Contact Vicki
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Contact Vicki
Choosing a private midwife can be an incredible option for women who want continuity of care, a relationship with the person who will support them through pregnancy and birth, and care that is more individualised than they may experience within a fragmented maternity system.
But there is something I think women need to understand:
Not all private midwives are the same.
Private midwifery has grown considerably, and with that growth we are seeing a much broader range of experience, philosophies, risk tolerance and approaches to birth. The words “private midwife” alone doesn’t tell you how someone practices. They don’t tell you how that midwife views physiological birth. They don’t tell you how comfortable they are with uncertainty. They don’t tell you how they approach VBAC, waterbirth, post-dates pregnancy, suspected big babies, prolonged labour, maternal age, declining routine procedures or variations from what might normally happen within a hospital. And they certainly don’t tell you whether that midwife’s philosophy of birth aligns with yours. That is why I believe women need to interview their private midwife and ask some really good questions.
Before interviewing anyone, spend some time considering what is important to you. What does a good birth experience look like to you? That doesn’t mean writing a rigid birth plan and expecting everything to happen exactly as you’ve imagined. Birth doesn’t always work like that.
It means identifying your values. Perhaps continuity of care is particularly important to you. Maybe you want someone who is very comfortable supporting physiological birth and allowing labour to unfold without unnecessary time pressure. Perhaps you want a homebirth. Maybe you have had a previous caesarean and want a midwife who is genuinely supportive of VBAC.
Perhaps you want waterbirth, minimal vaginal examinations, intermittent monitoring where appropriate, freedom of movement, delayed cord clamping or expectant management beyond your estimated due date. Or perhaps you feel safest with someone who takes a more conservative approach to risk. There isn’t one correct answer. The important thing is finding a practitioner whose approach is compatible with yours.
I think this is something women sometimes assume.
They hear “private midwife” and imagine a particular style of midwifery – highly woman-centred, deeply trusting of physiological birth, comfortable sitting quietly and watching birth unfold.
There are certainly private midwives who practice this way.
Some of our long-standing private midwives were the women who pioneered and practised this model of care long before it became more widely available. Their approach was grounded in protecting the birth space, observing the woman, trusting the physiology of birth and understanding normal physiological variation.
But private midwifery is evolving.
Midwives are entering private practice from many different backgrounds, including busy tertiary hospitals where their professional experience may have involved caring for large numbers of complicated or higher-risk pregnancies. That experience can be incredibly valuable. But we also need to recognise something about human psychology: what we repeatedly see influences how we perceive risk.
This is a question I think deserves more discussion.
Hospitals are designed to care for the entire spectrum of pregnancy and birth, including serious complications and emergencies.
A clinician working within that environment may therefore see shoulder dystocia, postpartum haemorrhage, foetal compromise, uterine rupture, severe pre-eclampsia, neonatal resuscitation and other complications far more frequently than the average person will ever encounter. That experience creates knowledge and clinical skill. But sometimes it can also create fear. If you repeatedly see the births that go wrong, it can become easy to anticipate the thing that could go wrong. This is not unique to midwives. It is a normal human response to repeated exposure to adverse events.
The question isn’t whether your midwife has worked in hospital. The question is how she has processed that experience and how it influences the care she provides now. Does she bring valuable hospital knowledge into private practice while still trusting physiological birth? Or does she bring the hospital’s fear of what might happen into every birth?
There is an important difference.
I want to make this distinction very clear. I absolutely want a midwife who understands risk. I want her to recognise when something isn’t right. I want her to have excellent clinical judgement. I want her to recognise deterioration and recommend transfer when hospital care is genuinely needed. And if an emergency occurs, I want someone who can act calmly and competently. Being supportive of physiological birth does not mean ignoring pathology.
Good midwifery sits somewhere between complacency and fear. It is the ability to understand what could happen without treating every woman as though it will happen. It is recognising risk without allowing risk to dominate every decision. It is knowing when to intervene, and equally importantly, knowing when not to intervene.
Of course, you should ask about registration, insurance, experience, emergency equipment, transfer arrangements and clinical protocols. But I would go much further. Ask questions that help you understand how your midwife thinks.
For example:
“What does physiological birth mean to you?”
Listen carefully to the answer.
“What situations would make you recommend transferring from home to hospital?”
Don’t just ask what the triggers are. Ask how those decisions are made and whether there is room for individual circumstances and discussion.
“How do you feel about going beyond 40 or 41 weeks?”
Does the conversation immediately become about risk and deadlines, or does she explain absolute risk, relative risk, monitoring options and your individual circumstances? Is she likely to “abandon” you if your pregnancy goes beyond a certain point, or if you make an informed decision that falls outside what she is personally comfortable with? What happens then? Will she continue to support you, discuss your options and work through those decisions with you, or does her support come with conditions?
“How do you approach suspected big babies?”
Does estimated foetal weight automatically change the birth plan, or will she discuss the limitations of late-pregnancy estimates and consider the whole clinical picture?
“How do you support VBAC?”
If you’re planning a VBAC, go further. Ask how many VBAC births she has attended. Ask what would make her uncomfortable. Ask how she views continuous monitoring, waterbirth, spontaneous labour, induction or augmentation and time limits during labour.
“What happens if I decline something you recommend?”
This is a particularly revealing question. You are not looking for someone who will simply agree with everything you say. A good practitioner should tell you when she has concerns. But you should be able to have disagreement without feeling bullied, frightened, punished or abandoned.
“How do you communicate risk?”
Does she use absolute numbers as well as relative risk? Does she explain benefits, risks and alternatives? Does she explain what might happen if you choose to do nothing for the moment? Can she comfortably say, “Here is what concerns me, here is the evidence, here are your options, and ultimately this is your decision”?
That tells you a great deal.
One of the best ways to understand someone’s philosophy is to give them scenarios.
“What would happen if my waters broke and labour didn’t start immediately?”
“What if I reached 42 weeks?”
“What if I am in prodromal labour for 3 days and not progressing?”
“What if baby was estimated to be 4.2 kg?”
“What if I didn’t want routine vaginal examinations?”
“What if labour slowed for several hours but baby and I were both well?”
“What if I wanted to birth in water?”
“What if I disagreed with your recommendation to transfer?”
You aren’t testing your midwife or trying to catch her out. You’re discovering whether you can work together. And remember that answers such as “it depends” aren’t necessarily evasive. Birth is nuanced. In fact, sometimes “It would depend on what else was happening, and we’d discuss it together” is exactly the answer you want to hear.
I also think this is an important question:
“How do you feel about transferring into hospital?”
A good private midwife shouldn’t be frightened of hospital either. Hospital is not the enemy. There are circumstances where access to obstetrics, anaesthesia, theatre, blood products, neonatal care and other medical services can be lifesaving. You want a midwife who can move between those worlds when necessary. Someone who doesn’t transfer unnecessarily because she is frightened of what might happen, but equally, someone who doesn’t delay an appropriate transfer because she feels she has something to prove about homebirth.
Neither extreme serves women well.
Something else I feel very strongly about is that women shouldn’t place the entire responsibility for understanding their pregnancy and birth in the hands of their midwife, or any other maternity care provider. Having a knowledgeable, experienced midwife whom you trust is incredibly valuable, but you are still the person making decisions about your body, your baby and your care.
Do your own learning.
Read. Research. Listen to good-quality podcasts. Attend independent childbirth education classes that aren’t restricted by the policies or usual practices of the hospital where you are giving birth. Learn about physiological birth, common interventions, induction, monitoring, pain relief, caesarean birth, postpartum care and the different situations that might arise during labour.
Importantly, learn about informed consent and informed refusal.
Understand that being offered or recommended something doesn’t automatically mean you have to agree to it. Equally, declining something shouldn’t simply be about saying “no” because you read something on social media. It means understanding why something is being recommended, what the potential benefits and risks are, what the alternatives are, what may happen if you wait or do nothing for the moment, and then making the decision that feels right for your individual circumstances.
Ask questions. Ask for evidence. Ask for absolute risk rather than being frightened by relative risk alone. Ask whether something is being recommended because of your individual clinical circumstances or because it is routine practice, policy or simply the practitioner’s preference.
And remember that this responsibility doesn’t disappear because you’ve chosen a private midwife.
A good relationship with your midwife should involve collaboration, discussion and mutual respect, not simply handing over responsibility and saying, “You tell me what to do.” Your midwife brings her clinical knowledge, training and experience to the relationship. You bring something equally important: your values, preferences, knowledge of yourself and the right to decide what happens to your body. The more you understand before labour begins, the better equipped you are to participate meaningfully in those conversations if circumstances change. Ultimately, informed decision-making is a partnership, but the final decisions about your care belong to you.
Listen to how your prospective midwife talks about birth.
Does she frequently say:
“I don’t allow…”
“I won’t let you…”
“You’re not allowed…”
“I always transfer for…”
Or does she use language such as:
“I’d recommend…”
“We would discuss…”
“I’d explain why I was concerned…”
“These would be your options…”
“Ultimately, you would decide…”
Language can tell you a great deal about someone’s underlying philosophy. Also notice whether rare complications dominate the conversation. Safety matters enormously, but there is a difference between providing balanced information about risk and using frightening possibilities to direct a woman’s decision.
Sometimes you can really like someone personally and still discover that they aren’t the right midwife for you. That’s okay. A midwife can be highly skilled, compassionate and professional and still not be your midwife. Equally, a midwife may decide that she isn’t comfortable providing the type of care you are seeking. That conversation is far better to have at 16 weeks than at 39 weeks.
One of the enormous strengths of private midwifery is continuity of carer. Research consistently supports the benefits of midwife continuity models, including improved experiences and a number of favourable maternity outcomes. But continuity isn’t simply about seeing the same face at every appointment. Relationship matters. Trust matters. Philosophy matters. You need to feel comfortable telling your midwife what you really think. You need to be able to ask questions. You need to know that if she becomes concerned, she will tell you clearly and honestly.
And she needs to know that you respect her professional responsibility to raise those concerns. That relationship works both ways. Don’t choose a label. Choose the person.
I am a huge supporter of midwifery continuity of care and of women having access to private midwives and homebirth where appropriate. But I don’t think we do women any favours by assuming that every practitioner within a particular model practices the same way. Private midwives aren’t interchangeable. Neither are obstetricians. Neither are doulas. We all bring our training, experiences, beliefs, biases and previous encounters into the birth space.
So before choosing your private midwife, work out what matters to you.
Then ask questions. Lots of them. Ask about physiology. Ask about risk. Ask about emergencies. Ask about hospital transfer. Ask about informed decision-making. Ask about the situations that make her nervous. Ask what she has learned from her years working within the maternity system.
And perhaps one of the most interesting questions you could ask is:
“Has anything you’ve experienced in hospital made you fearful of something happening at a homebirth, and how do you make sure that fear doesn’t influence the care you provide?”
That isn’t an accusation. It’s actually a wonderful question about reflective practice. Because I don’t need my midwife to be fearless. I need her to be aware of HER fears. I want her to understand risk without seeing pathology around every corner. I want her to trust physiology without becoming complacent about complications. I want her to respect my autonomy while being willing to tell me something I may not want to hear.
And above all, I want to know that the decisions being made around my birth are based on my individual circumstances, good evidence and genuine clinical judgement, NOT somebody else’s birth, hospital policy, or fear of what might happen. That balance, to me, is the art of excellent midwifery.
At the 2024 Perth Pregnancy, Birth & Postpartum Expo, we had a collective of private midwives sharing their knowledge with the community. One of the resources they were handing out was a flyer with questions women could ask when interviewing private midwives, to help them find the right midwife for them.
I thought it was such a great resource that I kept a copy. What I particularly loved about it was that the private midwives themselves were actively encouraging women to ask questions, explore different philosophies and approaches to care, and make sure the midwife they chose was genuinely the right fit for them.
It reinforces that asking lots of questions isn’t about distrusting private midwives, it’s about making an informed choice and finding someone whose philosophy, approach to risk and birth, and way of working aligns with what matters to you.
So, I kept the flyer, and it is something that I share with my clients… so here it is!
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
Contact Vicki