The first consultation with a potential midwife is, in practice, a job interview — except that many women don't treat it that way. They are grateful to be seen, relieved to find someone available, and inclined to interpret warmth and confidence as competence. Sometimes they are right. But warmth and alignment are not the same thing, and it is worth knowing the difference before you sign on.
These are the questions that matter.
About their practice and experience
How many births do you attend per month, and how many per year?
A midwife attending too many births may not be available when yours begins. Too few may mean limited recent experience. Ask what happens when two clients go into labour simultaneously — who attends, and what is the backup arrangement?
What is your transfer rate, and what are the most common reasons?
A midwife who claims never to transfer may not be recognising when transfer is appropriate. One who transfers frequently may have a low threshold. Neither extreme is ideal. What you want to understand is their clinical judgement — and their relationship with the local hospital system.
Who is your backup midwife, and have I the opportunity to meet them?
You should meet the person who may attend your birth if your primary midwife is unavailable. This is not optional. Ask for this meeting to be arranged before you commit.
About their philosophy
How do you approach informed consent during labour?
What you are listening for: do they describe a process of sharing information and supporting your decision-making, or do they describe a process of recommendation and compliance? Both exist. Know which one you are hiring.
What is your approach to monitoring during labour?
Intermittent auscultation is standard for low-risk home birth — Doppler monitoring of the baby's heart rate at regular intervals. Ask how frequently they monitor, what they listen for, and at what point monitoring findings would prompt a recommendation to transfer.
What do you see as the role of a birth partner or doula?
Some midwives work closely with doulas and welcome additional support. Others prefer a smaller room. Neither is wrong, but it should match your birth plan.
About the logistics
What does your fee include, and what is not included?
Prenatal visits, birth attendance, postpartum visits — clarify exactly what is covered and what is billed separately. Ask about the supplies they bring versus what you are expected to provide.
At what point in my pregnancy do you stop taking new clients?
And conversely — at what gestation do you no longer accept a transfer client if my current arrangements fall through?
What are your requirements for a home birth — what would make you not attend?
This question surfaces their clinical criteria for home birth safety and helps you understand whether your situation is straightforwardly within their scope, or whether there are factors that need discussion.
The question beneath all the questions
When you leave the consultation, ask yourself: did I feel like a person whose choices and knowledge were respected? Or did I feel managed? Trust that feeling. It is telling you something accurate about the relationship you are about to enter.
This essay is part of the ongoing Journal at The Home Birth Path. The full Preparation Guide includes a printable version of this question list.
