Resolve a debate...

[saffrongirl]

So I just had my second homebirth on 9.29. We had hired a midwife and the agreement with her is that $2600 covered all the prenatals, the L&D and at least 4 post-partum visits. Midwife was great through all the prenatals. I had about three weeks of prodromal labor that drove me batty but she was very calming and encouraging. I went into active labor at about 2AM and then woke DP and had my mom come over at about 4AM. I was in contact with the midwife via text. At 6 I got in the tub and felt a lot of downward pressure. My mom had called the midwife to have her come but she was already with a laboring mom. At 6:30 it was obvious that things were really progressing so we called our MW again. She was still with someone else so she called her back up to come be with us. Her back up was ill so she called HER back up who was about 45 min away. Long story short, I gave birth to our dd at 7:04 with just my mom and DP there and the "third string" midwife arrived at 8:10. Our actual MW got there at 4 or 5PM and was very sad and apologetic to have missed the birth. Post-partum visits have been fine and she has continued to be supportive, etc.

So here's the debate: DP thinks she should have offered to give us a discount since she wasn't at the birth and we did it ourselves. The MW who did come eventually helped birth the placenta but she was very frazzled and distracted. Also, I had specifically asked at least four times during the course of the pregnancy what she does if births overlap. She had responded that it had never happened to her but she does always have a back up.

My stance is that everything went fine and that it was sort of empowering. It was totally not planned that way but I believe that things mostly have a way of going how they are supposed to and this is no exception. Our MW was supportive to us for the past ten months and things just happen that are out of our control sometimes.

Anyway, what do you think? Should we ask for a discount or just let it go?

[GoBecGo]

I would let it go, BUT i would let it go because my mw only books 11 clients a year to minimise the chance of births overlapping, and so if it happened i know it would have been purely unlucky, which i don't think she should suffer for financially. She did say it's happened to her once with a 37weeker and a 42weeker coming the same night - that kind of thing isn't common for her!

I'm in the UK, my whole fee will be £2500 which includes a back-up MW (she has another midwife with her at every birth), which i think is more than you're paying. Sometimes the fee a mw can charge HAS to dictate her booking policies if she is to keep food on the table etc.

Whoops, hadn't finished! If you feel she overbooks and this was bound to happen eventually you could ask for a discount, but she might not be receptive depending on how much she had to pay out to et the 3rd string to your house, albeit late for the birth.

[notjustmamie]

Did you discuss any of this ahead of time or does she have any provision in her contract that covers her responsibilities in the event that she cannot attend the birth?

I would call this something of an "Act if God" type situation. Your MW was not negligent, she was doing her job and just happened to get to mamas who went into labor the same day. She called her back-up in a timely fashion. Sadly, her back-up was sick and a second back-up had to be called in. It seems like everybody did what they were supposed to in the situation, it just didn't work out the way it should have.

Personally, I would feel uncomfortable asking for a discount/refund unless the MW did something wrong. I doesn't sound like she did anything wrong.

[nashvillemidwife]

Originally Posted by notjustmamie

I would call this something of an "Act if God" type situation. Your MW was not negligent, she was doing her job and just happened to get to mamas who went into labor the same day. She called her back-up in a timely fashion. Sadly, her back-up was sick and a second back-up had to be called in. It seems like everybody did what they were supposed to in the situation, it just didn't work out the way it should have.

Generally, my policy is that I only give refunds if I was at fault in missing the birth. My financial agreement states all the circumstances I could imagine in which I would miss a birth that wasn't my fault and not entitled to a refund (weather, traffic, labor too fast, parents don't call in time or at all). I had never considered that a backup would be sick, but in this situation I think the fact that the first backup couldn't come was irrelevant. I would still consider it a case where the labor went too fast. Sounds like it was no more than an hour from the time you told the midwife to come until the baby was born? I think a midwife living 45 minutes from you, primary or backup, is perfectly reasonable and for a lot of my clients I wouldn't have made that myself in the best of circumstances.

Also, I don't have a refundable "birth fee". My global fee is a package price and there's not a specific portion set aside as being for the birth. If a client were to make an argument for a refund I might consider giving them an itemized bill for the care I actually provided, including an hourly fee for the time I spent with them in labor and travel fees. I don't know how much time she spent with you during the three weeks of prodromal labor, but I can pretty much guarantee you that my itemized fee would come out to more than what the client paid me and they would owe me more money.

[saffrongirl]

Yeah I agree. I gues. DP's thing is that we did ask at least 4X about her policy for overlapping births. The reason we specifically asked is because my midwife for my first dd's birth only took 2 due dates per month to minimize chances of overlap. With this MW we were assured that things "had always worked out" previously.

To me, her care prenatally and post was invaluable. To DP (perhaps mostly because he's male), we paid her for "the important part" and she wasn't there.

I haven't checked the contract yet but I bet it has some "Act of God" portion. I want to let it go but he keeps bringing it up when the birth gets discussed and it's annoying to me. Lol.

Eta: our MW is usually only about five min away (home and office) so if she hadn't been with the other mom, she would have had more than enough time to get here.

[pjs]

I wouldn't ask for a refund- she wasn't negligent and did everything she could.

[camprunner]

This almost happened to us. We would not have asked for a refund had the backup missed the birth (which in that case wasn't going to happen because I was holding out and never felt an urge to push due to my water not breaking on it's own). I also asked repeatedly for her back up plan if she was unable to make it and she stated several times that it had never happened and later we laughed about how I was so insistant upon that detail and this was the first time she'd needed a back up at all.

[prancie]

It was not her fault that he back-up was ill, i'd give her a break and be glad that she had enough foresight to have a 3rd person who could get to you. I'm jealous of your UC!

[Chamsia]

I had a hb in 2006 and am planning another for next spring. We've moved since, so I have a new mw.

MW #1 had the same line, "things tend to work out", and I don't think I pressed her on it, though 'twas years ago so I may be forgetting. (Everything worked out.) MW #2, whom I'm working with now, is uber-professional (#1 was a sweet hippie) and has every possible thing written out and planned for. Nonetheless she still limits her patients to ensure that overlap doesn't occur. But she has 2 backup mws, besides the doula whom she routinely works with at births, in case of an overlap.

Perhaps you and DP could craft a letter expressing your appreciation for all her great work, but also voicing your disappointment that she wasn't there? Especially since you had enquired about this possibility so much...I don't know.

I think that, since this has happened, she will surely re-evaluate her planning process to assess how many patients she takes at a time, and to be sure to be in touch with the back up mws as birth times approach.

What I find disconcerting here is not that there was no mw with you, since it wasn't her fault and it all worked out fine. What bothers me, and what I bet is really bothering your DP, is that (from what you've written) it seems like she has not taken any responsibility/expressed any regret. Considering how many times you asked about this possibility, one would think she would be feeling mighty sheepish and be apologizing like mad or something.

It seems like the issue to be resolved is your husband's feelings, not the $ itself. So I guess what I would do would be to meet or talk with the mw myself. I'd express thanks and appreciation for all she did. Then, perhaps, I would allude to the fact that my hubby doesn't understand that her support is about so much more than the birth itself...oh boy. I just really don't know.

Well, I've typed out my thought process for you at least. Perhaps it will help. I think it's important for you to resolve this so you can all enjoy the memory of your awesome birth without this annoying issue coming up every time. But we all know that you can't just say "let it go" and have that happen. Your DP needs some sort of acknowledgement. He is right in a way--you did not get everything you paid for, or thought you were paying for. But it was no one's fault. And everything is just fine.

I've been trying to teach my 3 1/2 year old to just say "oh well" instead of freaking out about (usually inconsequential) disappointments. But it is hard for all of us.

Best wishes! Sorry for the lack of advice!

[LisaSedai]

I'd pay her the full amount if it were me.

[hapersmion]

I think the only way to really answer is to check your contract. It ought to be in there. My current midwife doesn't give refunds for that, but she's told us up front that she doesn't. A previous free-standing birth center I went to had it in their contract that they would give a certain amount of refund if the baby was born less than 25 minutes after your arrival at the center, which I thought was pretty cool.

[erin_brycesmom]

I don't think I would ask for any kind of discount because it was only 34 minutes from the time you guys called/talked to her to the time you gave birth. In that short period she did make a reasonable attempt to get a back-up to you. But isn't it just like men to think this way, lol. I'm sure my dh would be saying the exact same things. I do think that if you are unhappy with the care received from the back-up, you might feel better discussing that with your MW.

[nashvillemidwife]

Originally Posted by Chamsia

I think that, since this has happened, she will surely re-evaluate her planning process to assess how many patients she takes at a time, and to be sure to be in touch with the back up mws as birth times approach.

How many births does she take a month? I must have missed it if the OP said it was excessive. Around here 4 is standard, but two moms laboring at the same time is a possibility with just two a month. Actually, even if you're the only mom due a midwife can still have an illness or other emergency that would require her to call a backup. I take 2-4 births a month, sometimes up to 6 depending on backup and their proximity. In 10 years I've never missed a birth because of client overlap, thought I have missed one because I was sick (and I was actually the backup assistant). One incident now certainly would not lead me to conclude I should re-evaluate anything, and I'd resent the suggestion.

Seriously, I think your DP is just misguided here and this seems to be the general position of everyone who has responded. I would advise you to tell him to let it go. You never did say, how much care did she provide during the three weeks of prodromal labor? I can assure you it caused her some distress too., in addition to time, energy, and expense. Did she provide phone support during the labor? How many weeks was she on call? How long was she there after the birth? Prenatal visits? Postpartum visits? I think $2600 is a steal on those services alone. The idea that all that hard work should be discounted and that getting there in time to put her hand under your bottom to keep the baby from hitting the floor is "the hard part" is an insult and minimizes the invaluable work she actually did.

[sunflowergrrl]

this is a little off topic, but OP, I am interested in what your surprise UC was like?!? What was it like when you realized there would be no midwife for the birth? And what was that hour like between when the baby was born and she arrived?

I THOUGHT I might end up giving birth without my midwife since she lived kind of far away and my last labor was quick. (although I knew the studnet midwife would be there since she lives close). Instead my labor was very pokey and there was plenty of time ;-)

[saffrongirl]

Originally Posted by nashvillemidwife

How many births does she take a month? I must have missed it if the OP said it was excessive. Around here 4 is standard, but two moms laboring at the same time is a possibility with just two a month. Actually, even if you're the only mom due a midwife can still have an illness or other emergency that would require her to call a backup. I take 2-4 births a month, sometimes up to 6 depending on backup and their proximity. In 10 years I've never missed a birth because of client overlap, thought I have missed one because I was sick (and I was actually the backup assistant). One incident now certainly would not lead me to conclude I should re-evaluate anything, and I'd resent the suggestion.

Seriously, I think your DP is just misguided here and this seems to be the general position of everyone who has responded. I would advise you to tell him to let it go. You never did say, how much care did she provide during the three weeks of prodromal labor? I can assure you it caused her some distress too., in addition to time, energy, and expense. Did she provide phone support during the labor? How many weeks was she on call? How long was she there after the birth? Prenatal visits? Postpartum visits? I think $2600 is a steal on those services alone. The idea that all that hard work should be discounted and that getting there in time to put her hand under your bottom to keep the baby from hitting the floor is "the hard part" is an insult and minimizes the invaluable work she actually did.

The MW doesn't put a limit on her births per month and every time we asked her about it, she said that it just works out. I do believe in the concept of "things working out" cosmically but each time I asked her, she left it at that and never really talked about a back-up although I knew she had one.

As far as prodromal labor - we just had the regular visits - one a month until 34 weeks and then once every other week. She did two internal exams at my request and swept membranes at the last visit. She is/was always available via phone and my mom did talk with her a few times while I was actually in labor although she WAS with another mom. She showed up in the evening after I gave birth in the morning and then the next day and another time after. I have visits with her at 4 weeks PP and then 6 weeks PP.

I really don't feel like she's at fault. I would use her again in a heartbeat. I personally feel that most of the care is done during the prenatal visits anyway and who cares who catches the baby. For DP though, it WAS about catching the baby - for her to be there just in case. This was his first homebirth though and my second, so possibly that has something to do with it too. I don't know. I agree with all of you, but like I said before, it's difficult because he sort of rolls his eyes when we say that dd was born at 7:04 and MW was there at 8:10 and I feel so proud.

[saffrongirl]

Originally Posted by sunflowergrrl

this is a little off topic, but OP, I am interested in what your surprise UC was like?!? What was it like when you realized there would be no midwife for the birth? And what was that hour like between when the baby was born and she arrived?

I THOUGHT I might end up giving birth without my midwife since she lived kind of far away and my last labor was quick. (although I knew the studnet midwife would be there since she lives close). Instead my labor was very pokey and there was plenty of time ;-)

My first dd took 18 hours to come so I was fully expecting a long time with this one too. Although I had the prodromal labor, active labor was about 5 hours from start to finish. I really didn't realize it was going to be a UC until my body just started pushing. My mom checked me and held her fingers out and asked DP, "how many cm do you think this is?" He responded with, "um, maybe 8 cm?!" I said "NO WAY - HERE'S HER HEAD!" It was total instinct and there was nothing in the world that could have made me be able to stop pushing. Her head came out with that first push and then I consciously put more effort into pushing with the rest of her body. My first words were "Holy SH!T, that just HAPPENED!" LOL. That hour until the MW got there went really fast actually. I just hung out and we looked at the baby and kept her warm. I was totally euphoric. In that moment, I was really confident and peaceful with no worries about how things had gone.

As an aside, I had to work through some fear of pain issues in the weeks before giving birth. I had a mantra that was something like "All I have to do is relax and breath, my body knows what to do." I think it's interesting that when it was all said and done, my body really did know what to do - it seriously pushed her out without any conscious effort on my part.

[zoebird]

i would let it go. it is likely that the money is given over to the midwife who did attend (in some way), and so i would let it go.

[sunflowergrrl]

Saffrongirl, thanks for sharing that! Sounds like a beautiful birth and a great example of our bodies and our babies knowing exactly what to do! I'm glad the time after the birth was peaceful as well.

[SublimeBirthGirl]

Here's the way I look at it. If you'd been in active labor for 50 hours, pushing for 4, your midwife would've been with you. She would not have then said, "Your labor was X hours longer than average so here's your bill for the extra." Birth is unpredictable. You don't know who's going to have a long labor and who's going to have a short labor. She was at a birth and her back up was sick, but she got a midwife there fairly quickly. It's not really her fault. I think your DP is off base on this and you should let it go.

[ErinBird]

My MW missed my second birth. She made the decision to leave around 2am so I could rest and I suddenly felt the urge to push at 5:30am. I had someone call her, but baby was out pretty fast and the MW lives at least 15 minutes away at that time of day. She must have taken off at a run and called her assistants along the way because the MW got there ten minutes after the birth and the students showed up about 10 and 15 minutes after that.

It didn't occur to me to ask for a discount- she still did the post-birth work up for me and baby and cleaned up the birth mess.