What to Expect at a Midwife Interview

Most initial consultations run 45 to 60 minutes, and some practices schedule 90 if they include a full health history intake. Expect to spend about half the time hearing about her practice and half asking your own questions.

Some midwives do a first pass by phone for 20 to 30 minutes, then schedule an in-person meeting if both of you want to keep going. That saves time if her practice is full, she doesn't serve your area, or your health history puts you outside her scope.

Bring your partner or a support person. Many midwives prefer it, because they want to meet everyone who will be at the birth. Ask what the consultation costs when you book: some practices don't charge for it and some do.

She'll ask about your health history, including previous pregnancies, surgeries, medications, and conditions like high blood pressure or diabetes. That's how she works out whether home birth fits your situation or whether you need specialist care alongside it.

She'll also ask about this pregnancy: your due date, any complications so far, where you're getting prenatal care now, and why you're considering home birth. If you're early or not yet pregnant, she may ask about your general health and risk factors instead.

Expect questions about your living situation, like whether you have running water, how far you live from a hospital, and who will be present at the birth. These aren't judgments. They're logistical factors that affect planning and transfer time.

Ask how many births she has attended, both as primary midwife and as assistant. For CPMs, NARM's portfolio route sets a floor: at least 10 births attended in any capacity, 20 as an assistant under supervision, and 25 as primary midwife under supervision, with 10 of those out of hospital, alongside 75 prenatal exams and 40 postpartum exams. ^[1] That is the minimum to certify, not a description of a seasoned practice. Many midwives have attended several hundred births.

Find out her transfer rate and what her clients transferred for. MANA Stats reported intrapartum transfer rates of 22.9 percent for first-time mothers and 7.5 percent for experienced mothers across 16,924 US planned home births, with an overall rate of 10.9 percent. ^[2] Birthplace in England reported 45 percent and 12 percent for the same groups in a different maternity system. ^[3] Use both as context rather than a target, and ask specifically about emergency transfers versus non-urgent ones for things like a labor that stalls or a request for pain relief.

Ask about her training and credential. CPMs are certified by NARM, and the CPM is the midwifery credential built around out-of-hospital experience. ^[1] CNMs and CMs are certified by the American Midwifery Certification Board, and CNM training is primarily hospital-based, though many CNMs attend home births. ^[4] Ask whether she carries malpractice insurance and at what limits. Many midwives attending home births do not, ^[5] cost and availability vary by state and credential, and states differ on whether coverage is required at all. Carrying it is one signal about a practice's risk infrastructure, not the only one.

What a midwife carries and what she is licensed to administer vary by state and by credential, so treat this as a question rather than a checklist you can score her against. Ask what she brings to a birth, what she is authorized to give under your state's rules, and what she would do if she needed something she doesn't carry. Ask to see the bag if you want to; most practices are happy to open it.

Ask her to walk through her protocols for the complications that actually come up: a labor that stops progressing, meconium in the fluid, bleeding after birth. Specific answers beat reassurance. At what estimated blood loss does she act, and what does she do first? What fetal heart rate pattern moves her from watching to transferring?

Find out when she calls for backup or transport. Practices usually have written thresholds: a blood loss volume, particular heart rate patterns, a time limit on labor without progress, or your own request at any point. Ask which hospitals she transfers to and whether she has working relationships with physicians there.

Most midwives charge one flat fee covering prenatal visits, the birth, and postpartum care. A survey of 129 practices across 49 states put the average global fee at $4,650 and the median at $4,400, with a range from $2,000 to $9,921 and regional averages running from $3,976 in the Midwest to $5,299 in the Northeast. ^[6] Ask where her fee sits in that spread and what drives it.

She'll break down what's included. Practices commonly cover a set number of prenatal appointments, on-call availability starting around 37 or 38 weeks, labor and birth, immediate postpartum care, and several home visits in the weeks afterward. Some include birth pool rental, lab fees, and newborn screening. Others bill those separately. Get the list in writing rather than from memory.

Ask about the payment schedule. Many practices take a deposit at hiring, then monthly payments with the balance due around 36 weeks, but the amounts differ enough that you should ask for her actual numbers. Ask what happens if you move to hospital care before labor, since refund policies vary. Also ask whether she bills insurance directly or gives you a superbill to submit yourself.

She'll describe her general approach: does she actively manage labor with frequent exams and position changes, or does she take a more hands-off approach? Neither is wrong, but you want alignment with what you're hoping for.

Ask about her views on common interventions. Does she do routine cervical exams, or only when there's a specific reason? Will she break your water to speed labor, or wait? Does she cut episiotomies, and if so, under what circumstances?

Talk through pain management. Home birth means no epidural, so ask what comfort measures she uses, how she works with water and position changes, and what her experience with unmedicated labor looks like. If you're worried about pain, say so. Her answer tells you whether she's someone you can be honest with.

Ask about her backup system. Who covers if she's at another birth, sick, or away? Will you meet her backup midwife before labor? Some practices have partnerships where you meet everyone, while solo practitioners have arrangements with other midwives you may not meet until labor.

Find out when she wants you to call during labor and when she'll come to your home. Many midwives come once you're in active labor, often described as contractions every 3 to 5 minutes lasting 60 seconds for at least an hour, but the trigger varies by practice. Ask whether she sends an assistant or apprentice first or comes herself.

Talk through postpartum visits. Practices commonly visit at home within the first day or two after birth, again a few days later, and at least once more before six weeks. Those visits usually cover your bleeding and healing, the baby's weight and feeding, and newborn screening where your state requires it. Ask how many are included in her fee.

Pay attention to how she answers hard questions. If you ask about emergencies or complications, does she give you straight information or brush the concern aside? You want a midwife who respects the worried questions as much as the easy ones.

Notice whether she listens. Does she interrupt, or let you finish? Does she ask follow-up questions about your specific situation, or hand you generic answers? A good midwife treats you like an individual.

Trust your gut about the relationship. You'll be calling this person at 2 a.m., letting her into your home during some of the most vulnerable hours of your life, and relying on her judgment in an emergency. If something feels off, even if you can't name it, keep interviewing.