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having a midwife just to "catch" the baby?

post #1 of 102
Thread Starter 
I really would like to try for a homebirth. The problem is that I don't have the money to pay out of pocket for midwifery care, plus the driving to see the only midwife I'm aware of (about an hour and a half away). I'm considering asking the midwife what her fee would be if I switched to her during my third trimester and homebirthed with her. I would be more comfortable having a midwife, even if I labored and delivered alone, just to check things over and help me get the birth certificate easier, etc. Plus women in my family tend to cook our babies longer, and I'd like someone to keep an eye on things. (I was induced with my last child for being overdue, and I don't think it was warranted, but at the same time I like the comfort of having a professional tell me everything is going fine.) Anyone done this?
post #2 of 102
It's not unusual. I would have no problem with a client that did something like this; it's not much different from someone that decides a few weeks before they're due to switch to a home birth provider and heaven knows that happens all the time!
post #3 of 102
I wanted to do the same but I found that even if you can find MWs who would agree to attend the birth without doing prenatal care the fee would be the same or not that much different than if you get all prentals.
They claimed that it is a lot of their time and energy to catch someone up who comes in late to care.
post #4 of 102
So there are a couple of issues...

If I did this most of my clients would just come to me at the end of pregnancy to save money, I need to earn a living.

The large part of safety in homebirth lies within getting to know your clients and their bodies well, and in clients getting to know you...trust.

I could expand on this but don't have a lot of time now...perhaps others could chip in...

I do charge a full fee no matter when people come to my care, most midwives I know do, but you may find someone who does not...never hurts to ask! Just don't compromise quality for cost savings would be my advice.

Good luck!
post #5 of 102
I'd say it would reduce my fee by a few hundred dollars. I tend to bill my clients on a prenatal by prenatal basis, since I never know how many prenatals we'll manage to get in, and I'm not billing for services I didn't render. It's just going to depend on the provider. For me, as long as I'm kept up-to-date with how prenatals went with the doc I would be fine. I had one client that lived a ways away so we did a similar setup, and she would email me after prenatals with her info. I always knew how her pregnancy was going, her measurements etc, and was able to keep a record on it without a hassle or feeling like I had to play catch up. I did meet with her for a few prenatals in the last trimester so I could get a good feel for her pregnancy, babies position, and how to get to her house but our set up saved her from paying for the full prenatal schedule and making several long distance drives while ensuring she still received good care. So, it's doable. The kicker is finding someone willing to do it.
post #6 of 102
Paige has a good point. I wouldn't do something like this for every mom; as she said, we need to make a living and I want to make clear that a set up like this would reduce my charges for prenatals, not for the birth itself. However, I do live in a state where the midwives are few and far between and a midwife can have clients several hours away. It's impossible for a midwife to provide the full prenatal care to those families (no midwife would have time to continuously make that drive, and no family would be willing to) so the families have co-care to make sure they get the full prenatal care they desire. It's not unusual for a midwife to plan several long distance prenatals for one day, so that her families in that area can share the expense of her travel charges and prenatal fees. It makes sure that she sees her families more often than she otherwise would, and saves them from a prohibitive cost. That may be a possibility for you; it wouldn't hurt to ask.
post #7 of 102
Quote:
Originally Posted by olstep View Post
I wanted to do the same but I found that even if you can find MWs who would agree to attend the birth without doing prenatal care the fee would be the same or not that much different than if you get all prentals.
They claimed that it is a lot of their time and energy to catch someone up who comes in late to care.
Midwifery services are invaluable. All the time and attention I have receieved through pregnancy was worth more than my midwife's global fee. To ask her to do that in a few short weeks before delivery is, IMO, asking a lot and I would certainly expect to pay her global fee regardless of how many prenatals we had because of the attentive/compassionate/loving care I recieved. Even the best doctors I've met have not given the same standard of care, not because they don't want to but because they are limited in their time. A midwife makes your birth month yours, she makes sure she isn't over loaded and does everything in her power to ensure her ability to attend you during birth and the immediate post partum. That means time away from her family, which we all know that time is precious, but the time away from her family is more than a few prenatals and the birth. It's time charting, learning, thinking, answering phone calls, answering e-mails, being prepared to up and leave at any moment for when the call comes.

Like Paige said, they need to earn a living and believe or not the living they do earn is pretty darn modest after all the costs of running a business, continuing education via classes/conferences as well as paying for studies to be able to read them, don't forget the gas it takes, the equipment, etc.

As for the OP, there are midwives that do thise I'm sure. I wish you the best of luck on figuring out the right birth choices for you!
post #8 of 102
Quote:
Originally Posted by olstep View Post
I wanted to do the same but I found that even if you can find MWs who would agree to attend the birth without doing prenatal care the fee would be the same or not that much different than if you get all prentals.
They claimed that it is a lot of their time and energy to catch someone up who comes in late to care.
I would expect a midwife who attended a birth of mine to charge the full fee. She is the care provider responsible from a legal standpoint for the birth outcomes, and does not deserve to have to come in and deal in the relative crisis situation of birth with whatever competant or incompetant care you may or may not have recieved through the pregnancy.
post #9 of 102
Quote:
Originally Posted by Right of Passage View Post
Midwifery services are invaluable. All the time and attention I have receieved through pregnancy was worth more than my midwife's global fee. To ask her to do that in a few short weeks before delivery is, IMO, asking a lot and I would certainly expect to pay her global fee regardless of how many prenatals we had because of the attentive/compassionate/loving care I recieved. Even the best doctors I've met have not given the same standard of care, not because they don't want to but because they are limited in their time. A midwife makes your birth month yours, she makes sure she isn't over loaded and does everything in her power to ensure her ability to attend you during birth and the immediate post partum. That means time away from her family, which we all know that time is precious, but the time away from her family is more than a few prenatals and the birth. It's time charting, learning, thinking, answering phone calls, answering e-mails, being prepared to up and leave at any moment for when the call comes.



I signed on with my MW at 36 weeks. I would never have suggested paying less than the full fee - she spent hours and hours trying to get me "caught up" on care.
post #10 of 102
Quote:
Originally Posted by jeminijad View Post
I would expect a midwife who attended a birth of mine to charge the full fee.
Full fee for the birth? Or for the prenatal visits as well - the service she didn't provide?

As for "relative crisis situations" aren't they a natural part of a birth. So why to complain that a provider needs to deal with them?


At least Paige, CPM was honest:

Quote:
Originally Posted by Paige, CPM View Post
If I did this most of my clients would just come to me at the end of pregnancy to save money, I need to earn a living.
post #11 of 102
We started care in our 3rd trimester but are paying the full fee, and i believe my mw deserves it. And honestly even though we are going into debt to have this homebirth, the price is worth it in my health.

Can you work out a payment plan???
post #12 of 102
Quote:
Originally Posted by Comtessa View Post


I signed on with my MW at 36 weeks. I would never have suggested paying less than the full fee - she spent hours and hours trying to get me "caught up" on care.
I have never got a decent answer when I tried to find out what that "catch up" talk is about.
My understanding is that majority of woman who opt for HB are well-informed, well-read and take good care of themselves. They would at least have all lab. work done and most likely see an OB regularly.
I am sorry, but I have a feeling that the "catch up" talk is just a talk to justify her fee. Personally, I'd stay away from this type of MW.
post #13 of 102
I switched to a CPM at 38 weeks because of issues with the CNM I was using. I paid her the full fee because it was worth it to me to have here there. We didn't have all of the money up front, so we made monthly payments until our tax return came.
post #14 of 102
Quote:
Originally Posted by olstep View Post
I have never got a decent answer when I tried to find out what that "catch up" talk is about.
My understanding is that majority of woman who opt for HB are well-informed, well-read and take good care of themselves. They would at least have all lab. work done and most likely see an OB regularly.
I am sorry, but I have a feeling that the "catch up" talk is just a talk to justify her fee. Personally, I'd stay away from this type of MW.
Wow. This really bugs me.

unfortunately, though most women who opt for hb care do try to inform themselves and take good care of themselves, without the guidance of a mw who really knows homebirth, a family's self-informing and self-care may actually fall somewhat short of 'good enough'. Their 'self-informing' may be all about 'hb safety' (to convince themselves and families) and 'labor prep', but not so much about nutrition and other elements of holistic self/baby care. They may have watched some videos and heard good hb stories, but really have not considered the nuts and bolts of preparing for, and having a homebirth, breastfeeding, postpartum recovery....Mom may be very well informed but Dad utterly clueless. Not to mention that OB prenatal care falls quite abysmally short of adequate to help women stay healthy, and believe it or not many families think that all they have to do is listen to their doc, have their labs done. So, if their OB did or didn't say it, then it's assumed to be either 'true enough' or 'we didn't need to know that'....meaning that there really *can be* quite a lot of 'catch up' to do. Catch up on information, undoing misconceptions....

And I'm with Paige--getting to know people well enough, establishing mutual trust--these things are so very important to the success and smooth, happy running of a homebirth. This takes time; so when people come late to care for any reason I may give them a small discount (IF they have had some prenatal care already) but not much-- because I'm going to see them as often as possible in the time we have left before the birth. And seeing them as often as possible means that I will have to make rapid adjustments in my own scheduling expectations and consciousness both (to mentally/emotionally 'make room' for these new people)--these things are a form of work as well, and believe me it is harder work than having at least 20wks or more to integrate clients in all necessary ways.

As I have often tried to explain to potential clients--this is not like your typical OB managed experience. Homebirth with a mw will NOT be 'just like a hospital birth, only at home'. I am not merely the kind of med/surg technician that an OB is--an OB doesn't ever have to have met a woman prior to managing her birth because OBs apply a fairly standard set of impersonal, universal rules, protocols and so forth. Their type of 'medicine' can very often rescue women and babies from the inadequacies of OB prenatal care and ill-nourished, minimally informed and generally unprepared women. Does a mom's labor stall? Fine, give 'er some pit and/or do surgery. Is mom malnourised and therefore prone to excessive bleeding--ok, we can fix that too, with meds or surgeries. And so forth.

But what a hb mw does is far different. It is holistic, and highly individualized, finely nuanced and time-intensive.

Finally--sure I understand that for some families, $$ is an issue and they hope to let insurance pay for some of the care and then get a discount from a mw. But we mws DO have to make a living, and it generally IS a fairly modest living at that. Besides, I do this work primarily because I love doing this work--and I happen to believe that my own happiness and joy are pretty important to doing this job well along with helping to keep me healthy for my own AND clients' sakes. It is my prerogative, therefore, to make choices about how I'll do this work. I prefer to meet people sooner, and to be paid full fee--this is more comfortable for me and it seems to work quite well for my clients also (at least judging from my stats and happy customers). So what? Making such choices does not make me greedy or otherwise somehow suspect.

To be clear, I have met some families at the last minute that were a joy to serve--we 'clicked' immediately, they were very highly self-responsible, and all went perfectly well without a hitch--allowing them a discount was no problem at all. But then there have been those latecomers where it did not all go so well--in terms of birth itself, and in terms of the 'joy factor'. And to be perfectly frank, they were generally the ones who DID think they could hire me, and treat me, as if a mere technician who could 'just catch the baby'. They really didn't get it, did not see or respect the core of my way of working; they really weren't so prepared or self-responsible; they did not care to establish trust and comaraderie with me; there generally were more issues and even scary moments during/after birth for them. Things that of course they figured *I* should be able to rescue them from....at a discounted rate, of course. And accept the blame--and their gossiping about me all over town-- if I couldn't rescue them, of course.

Rant done!

Thanks to all who have said you understand why coming late to care should not automatically mean a big discount of a mw's fees
post #15 of 102
I have switched late in a pg and paid the full fee. In my area with several MW's there is only one that has a reduced fee, and that fee is birth only, no prenatals, it is only slightly less then the regular fee, and only for certain women to prevent circumstances like MsBlack described. As difficult as it can be for a woman to switch late and then pay the full fee, I completely agree and understand all the many reasons behind it. A MW has a very difficult job, and kuddos to all the MWs out there.
post #16 of 102
I will be switching at 26 weeks (due to moving out of state) and the midwife is not giving us a discount for the months we don't see her. I don't mind. I consider the fee to be to have my homebirth with a well qualified and very highly recommended midwife, the other visits are all just bonuses.
post #17 of 102
Quote:
Originally Posted by MsBlack View Post
though most women who opt for hb care do try to inform themselves and take good care of themselves, without the guidance of a mw ... a family's self-informing and self-care ... may be all about 'hb safety' ... and 'labor prep', but not so much about nutrition and other elements of holistic self/baby care.
Not sure what other elements of holistic care you have in mind but if it is mainly nutrition (and exercise), they are normally a part of woman' everyday self-care, not something new or specific for pregnancy only to not be able to make necessary adjustments.

Quote:
As I have often tried to explain to potential clients--this is not like your typical OB managed experience. ... I am not merely the kind of med/surg technician that an OB is--an OB doesn't ever have to have met a woman prior to managing her birth because OBs apply a fairly standard set of impersonal, universal rules, protocols and so forth....
But what a hb mw does is far different. It is holistic, and highly individualized, finely nuanced and time-intensive.
I hope that MWs have their protocols and rules as well. For their own sake as well as their clients'.

If all the woman wants (as OP said) from a MW is to catch the baby, make sure that both are fine and help with cleaning, why to to impose (and make her pay) for the service she does not ask?

For her benefit or MW's convenience (psychological and/ or financial)?
Some women need to be pampered and told what to do, some don't. We are talking about individualized care, aren't we?

I am in no way questioning a MW fee or her need to make a living.
Personally I chose the MW whose fee is higher than the average in my area. It is not the fee that I took in consideration but the facts that she knows her business, very straightforward and, not the least, doesn't pour that holistic talk on me.

Quote:
there have been those latecomers where it did not all go so well--in terms of birth itself, and in terms of the 'joy factor'. And to be perfectly frank, they were generally the ones who DID think they could hire me, and treat me, as if a mere technician who could 'just catch the baby'.
I am sorry but if you take money for the service you are offering, you are considered hired. If it is not acceptable for you, there is always an option to not take the money or the client.


Quote:
They really didn't get it, did not see or respect the core of my way of working; they really weren't so prepared or self-responsible; they did not care to establish trust and comaraderie with me; there generally were more issues and even scary moments during/after birth for them.
Did it happen because they didn't want to become friends with you, or because you were not able to move from your ideal model of care and adjust to their needs?

One of midwives with 30 year experience said that 99% of births she attended would've gone as well as if she hadn't been present there.
Something to think of...
post #18 of 102
Quote:
Originally Posted by olstep View Post
Did it happen because they didn't want to become friends with you, or because you were not able to move from your ideal model of care and adjust to their needs?

One of midwives with 30 year experience said that 99% of births she attended would've gone as well as if she hadn't been present there.
Something to think of...
Hmm. I think a huge part of the reason midwives like to see their clients often before the birth is so that they know how to modify their approach to the birth for that particular client. If a midwife doesn't know you or what you need to feel comfortable how is she supposed to move from her "ideal model of care" and where is she supposed to move?

I consider it a midwife's job to quietly observe and help where she is needed, including giving the mother more support if that's what that mother needs. Birth generally goes well. I don't think many midwives think that they need to do a lot during a birth to make it go well, and I think everyone reading feels the same way. So your last little bit isn't some huge revelation for me, at least. I think we've all thought of it, otherwise we probably wouldn't birth at home.

What percentage of the fee do you think the birth should be? "Just the birth" means being on call 24 hours a day 7 days a week for about 6 weeks. Missing family events, canceling and rescheduling appointments of all kinds, etc. Honestly I have always considered the fee to be for the birth itself, and the appointments leading up to it part of the preparation for the birth.
post #19 of 102
I come down on the side of the fee is for the whole deal, no matter how many visits you get ahead of time or what services you want. Everything prenatal is to check things are progressing fine and to prepare for the big event ahead. My midwife remarked repeatedly DH and I were the ideal clients, I'd done the research and we knew everything she'd normally answer (birth process, nutrition, immune system support, exercise, normal pregnancy complaints, postpartum, breastfeeding, tests, choices, anything), that my appts even went past 15 minutes was just to chat and talk advocacy. No discount though, you pay what you pay. Sometimes for financial difficulty they'll give a discount. That's a gift.

Now, she was great and gave me just the service I expected from her, taking time to find out just what that was (and I suppose check that I knew what I was talking about and my choices were safe ones). She didn't do much prenatally but chat and watch my BP and hemoglobin. During labor she was in the house the last few hours to check in, Doppler check, quietly ask what I wanted her to do, and just be supportive and calm. It was our understanding that the responsibility for the outcome wasn't even on her, it was our own so much as is was anyone's. Still no doubt every midwife feels an obligation to make sure everything progresses safely under her watch. That could account for a great deal of what they need to catch up on if they come on the scene late, becoming assured that the woman is truly healthy all around. so few are these days, though homebirthers have better averages I'm sure when it comes to nutrition, emotional and mental blocks, whatever else can cause problems.
post #20 of 102
Quote:
Originally Posted by mbhf View Post
Hmm. I think a huge part of the reason midwives like to see their clients often before the birth is so that they know how to modify their approach to the birth for that particular client. If a midwife doesn't know you or what you need to feel comfortable how is she supposed to move from her "ideal model of care" and where is she supposed to move?
We are talking about grown-up women not babies who have no language skills and can't speak their needs, aren't we? Would you say it your client's expectations were not clear for you after the interview?

Quote:
Originally Posted by mbhf View Post
What percentage of the fee do you think the birth should be? "Just the birth" means being on call 24 hours a day 7 days a week for about 6 weeks. Missing family events, canceling and rescheduling appointments of all kinds, etc. Honestly I have always considered the fee to be for the birth itself, and the appointments leading up to it part of the preparation for the birth.
I do not understand why you need to give up on your personal life, family events, etc for 6 weeks to provide your service on the one only day when actual birth will happen.
I am not a MW and I do not know this job.

If we believe that prenatal appointments are so important and most work is done before the birth, than what should be the fee for the birth itself?

It is not the fee I am questioning. But hypocrisy: they push the service I am not asking for, claim that I need it while it is them who need/ want it and ask me to pay for it.
When it comes to money they are business women, when it comes to the service they are paid for, they feel offended with the fact that they are hired. They are free spirited artists who provide holistic care.

Why not be honest? If you can't or are not willing to provide the service I am looking for, just put it straight. Why to act like a sale person and impose the whole package which you are interested in (due to the lack of practical experience or a financial reason) but not me?

It is not directed to you, mbhf. I have no problem with anything you said in you post.
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