How To Choose An Aligned Birth Team For Your Homebirth

Creating an aligned birth team is one of the most important tasks in pregnancy. Some choose to birth simply with close family members present and feel safest with decision. Others prefer to have womanly support throughout their perinatal journey, along with skilled hands present at their birth— providing a sense of peace— although we know no one can guarantee the prevention of adverse outcomes.

Why is it crucial to have an aligned birth team that you connect well with? Physiological birth requires a familiar environment for labor hormones to flow freely, for the mother to be in tune with her body and baby, and for her pre-frontal cortex— the part of the brain responsible for thinking and analyzing— to step back and allow her to surrender to her labor process. Your birth team is a major factor of the environment. The wrong birth attendant— birth professional, family member, or friend— present can bring fear and anxiety into your laboring process, disrupting the labor process— which can lead to a myriad of labor and postpartum complications.

Types of Birth Attendants

There are several different types of birth attendant, and various titles, roles, skills, and practices. Let’s go over some of the most common types.

• Doulas: Non-clinical support birth attendants who provide emotional, physical, and informational support during pregnancy, birth, and postpartum, but do not offer medical care.
• Monitrices: Similar to doulas but with clinical training (often nurses or midwives) who can provide basic monitoring and clinical skills at home.
• Certified Nurse Midwives (CNM’s): Midwives with nursing degrees and graduate-level midwifery education; licensed and regulated, often practicing in hospitals, sometimes homes or birth centers.
• Certified Professional Midwives (CPM’s): Midwives credentialed through the North American Registry of Midwives, specializing in out-of-hospital birth; not required to be nurses.
• Community Midwives: Generally refers to midwives serving their local communities, often providing culturally rooted or relationship-based care; training and credentialing vary.
• Licensed Midwives (LM’s): Midwives who hold a state license (where licensing exists) and meet specific requirements set by state regulatory boards; often also CPMs in the U.S.
• Certified International Midwife (CIM’s): A primary healthcare provider trained to care for women across all stages of life, including gynecologic care, family planning, pregnancy, birth, postpartum, and newborn care. While CIM’s are highly skilled in providing evidence-based, respectful, and humanized maternity care, their certification does not confer legal authority to practice— local or national laws determine legal recognition and scope of practice.
• Unlicensed Midwives: Midwives practicing without state licensure, sometimes by choice or in states where licensure doesn’t exist; training varies.
• Traditional Midwives: Often elders or experienced women in a community who pass down skills outside formal schooling, practicing according to cultural, familial, or spiritual traditions.
• Student Midwives / Apprentices: Students training under experienced midwives, often in long-term mentorships. They may assist at births and gradually take on more responsibility. Depending on the type of midwife they intend to become, they may have checklists of skills to learn and practice in the appointments and births they attend. (typically those pursuing certification and/or licensure)
• Birth Assistants: Sometimes called midwife assistants, they help the primary midwife during birth with setup, charting, and support but do not serve as primary care providers.
• Birthkeepers: The term “birthkeeper” was coined in the 1970’s by Jeannine Parvati Baker, who likened it to “Earth Keeper” to honor those who serve birthing women with love and peaceful, holistic care. Today, some birth attendants use this term to reflect intuitive, woman-led support outside the medical system and focus on the emotional, energetic, or ancestral aspects of birth, often rooted in faith or tradition; may or may not include clinical skills.
• Postpartum Doulas: Specialize in support after birth— helping with newborn care, breastfeeding, emotional wellbeing, and household tasks during early postpartum weeks.

Birth attendants may hold one title— or two or even three— from the list above. This is why it’s crucial to interview and ask insightful questions to learn more about how she practices.

It is legal in all fifty states for women to birth at home, but many midwives— certified and/or licensed in particular— are subjected to certain restrictions and limitations in how they may practice, placed by the government. Some of these restrictions may be the inability to continue care in pregnancies past 42 weeks of gestation, VBAC’s, breech, and multiples. Many midwives are taught in midwifery schools and apprentice with midwives that practice under a technocratic model of care, versus the holistic model of care that midwives traditionally have practiced for thousands of years. It’s important to know what kind of care you want to receive, what you want your birth to look like, and what skills and tools you’d like the midwife you hire to have. This will be different for everyone, which is why it’s essential you get clear on the type of birth and care you envision for your perinatal journey. There is a midwife for everyone woman, but not every midwife is for every woman.

What Type of Birth Do I Want?

Here are some reflective and introspective questions may be helpful in determining the type of care and birth you want and the type of midwife that can support your birth vision:

• How do I define holistic versus technocratic care, and which aligns more deeply with my values and instincts?
• What kind of care do I want to receive during pregnancy, birth, and postpartum?
• What kind of birth do I envision for myself and my baby?
• How does my vision for birth reflect my hopes, beliefs, or wounds around autonomy, authority, and trust in my own body?
• What fears or beliefs might be shaping how I think about risk, safety, and freedom in birth?
• What skills, tools, or approaches are most important to me in a midwife’s practice?
• How do I feel about the restrictions some midwives face, and does that impact the type of midwife I want to hire?
• In what ways am I willing— or not willing— to take responsibility for my birth choices outside of government-approved systems?
• How can I discern whether a midwife’s training and philosophy align with my own values and desires for birth?
• What do I need to feel fully supported and seen by the person I choose to walk beside me in birth?
• What does feeling safe in birth look and feel like to me?
• What role do I want my partner, family, or community to play in my birth space?
• How do I want to be spoken to, touched, and cared for during labor?
• What fears or uncertainties do I have about birth, and how do I want those to be held by my birth team?
• What does it mean for me to be respected and honored in birth?
• Where do I feel most at home and able to surrender to the process?
• What kind of environment helps me relax, open, and connect to my instincts?
• How do I imagine the early moments postpartum unfolding, and what support would make that feel nourishing?
• What would it mean for me to look back on this birth and feel powerful, whole, and deeply supported?
• Am I seeking someone to guide me, witness me, walk beside me—or something else entirely?

Interviewing a Midwife

It is essential to ask prospective birth attendants questions that give you insight on their beliefs about physiological birth, their skills, and if they’re licensed or certified— what restrictions or limitations they may have from their governing body. Their background in their education and training, the tools they bring to births, and their protocols may give you insight in their beliefs and practices. Asking the right questions will help you find the most aligned birth support for the birth you envision for your pregnancy. Don’t be afraid to ask many questions. Don’t be afraid to explore different options. You may be surprised— or not— in who feels the most right to hire.

Here are some questions to ask when interviewing a prospective midwife:

1. What drew you to midwifery, and how were you trained?
2. Are you licensed or certified through a state or national body? If so, what are you legally obligated to report or act on?
3. How would you describe your philosophy of birth?
4. What does physiological birth mean to you?
5. How do you continue learning about physiological birth and staying connected to traditional wisdom?
6. In your care, how do you support the body’s innate processes without interruption?
7. How do you respond when birth doesn’t unfold on a textbook timeline but remains low-risk?
8. What is your stance on routine cervical checks, membrane sweeps, and artificial rupture of membranes?
9. When do you typically check for dilation in labor— if at all?
10. How do you determine when to step in versus when to allow the process to unfold?
11. Are there any protocols you’re required to follow that might override a family’s informed choice?
12. Are you able to attend a birth beyond 42 weeks, breech, VBAC, or twins at home? What is your training or experience with these?
13. Under what circumstances would you risk a woman out of your care?
14. What signs or factors would cause you to recommend a transfer during labor?
15. How do you handle a transport— do you stay with the family or pass off care entirely?
16. Do you have collaborative agreements with hospitals or physicians?
17. What’s your experience with “slow” labors, posterior babies, or long pushing phases?
18. What fears (if any) have come up for you in attending births, and how do you navigate them?
19. How do you remain grounded and present in high-intensity or unexpected moments?
20. How do you handle situations where a family’s informed choice goes against your preference or training?
21. Are you comfortable with families declining certain tests, procedures, or timelines?
22. How do you support women who wish to guide their own birth with minimal external monitoring?
23. What is your fee structure, and what does it include? Are there any additional costs I should expect?
24. How do you handle insurance or reimbursement paperwork, if at all?
25. What supplies and equipment do you bring to a homebirth? What do you expect me to have ready?
26. How do you handle prenatal appointments (where, how often, and how long are they)?
27. Who is your backup if you’re unavailable? Can I meet them ahead of time?
28. How many clients do you take per month?
29. How long do you stay after the birth, and how many postpartum visits do you offer?
30. What kind of documentation or records do you provide after the birth?
31. Do you offer help with birth certificate or newborn paperwork?
32. What is your policy on student midwives, apprentices, or assistants attending births?
33. What is your cancellation or refund policy if I need to transfer care or change my plans before or during pregnancy?
34. Under what circumstances would you offer a partial or full refund?
35. If you are unavailable for my birth and your backup midwife attends, does that affect the fee?

I don’t think this list includes every single question one can ask— but it provides a solid starting point for your research. It’s also essential for you to connect well with everyone who will be attending your birth— so factor that into your interviews or consultations as well. This person will be seeing you in your rawest and most vulnerable state so you need to feel comfortable with them.

After the Interview

Don’t rush the process of putting together the right birth team, but also, take into consideration that many midwives do get booked quickly, especially if there aren’t many serving your local area. Some midwives travel so that is often an option as well. Good midwifery care is worth every penny invested. The care you receive during your perinatal journey is incomparable to obstetrical care— which is often much more expensive. Write the midwife’s answers down during the interview so you don’t forget any answers. Take some time after the interview to pray and to reflect over the interview. Pay attention to how your body feels during and after the interview. Does it feel relaxed or reserved? Calm or tense? Do you feel refreshed and uplifted or fearful and stressed? Our body can give us so much insight.

Here are some questions that may help you come to a decision after an interview:

• How did I feel in my body while talking with her— tense, relaxed, open, guarded?
• Did I feel truly heard and respected, or did I feel dismissed or talked over?
• Were there any red flags or hesitations that I brushed aside during the conversation?
• Did her philosophy and approach align with what I believe and want for my birth?
• How did she respond to my hopes, preferences, or questions about things that matter deeply to me?
• Did I feel free to share my desires and concerns openly, without fear of judgment?
• Can I imagine her presence in my birth space feeling supportive, calming, and safe?
• What lingering questions or feelings do I have that I want to explore further?
• What did my intuition say as I listened to her speak about birth and her role in it?

I hope this guide is helpful to you and I wish you success in finding aligned birth support for your birth vision. If you have any thoughts or insights, please share below. If you’re seeking deeply attuned, holistic support on your journey to birth, I offer home birth doula services, childbirth education, and women’s gatherings, virtual and in person, rooted in honoring your wisdom, instincts, and vision for birth. You can learn more about my offerings here and reach out to connect— I would be honored to walk alongside you if we align.