Questions For Your Pregnancy Care Provider:

If you are pregnant and planning a natural birth, here are a list of questions you may want to ask as you choose your midwife or care provider. Jenny West has given her answers below.

How long have you been in active practice?

I was originally licensed in El Paso, Texas in 1989. I now maintain a New Mexico State License since 1993 and a National License (CPM-Certified Professional Midwife) since 1998.  I have had the honor and privilege of helping over 875 women and families birth their babies into this world.

Where did you train to become a midwife?

I trained at a birth center in El Paso, Texas, called Casa De Nacimiento. I completed a three month training intensive, took the El Paso County Exam (written and oral!), passed it with flying colors and was then asked by the owner to stay to teach and be a licensed midwife on the premises. I trained five midwives in the six months that I taught. During my stay, the birth center was handling between 40-60 births a month. As a student, you live right in the center and are responsible for assisting and learning prenatal care, pregnancy testing, nutrition counseling, labor checks, labor sitting, birthing, immediate and long-term postpartum care for the mother and the baby, childbirth education, lab work, charting, phone etiquette, cleanup, changing shifts, getting along with 2-6 other women, working with 1-4 supervisors, interfacing with the local hospital, studying a set list of texts and trying to catch some sleep in between. Oh, and of course, desperately trying to learn enough Spanish to communicate with your clients! The 2 am phone calls were the worst, I couldn't rely on my ever-expanding skill of Charades to help me figure out what was being said! And Spanish over the phone sounds sooo much faster than in person!

During my stay at the center, we had a situation for approx. 6-8 weeks; we had only one intern and myself! We worked 36-hour shifts and just pulled each other out of bed to attend laboring women, as needed, and traded off 'doing the cita's (prenatal visits-like 33 a day).' Talk about being allowed to test what you know and what you think you know! On some days, I'm sure we looked like we were dead and just didn't know enough to lie down!! I do remember falling asleep directly on a laboring woman, between contractions. She was very accommodating and just jiggled me awake when her contractions started!

In retrospect, it was an experience of a lifetime. Experiencing 'birth-center birth' as a supervisor helped make me the midwife I am today, I encourage all my student midwives to see what it is like before they are licensed and 'on their own'

Do you hold a State or National Midwifery License?

I have a New Mexico State License (LM), as well as the National license from the North American Registry of Midwives (NARM), which is a Certified Professional Midwife (CPM). So, I sign my name, "Jennifer L. West, LM, CPM." 

How long did you train under supervision?

At the birth center, for about four months. The high birth rate allows you to really be exposed to a tremendous amount of experience and information in a relatively short period of time. I still rely on things I learned at the center, from a team of very experienced midwives, to this day.

How many births have you attended?

As a primary care provider, approximately 875 as of July 2010. I stopped keeping careful statistics after I started teaching, sorry to say.

How often do you need to take your clients to the hospital after labor has begun?

Less than 3 percent. I fully expect your body and your baby to know exactly how to birth. I had ten years of emergency medical experience before I became a midwife, so feel comfortable interfacing with the hospital staff, if and when a transport is required. I have had 5 emergency transports in 21 years of practice. The main reason we end up going in to the hospital during labor is maternal exhaustion, which can lead to fetal distress, to name one possible scenario. If we need what the hospital does best, we go.

Being with the laboring woman throughout her labor often allows the midwife to prevent emergency situations, or spot a potential problem long before it's a crisis and take the proper steps to provide optimum outcomes for both mother and baby.

How often do you "risk out" clients to a physician's care during the prenatal period (that is, how often are you not able to safely take a client or continue with her care)?

Not often, as most common prenatal problems can be solved with information and a little dedication from the parents-to-be. However, not all situations can be corrected by nutrition, herbal supplements, etc. Here in Albuquerque, we are very lucky to have access to homebirth friendly physicians and can often provide co-care and give the birthing woman every opportunity to maintain her home birth. If the situation requires medical attention and expertise, care is then completely transferred to a physician.

How many emergency transports have you had?

Five in 21 years of practice. Two for 'in-labor' worries for the baby and three for mothers with immediate postpartum needs. 

Have you ever had a mother or baby die in your care?

No, never. I have helped women through miscarriages and a few late pregnancy fetal losses.  Sometimes babies choose not to be born, and there is rarely an explanation that we find acceptable or satisfying.  Often, no real reason for this outcome can be found.

Why did you become a midwife?

I took a three-day workshop on becoming a 'certified birth attendant' in 1988, while I was still working for the National Park Service. During the middle of the training session, I felt like this was 'IT' this was 'what I was supposed to be when I grew up!' I was third generation Park Service, had wanted to be a park ranger since I was a child. I took the birth training class to be a better paramedic. I had seen a birth or two in the back of an ambulance with everyone stressed and unsure of what was 'normal' and just hoping that the ambulance driver could just drive faster and the woman would push slower! I never imagined this one class would change my life forever.

After several phone calls and a little research, one of the birth centers in El Paso, TX called me back. I asked to come down for a two-week session; just to see if I really was willing to give up a steady paycheck. Initially, the center said, 'No, we don't allow students to come in for such a short period of time.' I told them I didn't intend to 'catch' babies while I was there, I just needed to be around birth, before I gave up what I thought was my lifetime career. I promised to scrub floors, do laundry, anything, just let me come down and be around birth. What if, after four or five births I hated it?? I had to find out. The owner finally said to come down and, 'We'll see.' I felt I had a strike against me and, maybe, this just wasn't such a good idea. Well, seven days into my 'two weeks,' I was catching my first babies!! The owner of the center told me I was such a midwife and I didn't even know it! I was thrilled beyond words (as I still am today).

I went back to the park, gave my resignation and went right back to the birth center to start my formal midwifery training. Being a midwife is a calling, and, boy, I got called. And, I have never looked back. I love what I get to do. Everyday. I had no idea that all the training I experienced and loved as a Park Ranger would be so applicable, and one day cross over and make me a better midwife, but that's exactly how it worked out.

What would you (the midwife) define as an "emergency"?

Anything that is beyond the skill of that particular midwife and is not resolving. Sometimes surrounding events, weather, skill-level of your assistant, distance from a hospital, etc., can add to the urgency of the situation. Optimum outcome for mother and baby is the base line of every decision.

What emergency equipment do you carry in your practice?

New Mexico law requires that licensed midwives carry oxygen, an oxygen re-breather mask for an adult, positive pressure ventilator (to help the baby breathe, if necessary), suction devices, be current in CPR training, Neonatal Resuscitation, IV setup, and carry medications that stop or prevent a hemorrhage. I am also trained to use and carry a laryngoscope to start an airway for a baby that does not start breathing on it's own. This tool allows me to provide 100 percent oxygen right to the baby's lungs while waiting for the ambulance to arrive.

We also are required to carry antibiotic ointment for the newborns' eyes, Vitamin K for the baby and perform the Newborn Metabolic Screening Test (the heel poke or PKU test). Some states don't allow their midwives to carry the tools that they need to properly provide good care to their clients. We are fortunate to have these laws in place, here in New Mexico, to protect the client and the midwife as well.

I have also learned about herbs, homeopathics, tictures, foods and flower essences as well.  I bring these complimentary medicines in the door with me to every birth.  I have energy work skills as well, CranioSacral therapy, Total body Modification, Korean Hand Therapy (acupressure done on the hands only) and hypnosis.

Do you have physician and/or hospital support in your area? Is it homebirth friendly?

Yes, yes, and yes.

Do you have policies and procedures in place for your practice?

The New Mexico Midwives Association has the responsibility and the privilege of generating and maintaining a workable set of guidelines for us to practice by. Some midwives that practice in states where homebirth is still illegal (amazing, isn't it!), have contacted the New Mexico Midwives Association to purchase our guidelines for their own use. It is reassuring to the client to know that research, experience and a great deal of thought and heated discussion goes into the guidelines we practice by.

Do you use complimentary medicines in your practice? Are you willing to work in conjunction with other practitioners during the pregnancy and/or birth?

Yes, I use homeopathic remedies, herbal teas and tinctures, flower essence remedies, HypnoBirthing®, water, CranioSacral, Total Body Modification (www.tbsmseminars.com), Korean Hand Therapy (www.khtsystems.com) and nutrition. I have worked with several complimentary practitioners here in Albuquerque, including chiropractors, naturopathic physicians, acupuncture, massage therapists, Chinese medicines, yoga and anything else that is conducive to making my client feel more healthful, happy and secure in her birth.

Do you have community referrals for complimentary medicines and other prenatal/postpartum support? (such as chiropractors, massage therapists, homebirth-friendly pediatricians and naturopathic physicians)?

Yes, I have established a great group of practitioners that I feel comfortable consulting with and have taken good care of the clients in my practice, through information, guidance and advice.

Do you have current or previous clients that would be willing to speak to me about their birthing experience?

Yes, both.

Do you require lab work?

Yes, but it is kept to a minimum, unless your pregnancy or health demands more information. Usually, I do a prenatal panel in the beginning, a pap smear, if needed, a blood volume check at 28-30 weeks along and a finger-poke at 33-35 weeks along to check your iron level. Our practice guidelines demand that we offer and discuss a few more lab tests, however, we have no regulations that require these extra tests to date; GBS, Glucose Tolerance test and AFP, to name a few.

Do you encourage father/partner participation?

Yes, the father is the second most important person in the room; the laboring woman is the most important person. We encourage the ather/partner to participate as much or as little as they are comfortable with.

Do you attend birth alone, with an assistant or with a student?

I often attend births by myself, as I may or may not have an assistant and/or a student with me for your care. Often clients feel that they can't have enough people to help them through labor, and if this is the case, we can arrange to have a second midwife or doula available for your birth. Others request we keep those attending the birth to a minimum, and the fact I feel comfortable attending births by myself can be the very reason I am chosen as the midwife. We do our best to accommodate your requests within reason and with safety in mind.

What if you are at another birth when I go into labor?

I have access to several other midwives. We all support each other, as needed. I believe, after so many years of being in practice, that the babies talk to each other and plan their arrivals.  I have only missed a handful of births since 1989. Usually, I miss a birth due to the fact that the mother does not think this is really labor, she is waiting for it to be hard, or painful and she is shocked that she has the urge to push so soon, while labor is still so managable. If you want a specific back-up midwife or apprentice-all that can be arranged prior to the birth. I also limit the number of clients I will take in any one month in an attempt to prevent just such an occasion.

Why should we come to you?

Because I'm one of the best! Albuquerque Homebirth offers you a complete service, with your needs in mind. We provide well tested information, supplies, support and a variety of coping options to help you throughout your pregnancy, labor, delivery and postpartum. We take care of the details; all you need to do is be pregnant!

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