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Midwifery Students Tribe 2009 - Page 69

post #1361 of 1527
It looks like I'll be joining the AAMI students sooner rather than later. I spoke to Carla today and she's offering me an amazing deal I'd be crazy to refuse!
post #1362 of 1527
Pinard horn users... if you have tried both, do you prefer wood or aluminum? I'd like to try one. Fwiw, I have some hearing loss in one ear and sometimes deal with tinnitus also so hearing FHT through a fetoscope is sometimes difficult for me. I have an Allen 10 fetoscope and have used my midwife's Leff but would like another option for client's who choose to decline doppler use.
post #1363 of 1527
Hello, everybody! I haven't had the opportunity to read this whole thread (it's intimidating!), but I just wanted to make a quick intro.

I'm currently working on getting my B.S. in Midwifery at Aviva Institute. It's a great program thus far, and I'm enjoying it a lot. I won't be attending births until next year at the earliest, however. It's a three year program, and I'm year one. I already found a potential preceptor who seems like a good match. I'll have to travel about 1 1/2 - 2 hours, but that's not too bad. There aren't any legally practicing homebirth midwives in this area, but I hope to start a homebirth practice when I graduate.

What kind of practice do you ladies plan on joining/starting when you're done with school? Who will be your target clients?
post #1364 of 1527
Thread Starter 
Quote:
What kind of practice do you ladies plan on joining/starting when you're done with school? Who will be your target clients?
At this point it will be a quiet homebirth practice, just me. Someday when going back to the USA, I'll probably want to work at a birthcenter with other midwives. Or start my own if there isn't one already.
post #1365 of 1527
Quote:
Originally Posted by busybusymomma View Post
Pinard horn users... if you have tried both, do you prefer wood or aluminum? I'd like to try one. Fwiw, I have some hearing loss in one ear and sometimes deal with tinnitus also so hearing FHT through a fetoscope is sometimes difficult for me. I have an Allen 10 fetoscope and have used my midwife's Leff but would like another option for client's who choose to decline doppler use.
I use a pinard and also an economy fetoscope. My pinard is an aluminimum one, and I hear waaaay better on it than with the american kind. I've never tried a wooden pinard, though I'd love one of those beautiful hand-turned and carved ones
anyway, I pretty much keep the fetascope for letting mamas listen for themselves these days, as the aluminimum pinard gives such a clearer sound (and they cost like, $5 )

Quote:
Originally Posted by AtYourCervices View Post
Hello, everybody! I haven't had the opportunity to read this whole thread (it's intimidating!), but I just wanted to make a quick intro.

I'm currently working on getting my B.S. in Midwifery at Aviva Institute. It's a great program thus far, and I'm enjoying it a lot. I won't be attending births until next year at the earliest, however. It's a three year program, and I'm year one. I already found a potential preceptor who seems like a good match. I'll have to travel about 1 1/2 - 2 hours, but that's not too bad. There aren't any legally practicing homebirth midwives in this area, but I hope to start a homebirth practice when I graduate.

What kind of practice do you ladies plan on joining/starting when you're done with school? Who will be your target clients?
welcome! I love your username! that's hillarious
post #1366 of 1527
Quote:
Originally Posted by AtYourCervices View Post
What kind of practice do you ladies plan on joining/starting when you're done with school? Who will be your target clients?
I most likely will work at a birth center offering homebirth as well as birth center birth. It is a very diverse group on moms, but mainly natural minded pregnant women looking for women led childbirth are the target clients.

I'm most likely going to be a part time midwife. With a birth center with 2-3 midwives that is much more feasable then it sounds! I think I'll be thinking about getting pregnant again about the time I finish school, so that will be ideal. I hope to be on call 6-10 days per month and have office hours 2 days per week.
post #1367 of 1527
How will I be able to do this?! I want to have my own office, where I'll perform prenatal/postpartum appointments, test for STDs, PAPs, provide birth control, and do all the regular well woman care and teachings from menarche to menopause. I also want to be able to attend as many home births as I'm invited to attend. There's no existing practice in this area that would be a good fit for what I want to do, and besides I would prefer to be independent.

I have a friend who is in Nursing School who wants to eventually become a midwife. She has offered to act as the nurse for my practice. My husband would be able to handle the computerized records and website. I'd still have to hire somebody to answer phones, welcome clients (especially if I'm gone and at a birth), bill insurance, and clean the office.

How will I be able to pay for the staff? And office space? And supplies?

I'm worried that I'll have appointments scheduled, and I'll be called to a birth, thus having to reschedule appointments several times a month. There are no other midwives in this area. I would LOVE to have another midwife in the practice, but it just doesn't seem likely that it's going to work out that way. Will just one midwife and one nurse be do-able? Will the business be able to financially survive?
post #1368 of 1527
Quote:
Originally Posted by AtYourCervices View Post

How will I be able to pay for the staff? And office space? And supplies?

I'm worried that I'll have appointments scheduled, and I'll be called to a birth, thus having to reschedule appointments several times a month. There are no other midwives in this area. I would LOVE to have another midwife in the practice, but it just doesn't seem likely that it's going to work out that way. Will just one midwife and one nurse be do-able? Will the business be able to financially survive?
In my experience the office closes when the midwife is at a birth. It's standard practice to re-schedule appts. when you have a birth and voice-mail receives non-emergent calls. Emergency calls go to the cell phone and are returned at births when neccesary. If you want the office to stay open for gyn care while you are at births then you will have to have a qualified care provider for the office that doesn't ever go to births. Having someone else do prenatals while you are at a birth interrupts continuity of care which is something you'll want to consider thoroughly before doing.

I would highly advise not biting off more than you can chew. What you have described sounds more like a doctors office than a homebirth practice to me. Remember that stretching yourself thin also thins out the value that you can provide to your clients. A big component of midwifery services is the connection which can only be achieved through continuity of care and time.

Whether you can afford it depends on how much you charge and who and how many clients you have. Just remember that the more fluff you add the more it costs and the less clients will be able to afford your services without insurance that covers it (not sure if that's available in your state). I'd personally prefer to go to a midwife that had a small office in her home and no extra staff (other than an apprentice) than a busy office with a nurse (what would be her job exactly?), a receptionist and lots of overhead.
post #1369 of 1527
ITA with Sijae. What you want to do right off the bat sounds like it would lead to a burnout. I plan on being independent, so I can decide how many clients I want to take in any given month, seeing clients in their home or mine. Maybe someday I would have an office, but I will start small and work my way up to a larger practice, someday.

On another note, this weekend was the Midwives of Alaska conference and our guest speaker was Vicki Penwell from www.mercyinaction.com. If you ever get a chance to see her, she was great. A woman with a great heart. I am humbled.
post #1370 of 1527
Quote:
Originally Posted by AtYourCervices View Post
How will I be able to do this?! I want to have my own office, where I'll perform prenatal/postpartum appointments, test for STDs, PAPs, provide birth control, and do all the regular well woman care and teachings from menarche to menopause. I also want to be able to attend as many home births as I'm invited to attend. There's no existing practice in this area that would be a good fit for what I want to do, and besides I would prefer to be independent.
The first thing that sticks out for me is that you want to provide birth control. I think you'll probably want to check and see if your state allows CPMs to write prescriptions. This may not be a service you can legally provide. I could be missing something though and perhaps others can speak better to this than I can.

As others have mentioned, consider working from your home to start until you are bringing in an income substantial enough to carry the rent for an office.

Quote:
Originally Posted by AtYourCervices View Post
I have a friend who is in Nursing School who wants to eventually become a midwife. She has offered to act as the nurse for my practice. My husband would be able to handle the computerized records and website. I'd still have to hire somebody to answer phones, welcome clients (especially if I'm gone and at a birth), bill insurance, and clean the office.
I really don't think you need a nurse. I plan on having my own practice and a CNM and don't plan on having any nurses.

First, there is nothing that she will need to do. If you need blood drawn, you can draw it yourself. I can't even think of anything else that she would be useful for. Second, depending on your fee and your client load, you *may* not be able to pay her competitively. Her yearly earning potential as a nurse *might* even be larger than what you may earn in over a year and so this is something both you and her will need to think about carefully.

If you're gone and at a birth, the office closes and no one needs to welcome clients. Also realize that you will most likely be in the office only two days a week.

Schedule your clinic days for Tuesdays and Thursdays (or some other pair). The other days you are free for homevisits, births that come up, family time, etc. You likely will not need to be "open" M-F and this will only lead to a huge and unnecessary overhead. On one of those days you get in late and you work a later day until 8PM so that people that work can have an appointment after they finish work. On the other day you start early and end early so that people can get in before work.

You could have one person who is a part-time office assistant to help clean the office, bill insurance, answer phones if you feel like you will really need help. But, especially starting out, you may have to do these things yourself.

Concentrate on starting small and then as your practice gains clients, then add staff appropriately. The reality is that even with a larger client load, you may have to continue doing these tasks yourself in order to keep yourself financially solvent.

Quote:
Originally Posted by AtYourCervices View Post
How will I be able to pay for the staff? And office space? And supplies?

I'm worried that I'll have appointments scheduled, and I'll be called to a birth, thus having to reschedule appointments several times a month. There are no other midwives in this area. I would LOVE to have another midwife in the practice, but it just doesn't seem likely that it's going to work out that way. Will just one midwife and one nurse be do-able? Will the business be able to financially survive?
When you start thinking seriously about your fees, you will have to incorporate your expenses and a profit margin. You set your fee according to your expenses but when you're just starting out, your expenses should be essentials.

You will have to reschedule appointments if you are called away to a birth but that's ok! Nothing to worry about as that is the normal order of things in a small homebirth practice.

Good luck with your plans! It's easy to get overwhelmed but just take things one step and a time and remember to incorporate your philosophy about the type of care you want to provide and to think about *essential* services and expenses.
post #1371 of 1527
Greetings, fellow midwifery students! I don't post a lot, but I lurk and learn. I've recently sent in my NARM application! Whee! They called the other day with a few clerical errors, but other than that, I'm set to take the skills test. I'm excited, yet nervous at the same time, which seems reasonable.

For anyone who has taken this, does it mostly concentrate on the second set of skills verfications, or is it fair to think that anything from Practical Skills for Midwives is possible?
post #1372 of 1527
Quote:
Originally Posted by cristeen View Post
I just wanted to pop in real quickly and let you ladies know that Avery Jadin was born today at 1:50. And in spite of all I know and all I've studied, I still begged my MW to take me to the hospital for a c/s when I hit transition (she didn't, of course). He was born about 90 minutes later, and he's beautiful!

CONGRATULATIONS!!!
Looks like he shares a birthday with me and Bruce Springsteen!
post #1373 of 1527
AtYourCervices - I have to agree with what sijae and kimiij have to say.
In reading your post, it really does sound like a Nurse midwife or physician practice, not a personal homebirth practice. Most CPMs don't hire a nurse, or office staff for a one midwife practice. There isnt a need for that. If you are so busy that you do need to take this on, then you may be able to afford it, otherwise, most midwives working alone handle a small enough load to balance the rest as well as the births.

Continuity of care is extremly important to me. I believe that I would like to have an assistant, or better yet an apprentice to work with me, for when I do need an extra set of hands, but really am not interested in hiring someone with a nursing background, unless the fit and her veiws are very compatible with mine. I have choosen to not go the nursing route for a reason. Not saying there is anything wrong with it, for many it is great and we need all kinds! But my veiws are different, my path is different, and my state laws allow me to legally persue the path I desire.

Anyhow, for me I want to have a small homebirth practice that would ideally be 3-4 births a month. I would do prenatal/postpartum in the clients home to start and hopefully be able to have a place where I can set up a nice home office for some of this as well if I or the client prefers that at somepoint. If I am at a birth, clients can leave me a message, if it is an emergency, I will return the call from the birth as soon as possible. Otherwise meetings will be reschedualled. This is expected. All pregnant women expect this. I had to reschedual a couple appointments during my pregancy when I was seeing an OB. I prefered that over seeing another, or a back up, or a nurse, anyhow.

I do hope that I will be able in most cases to call and let the clients that may be affected know as soon as possible, so they can alter their plans as well, but will also explain these policies at the onset of the relationship.

I dont have a practice yet, and have not begun an apprenticship, so maybe I am off base. Sorry for rambleing.
post #1374 of 1527
I will be a Certified Midwife in my state, and I'll be able to write prescriptions. My friend who is going to Nursing school actually has the same ideals as me, she's just going that route for legal purposes. She wants to be a homebirth midwife eventually, but she'd love to join my practice as my nurse/assistant. Basically, we'd see her role as the monitrice, if I was busy at a birth she'd be able to go and check another mother who may/may not be in labor. Plus, I would really like her there for peace of mind, having a "witness" in case things go sour.

It won't be just a homebirth practice. I'll be doing a lot of community education, and serve women of all ages.
post #1375 of 1527
Just because I always like to share...
I started classes this week including A&P. I love the class of course, I am already learning some things I didn't know.
But I have a complaint. The class is nearly all nursing students (our community college has a big time nursing program) and EMT students of course. I am always the oddball. But most of them dont give a s**t about learning anything! I ran across this in Nutrition last year as well. I am a sponge and want as many details as I can get. But people are always speaking up, interupting in the middle of lecture to ask "is that going to be on the exam?" "so what of this are we supposed to know for the exam""would you actually ask about that as an essay question" I could go on. I am amazed at how many people put down thier pens when the professor says "you wont need to know this for the exam, but...."

AHHHHH!!! I could pull my hair out, please shut up so I can learn what I came here for!

OK, sorry

I have not touched my AAMI stuff at all for a week and a half, and really really really want to get orientation done. Oh goodness.

On another note, I got a letter from one of our County public health nurses, she is an RN and IBLCL for the county health dept reguarding a meeting planned to about a grass roots movement here local to start a breastfeeding coalition. I am being invited to come. wow. The only place she could have gotten my biz name and addy would have been a free online listing for Doula services. I have not advertised locally at all. She must have been doing a search for people that would be likely to be involved.
I am really excited as this is a great chance for me to make local connection with people in my area, including the LLL leaders.

now that I wrote a book, thank for listening!
post #1376 of 1527
Thread Starter 
Lisa that's awesome news.

I hear ya about your classes. It seems that quite a few people out there just want to get that degree and get to work. Never mind being the best they can be in their job. A lot of midwifery programs out there are like that though. Aimed at getting that CPM as fast as possible. I looked at a friend's curriculum from an MEAC school last summer. What a bunch of busy work, totally geared towards passing the NARM. And she says, oh I won't feel confident enough to be out on my own for a few more years. Why? Because she feels she doesn't know enough! And she's supposed to be graduating this fall.
post #1377 of 1527
Jumping in too!

After almost 5 years of doula work I'm finally taking the plunge! I started as a student this week with a busy practice. I thought I was waiting until this summer to start, but this is way more of an opportunity than I could pass up. I'm actually joining the same practice that JaneyD is a part of, she really is amazing and I'm excited to learn from both her and the senior midwife.

I'm now at the point that I need to decide on my schooling route and my mind is spinning. I need to read back through the thread to see what you all have to say.
post #1378 of 1527
Quote:
Originally Posted by memiles View Post
Jumping in too!

After almost 5 years of doula work I'm finally taking the plunge! I started as a student this week with a busy practice. I thought I was waiting until this summer to start, but this is way more of an opportunity than I could pass up. I'm actually joining the same practice that JaneyD is a part of, she really is amazing and I'm excited to learn from both her and the senior midwife.

I'm now at the point that I need to decide on my schooling route and my mind is spinning. I need to read back through the thread to see what you all have to say.
Glad you're joining our little world here. How exciting!
post #1379 of 1527
I am going through the same thing in my interpersonal communication class! I'm the only student in the class taking it b/c I want to not b/c I have to and I constantly hear people ask if blah, blah, blah will be on the test. It's annoying.
post #1380 of 1527
Quote:
Originally Posted by mamato3cherubs View Post
I have a complaint. The class is nearly all nursing students (our community college has a big time nursing program) and EMT students of course. I am always the oddball. But most of them dont give a s**t about learning anything! I ran across this in Nutrition last year as well. I am a sponge and want as many details as I can get. But people are always speaking up, interupting in the middle of lecture to ask "is that going to be on the exam?" "so what of this are we supposed to know for the exam""would you actually ask about that as an essay question" I could go on. I am amazed at how many people put down thier pens when the professor says "you wont need to know this for the exam, but...."

I have not touched my AAMI stuff at all for a week and a half, and really really really want to get orientation done. Oh goodness.
Hey Lisa, that sounds really aggravating! It's pretty scary too when you think about it, but I'm not surprised.

Quote:
Originally Posted by MamaRabbit View Post
A lot of midwifery programs out there are like that though. Aimed at getting that CPM as fast as possible. I looked at a friend's curriculum from an MEAC school last summer. What a bunch of busy work, totally geared towards passing the NARM. And she says, oh I won't feel confident enough to be out on my own for a few more years. Why? Because she feels she doesn't know enough! And she's supposed to be graduating this fall.
I totally agree! One of my reasons for choosing AAMI is that it ISN'T meac accredited. Accreditation is similar to licensing in how it chances emphasis and narrows choices

Quote:
Originally Posted by memiles View Post
After almost 5 years of doula work I'm finally taking the plunge! I started as a student this week with a busy practice. I thought I was waiting until this summer to start, but this is way more of an opportunity than I could pass up. I'm actually joining the same practice that JaneyD is a part of, she really is amazing and I'm excited to learn from both her and the senior midwife.

I'm now at the point that I need to decide on my schooling route and my mind is spinning. I need to read back through the thread to see what you all have to say.
Awesome! How exciting Good luck choosing the right school for you.
~~~~~~~~

I am working on my regular curriculum now for a submission goal of Jan 1st. I've been doing a little bit every day and feel like if I keep it up I will get there pretty painlessly. I'm officially back on call now but don't expect the next call for a few weeks.

Otherwise I've embarked on a fitness journey and have been working out at Curves daily and taking long walks. I feel so much better with more energy and more enthusiasm.

It looks like I will be going to the AAMI skills lab in Oregon next spring and also the Trust Birth conference I'm very excited! Maybe I will get to meet some of you ladies in person

Anyone reading Labor of Love? It's one of the worst books I've tried to read in a long time.
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