Interview by SafBaby Founders Sandra Blum and Samantha Fox Olson

After watching Ricki Lake and Abby Epstein’s documentary, The Business of Being Born, we really wanted to shine some light here at SafBaby on natural birth and midwifery. So, we interviewed the 2 filmmakers and happily bring you our exclusive interview today!

We know there are many things to consider when choosing a midwife. We wanted to address things that are most important and acknowledge that this is a really important decision. Truth be told, most parents spend more time researching a computer purchase than they do their birthing options, so we wanted to support the study.

Just sleepwalking into your birthing experience can potentially lead to a drastic outcome. On the other hand, making the right birthing choice for you, a well-educated and researched choice, can have a profoundly empowering and extraordinary results.

Interviewing Ricki and Abby About Educated Birth Options

What important factors should one consider in researching birth options?

We are just finished up our new book called “Your Best Birth” which deals with exactly that question! The book will be out in May 2009. But I think you need to spend time educating yourself about delivery options and then deciding where you would feel most comfortable.

If you are interested in seeking out a midwife or a birth center, you need to make sure that you are a good candidate for that type of birth and that your insurance will cover it. For a hospital birth, you should check out all the options in your area and find out the hospitals intervention statistics and the C-section rate of the practice you are are using.

Most importantly, make sure that you know what kind of birth you want early on – not at 36 weeks when it’s too late to change providers.

How should a couple choose a midwife? What are the most important things to consider?

First you should chose a location, as midwives practice in hospitals, birth centers and, in some states, in private homes. Once you sort through those options, then find out which midwives will be covered under your insurance plan.

When interviewing the midwife, make sure that you feel comfortable with her and that the personal chemistry is good. If she practices in a group, try to meet all the other midwives in the practice since you may end up with any one of them for your labor and birth. Your criteria should be the same as choosing an obstetrician or any healthcare provider.

How does one go about finding a skilled, experienced and certified mid-wife?

All midwives are certified either as nurse-midwives or professional midwives. The difference is that nurse-midwives went to an additional year of nursing school and can practice in hospitals.

Professional midwives normally only attend births outside of hospitals in homes or freestanding birth centers. Both types of midwives are trained, skilled and certified. You can find listings at or You can also find listings through your insurance company.

What is the difference between a birthing center and a hospital?

Some hospitals have a birthing center on a separate floor or in a separate building near the hospital grounds. Normally, these birthing centers are staffed with midwives and nurses who are experts at supporting low-risk, natural deliveries. Some obstetricians also deliver in hospital-based birthing centers.

Generally, the protocols are more flexible than the hospital’s regular Labor and Delivery floor so that patients can eat and drink, move around, labor in water and do not need to have continuous electronic fetal monitoring.

Anesthesiologists do not work in birth centers, so you won’t be able to get an epidural there. If you need any drugs, interventions or a C-section then you would be transferred to the hospital’s regular Labor and Delivery floor.

The other type of birth center is called a “freestanding” birth center which would not be physically connected to the hospital. Most of the freestanding birth centers are within a few miles of a nearby hospital and have a relationship or affiliation with the hospital in the event of a transfer. They are often more homey and have kitchens, courtyards and common rooms for laboring women and their families to relax. The are staffed by midwives.

Most women who have had a c-section are told that a 2nd vaginal birth is too risky, especially to try at home with a mid-wife. Is that true? Is it illegal in some states to even try?

Having a vaginal birth after a C-section is called VBAC. (Vaginal Birth After Cesarean.) Depending on the reasons for the primary C-section, a VBAC normally carries very little risk.

In past decades, VBAC’s were preferred over mandatory repeat C-sections. But what has changed is that insurance companies are refusing to cover VBAC’s in some places because they can get away with it. Sometimes they will only cover a VBAC if anesthesia and surgery are “immediately” available, but a lot of hospitals cannot afford to have OR on standby 24/7.

Even if the physician feels the risk is low and would prefer that the mother have a VBAC, they may not be able to offer it because of insurance restrictions. It’s a tragic loss of choice for the mother. Many midwives will attend VBAC’s at home because they feel the risk is minimal. Most obstetricians would agree that midwives can deliver VBAC’s but would prefer they do this in the hospital since there is a slight increase in the risk of uterine rupture.

In Abby’s situation, she had a medical doctor that was willing to be on call if she needed him for emergency. That is not typical. How can a woman encourage that type of support from her OB/GYN, to receive that security if needed?

Abby’s situation actually was very typical in the sense that ALL midwives working at home have a collaborating OB/GYN as back-up. If you are going to work with a home birth midwife you can normally meet their back-up OB/GYN when you go to the hospital for your sonogram or prenatal testing.

“Most OB/GYN’s have no interest in backing up midwives, because
it can raise their malpractice premiums…”

It just happened that Abby’s OB/GYN had worked with her midwife for years at the hospital and knew her well enough to offer his back-up. But had he not, Abby would have been transferred to her midwife’s regular back-up OB/GYN and hospital which was only a few blocks away.

Most OB/GYN’s have no interest in backing up midwives, because it can raise their malpractice premiums and add extra work and liability since they only see the midwife’s patients who develop complications or get transferred. There’s not much in it for OB/GYN’s to back up midwives and many are extremely opposed to any type of birth outside a hospital because they have no experience with it. The midwife should have a team in place that provides all the security you need.

If you don’t feel like she has a solid back-up OB/GYN that you can meet or transfer plan, then find a different midwife.

What are the benefits of water births? How about water hygiene?

There are many benefits of water births, but none have been scientifically documented that we know of. One benefit is of course, pain relief for the mother and some say the water is more gentle on the perineum so there is less tearing. Some also say the birth is more gentle for the baby and give them a transition from water to water, instead of hitting the air.

They don’t start breathing on their own until they come out of the water. The water does not need to be purified and can be regular tap water. Sometimes, the mom and baby get out of the water after the delivery of the placenta but there is no rush for hygienic purposes. Often the parents will sit in the tub and breastfeed after the birth, keeping the baby warm in the water.

Do any insurance companies cover using a midwife?

Yes, most insurance companies will cover midwives but you might have to pay a small fee out of pocket since some insurance companies reimburse midwives only 60% of what they pay OB’s for the same care. This makes no sense as midwives generally give MUCH longer prenatal visits and are with you throughout your entire labor, unlike the OB’s who only come in when you are ready to push. Many insurance companies cover home birth as well.

Thanks for your time and expertise in answering our questions here at
Keep up the great work Ricki and Abby! We are also excited for your new book, “Your Best Birth.”

Please visit The Business of Being Born website for a wealth of information
and read about their personal birthing stories.