anyone else for a poor birth outcome, consider those practitioners who carry insurance, such as hospitals, OBGYNs and in hospital CNMs who have developed protocols to protect themselves from litigious suits… that is why birth in hospital has the bizarre rituals it has developed.

CPMs and TBAs are free to practice without those protocols, only because they risk their personal freedom and financial lives in the process. Midwives thrive in Anabaptist populations such as the Amish and Mennonites because the people of those populations will not sue the midwife for a poor outcome due to their religious convictions. While poor outcomes are rare, they can happen anytime in birth. When lawsuits do occur it often marks the end of a midwife’s career, causing financial ruin and at worst jail time for the midwife.

Part of choosing a homebirth is placing yourself- the mother and father- of the baby as the responsible party. If you cannot as a parent handle the fact that you might bear a child with severe problems, you might need to re-think what you are asking of reality. Anyone who risks the joys of birth also risks having a child who is less than perfect. If you choose to view such a birth, not as an Act of God, but as something that needs to have blame placed on someone, you are not a good candidate for homebirth.

If you need to express your grief and suffering on these matters through legal means, you must consider the hospital and it’s protocols as your only choice. You are responsible for the risks and benefits of your birth and the risks you put yourself and your child through in your life. It is your job to make sure the person you have decided to have in front of you during your birth is a qualified professional with the equipment, training and skills to handle your birth and what might come up in it. Midwifery cannot guarantee a perfect child but it can give you the best odds of it occurring.

There is no malpractice option for those who choose homebirth, so either choose homebirth because it is the right decision for you and your family and your belief system or go to the hospital and enjoy the standard of care there.