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having a midwife just to "catch" the baby? - Page 2

post #21 of 102
Quote:
Originally Posted by JamieCatheryn View Post
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.
That makes more sense. Liability. Totally understand. But it is not my problem. It is MW's problem to decide if my labs provide her all the necessary information or she needs more time to make sure that her client is eligible for HB.

As for the emotional and mental blocks, it won't take long for an experienced person to catch them. And then it is up to MW to decide where to deal with it or pass on.

So again, we are talking about what a MW need to do to be in her comfort zone. It is MW right but why to claim it is done for the client?
post #22 of 102
I switched care to my MW's at 26 weeks. It never even occurred to me to pay less than her "standard fee". While my prenatals were about the overall health of myself and the baby, they were also about establishing a rapport between myself and the midwives, so we were all comfortable with one another. We did have more frequent meetings than usual at first in order to accomplish this.

Frankly olstep, it sounds like you want the "safety net" of having a MW present, but don't really want to pay for it, and are trying to justify that position. It seems as though you don't have much respect for everything a midwife does, and really just want a lackey to take care of things on the back end-and if you're able to find that, that's great-but the core of midwifery care IS personal attention and a much more intimate relationship between caregiver and client when compared to obstetrical care-that's generally why women choose midwife care. You're entitled to feel differently, but you shouldn't expect to get very far when trying to dismiss that as important or necessary, especially on a homebirth forum.
post #23 of 102
OP, I know mw's will sometimes gift discounts if someone has financial troubles.

As far as paying full payment when coming in late, I'd never thought about it before. I did notice that my midwife does pro-rate some of the prenatals, but not all. So there is a discount, but it won't go below a certain number.

As far as appts go, with my first 2 births, I postponed appts until 18 weeks even tho it was with cnm's at a BC. But the appts were much more like a traditional dr's office setting. It wasn't until my hb that I realized how great prenatal care can be!

I started appts this time (4th time, 2nd HB with this MW) at 11 weeks because I love the friendship we share.

Paying for a HB MW is a huge struggle for us as we've lost 60% of our income in the last yr, but it is well worth every penny! GL!
post #24 of 102
I'm not a midwife, but I do find it personally offensive when people expect business owners to change their business model and to adjust their fees for their own situation and dislike for the model.

As far as I understand, the midwifery model of care seems to be to care for the whole woman/baby, from the time she seeks out the care of the midwife, until the PP period has ended. Whatever fee a midwife chooses to charge for her services is up to her. It is up to the client to accept that fee or not to accept the fee. Please do not expect her to show up at a birth, without understanding the whole situation, and then charge you less. I would expect to be charged more for that service, as it requires going out on a limb..she's attesting to having been the care provider for a woman that she knows nothing about.

Frankly, midwives simply do not operate under the same safety net and good-ole-boys club of self-preservation that OB's do. If a midwife agrees to just show up to "catch" a baby, and that mom ends up having a placental abruption, then who's going to take the flack that the midwife didn't "get" she was a closet smoker? (not picking on anyone, just pick some issue where the midwife gets pinned) Uh, the midwife. "She should have known."

If you don't like the fee structure, find one that you do, or consider UC'ing. Another choice would be an OB, as they usually bill globally-which is an after the fact price model, and for the services provided...usually more expensive than a midwife, but at least you can "feel good" about not having to pay for useless visits, and they can feel good their malpractice insurance will protect them if your birth isn't ideal.
post #25 of 102
Nobody questions an OB charging over $7000 for running in as a baby crowns and catching it, even though the patient has never seen the OB before in her life. It was just who was on call. I find it interesting the differing opinions on a midwives fee.
post #26 of 102
Quote:
Please do not expect her to show up at a birth, without understanding the whole situation, and then charge you less. I would expect to be charged more for that service, as it requires going out on a limb..she's attesting to having been the care provider for a woman that she knows nothing about.

Frankly, midwives simply do not operate under the same safety net and good-ole-boys club of self-preservation that OB's do. If a midwife agrees to just show up to "catch" a baby, and that mom ends up having a placental abruption, then who's going to take the flack that the midwife didn't "get" she was a closet smoker? (not picking on anyone, just pick some issue where the midwife gets pinned) Uh, the midwife. "She should have known."
SO, this is becoming a more interesting discussion than I anticipated! Thank you! Now I can understand having the feelings that olstep is having based on her self knowledge and not knowing what a midwife really does...the above quote really explains well some of the challenges that midwives do face...and yes if there is a bad outcome we are scrutinized not just by our own birth community but on a microscopic and legal level that an ob would never be under (unless they were a long time repeat offender, but even then usually not). And that doesn't even mention how I would feel as a person having a bad outcome and my responsiblities... So, do I believe most women could be and are of perfect sound mind and health like olstep, yes, otherwise I would not do homebirth. BUT, I have been practicing long enough to know that it would be naive for me to assume just because I have met with someone once or twice before a birth that I have caught everything physically and mental integral to a safe birth. And, I really do imagine olstep that your interest in hiring a midwife instead of doing an unassisted stems from wanting someone to assist you just in case there is a rare issue...and I can tell you from a risk and liability standpoint, not getting to know you well before a birth physically and mentally is a risk factor...I want to feel those bellies every week...feel consistent growth, amniotic fluid, positioning, know that the family environment relationship wise (abuse) is safe and stable...it is not that I think or am waiting for a problem...but that is what I am hired for, safety (and emotional support as well in some cases) and support, why else would I be there? There is so much more to say...oh the case studies I could share! But anyway, olstep, I hope that this might clarify for you some more... ??
post #27 of 102
Quote:
Nobody questions an OB charging over $7000 for running in as a baby crowns and catching it, even though the patient has never seen the OB before in her life. It was just who was on call. I find it interesting the differing opinions on a midwives fee.
Yup... My second birth was a non-emergency transport to the hospital after the vast majority of labor had occurred at home under the watch of my midwife. I birthed less than two hours after getting there and the doctor came back to see us in the morning for about 15 minutes. I was in the hospital less than 24 hours. I was charged twice as much for that birth than my midwife had charged me for the many, many hours she had put into my prenatal care and attending the birth.

Midwifery care isn't an a la carte menu and shouldn't be treated as such.
post #28 of 102
Don't most midwives "book" only a limited # of births per month? I would think that it would be difficult to run any business not knowing how many of your births you expected to attend in the next year were going to be discounted due to the lack of prenatal visits to take place? It would be rather difficult to budget I would imagine, from a strictly financial standpoint. You pay for a gym membership for a month, you don't get a discount because you only go once.
post #29 of 102
Quote:
Originally Posted by thefreckledmama View Post
Frankly olstep, it sounds like you want the "safety net" of having a MW present, but don't really want to pay for it, and are trying to justify that position. It seems as though you don't have much respect for everything a midwife does, and really just want a lackey to take care of things on the back end-and if you're able to find that, that's great-but the core of midwifery care IS personal attention and a much more intimate relationship between caregiver and client when compared to obstetrical care-that's generally why women choose midwife care. You're entitled to feel differently, but you shouldn't expect to get very far when trying to dismiss that as important or necessary, especially on a homebirth forum.
Quite the opposite, I prefer to pay for the things I want. Money are just money. It is easier to pay and be done with it than to feel obliged.
In fact, after reading that some MWs have a hard time receiving their fees, I offered my MW to pay the full fee now and asked her to reimburse me what she gets from the insurance after the birth. But she wants me to pay only my portion, which she has got, except the last hundred dollars that I'll pay on my next appointment.
Does it make you feel better, thefreckledmama? I hope that next time you try to get to know a person before jumping to conclusions.
post #30 of 102
Quote:
Originally Posted by olstep View Post
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?
Clients aren't always completely comfortable or forthcoming about fears, anxieties, etc. in an initial interview. And, some grown-up women wearing their big girl pants completely lose their sense of logic during pregnancy and labor. I've seen women who were completely together and composed who just wanted their midwife to "catch their baby" need guidance and love and understanding through the process.

Quote:
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.
It's not just the call and then you come and catch a baby. Women call for concerns and worries all hours of the day and night sometimes for weeks before the birth. They call with false alarms, they ask for the midwife to come check them to see if they are progressing. Most women whose labor I have experienced are very demanding in the days leading up to the actual birth. Also, midwives who are on call with clients in window rarely schedule events that they would have to cancel, if they can avoid it. Also, be mindful that a midwife might be with a woman and her family for days during labor and birth.

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?

Quote:
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?
I am sure there's a midwife who would suit your needs, but please realize that your needs are very different than the majority of women I've encountered. Women choose midwifery care for a variety of reasons, but mostly it's because of the personal nature of the service provided--the relationship that leads up to the fulfillment of their needs and wants for their birth. It sounds like you just want someone to fill in your chart, show up, catch the baby and bill you. You're an anomalous client--I've only met a couple of women for whom this was their desired experience.

I'm also not sure I remotely understand your hostility toward midwives. ??
post #31 of 102
So the only option for the women like OP is to pay full fee out of pocket instead of letting insurance pay for not so personalized but still professional OB care?
What if I do not want to become intimate with my care provider? What if it is just a business for me? I do not pay for friendship not intimate relations. Am destined to go to hospital ?
Home birth: is it a luxury or a need? Should it be available for women without putting their families into debt or drugging them pregnant selves for two hours to see the only available midwife?
post #32 of 102
Quote:
Originally Posted by thefreckledmama View Post
Frankly olstep, it sounds like you want the "safety net" of having a MW present, but don't really want to pay for it, and are trying to justify that position. It seems as though you don't have much respect for everything a midwife does, and really just want a lackey to take care of things on the back end-and if you're able to find that, that's great-but the core of midwifery care IS personal attention and a much more intimate relationship between caregiver and client when compared to obstetrical care-that's generally why women choose midwife care. You're entitled to feel differently, but you shouldn't expect to get very far when trying to dismiss that as important or necessary, especially on a homebirth forum.
I agree...

"Hypocrisy" is about as far from a word I would use to describe the midwife-mother relationship as one could possibly use. If the patient does not agree with/understand the model of care, attacking it and refusing to pay for it is not helpful.

In addition, midwives face a hostile social/political climate in many parts of the US. If there is a problem during a birth, that they could conceivably have missed signals for during the months that you did not seek care with them, they still have to pick up the pieces and do so without society's general approval and assumption that they did the best thing possible, which the OB generally gets...

The laboring woman still expects the same positive end result, even if the midwife has not been given every opportunity to assist that in happening.
post #33 of 102
Quote:
Originally Posted by olstep View Post
So the only option for the women like OP is to pay full fee out of pocket instead of letting insurance pay for not so personalized but still professional OB care?
What if I do not want to become intimate with my care provider? What if it is just a business for me? I do not pay for friendship not intimate relations. Am destined to go to hospital ?
Home birth: is it a luxury or a need? Should it be available for women without putting their families into debt or drugging them pregnant selves for two hours to see the only available midwife?
Huh?

I'm not sure what much of your post actually means.

However, in guessing what you are trying to say, midwifery care is like any other paid for service. There is a cost associated with having children and giving birth. Just because you don't think it's "fair" doesn't mean anything.

Everything in life has costs. My DH and I have found that midwifery care is a lot more affordable to us, than the financial rape we get via the insurance company and going through an OB/hospital. We have private pay insurance with a maternity deductible of $5000 + 20% coinsurance. That's fairly standard. It costs $3000 for the midwife, and she takes payments leading up to the birth. We are a non-debt/credit family, so we pay for things as we go...whereas a hospital birth is billed globally at the end, and suddenly you are "in debt" the minute the baby comes.

Anyway, there are a lot of things that aren't "fair" to pay. Homebirth at this point is a luxury for many..that's not because midwives are evil, but rather that the medical birth establishment has made homebirth and most midwifery care out to be a risky fad novelty rather than a safe, healthy, empowering and more practical and cost effective choice.

The issue is with the attitude that people have in regards to paying for services. Most people think they are entitled to earn more money, yet when they pay for professional services, they complain about getting yanked.

Get over it if you want midwifery care. If you are more hung up on money than care, then go to a hospital..they are more than happy to charge high rates and pass it on to insurance companies and then policy holders. Plan ahead and save..that's my advice. We paid for a birth last June, and now I'm due the end of August with a baby we didn't think would be happening quite so soon..but we are overjoyed, and because we aren't in debt from over spending and a lifestyle we can't afford, tightening our belts a bit to cover excellent midwifery/homebirth care is do-able. Opting out of prenatals to lower expenses (even if that was ethical/acceptable to the midwife) would never be an option.
post #34 of 102
Quote:
Originally Posted by olstep View Post
So the only option for the women like OP is to pay full fee out of pocket instead of letting insurance pay for not so personalized but still professional OB care?
Well, midwives typically aren't like hospitalist OBs who only provide delivery services. In fact, the vast majority of providers and insurances work on a global fee--all care (regardless of whether or not it's used) is billed under one heading/number. I live in a state where midwifery is legal and insurance pays for it, and most companies do so with that global fee. The midwives in this state are highly qualified healthcare professionals who offer a different but no less professional service to their clients. So, yes, standard of care around here is global fee billing--if you have 2 or 20 prenatals, you pay the same rate. Fair or not, it's standard.

Quote:
What if I do not want to become intimate with my care provider? What if it is just a business for me? I do not pay for friendship not intimate relations. Am destined to go to hospital ?
You will become intimate with your care provider, whether or not you wish to. It's the nature of birth. You will share with this individual (or individuals) a very intimate experience. This doesn't mean that you must enjoy it or wish for it; it's just the nature of pregnancy, labor and birth. You can be as closed off emotionally as you wish, and I bet your care provider will still have emotions surrounding your experience, as it intersects with her own. Yes, you are not paying for intimacy or friendship, and I'm sure you can make that abundantly clear with your midwife. But, it doesn't change the nature of midwifery--personalized, professional care, for which you may pay a premium.

A good example of the converse: I never used the baby warmer at the hospital. I never used the IV pole. I never used the NICU, the surgical suite, or any classes or lactation consultant. The services are offered and available and impact the amount of money that one pays for the care--even though I never used them once.

Quote:
Home birth: is it a luxury or a need? Should it be available for women without putting their families into debt or drugging them pregnant selves for two hours to see the only available midwife?
Personally, I believe that midwifery is a need. I believe that ALL women deserve a midwife, even if they choose a cesarean, they deserve to have prenatal care offered to them in a personal and caring manner. And yes, midwives should have offices on every street corner, and accept state health insurances like medicaid. In Florida, midwives can accept medicaid and insurances. The rules and laws need to change so that every woman has access to safe, professional midwifery care as a primary maternity provider.

Some places, however, do not offer women this option. Midwifery care is a premium service in most of the country and if this is true, then midwives should be paid for that service, even if you don't use individual aspects of the care.

The long and short of it is: access to midwives needs to be expanded and covered under insurances. Until that happens, women must weigh the benefit of a midwife against the cost of a midwife.
post #35 of 102
Quote:
Originally Posted by olstep View Post
Home birth: is it a luxury or a need? Should it be available for women without putting their families into debt or drugging them pregnant selves for two hours to see the only available midwife?
I would imagine this is why women are working to change the system, so that they may birth in the safety of their own homes, with qualified midwives and without undue financial hardship. At present we have an unsatisfactory system, but I find this to be the fault of the insurance industry and the public in general, for sitting back and allowing things to get to where they are. Not the midwives, who are attempting to offer what from this thread seems to be a thankless service.
post #36 of 102
Quote:
Originally Posted by onlyboys View Post
You're an anomalous client--I've only met a couple of women for whom this was their desired experience.

I'm also not sure I remotely understand your hostility toward midwives. ??
I wasn't aware that my needs are that abnormal. At least I am quite straight as for what I am looking for. And it is up to a MW to decide whether I fit in her model of care or not.
No hostility towards midwives. I am sorry if I sounded so. I did have a very ideal image of what a Midwife is till I came across a couple of them who hide their monetary interests behind the holistic talk. Nothing wrong with the first but I can't stand hypocrisy.


Quote:
Originally Posted by onlyboys View Post
It sounds like you just want someone to fill in your chart, show up, catch the baby and bill you.
Wouldn't it make a MW's life easier to be just a professional? Mindful, careful but a professional not a babysitter? Or am I asking too much? She needs to get under my skin to provide a quality service?
post #37 of 102
Quote:
Originally Posted by olstep View Post
I wasn't aware that my needs are that abnormal. At least I am quite straight as for what I am looking for. And it is up to a MW to decide whether I fit in her model of care or not.
No hostility towards midwives. I am sorry if I sounded so. I did have a very ideal image of what a Midwife is till I came across a couple of them who hide their monetary interests behind the holistic talk. Nothing wrong with the first but I can't stand hypocrisy.




Wouldn't it make a MW's life easier to be just a professional? Mindful, careful but a professional not a babysitter? Or am I asking too much? She needs to get under my skin to provide a quality service?
Olstep, a midwife wouldn't view it as "getting under your skin." She would see it as a function of her job to learn what you need for your birth. The manner in which this typically happens is through prenatals that begin like every interaction--surface--and proceed into deeper waters with time and familiarity.

For most midwives, you will not be just another client; just another warm body to pay her bills. You will be someone who she will accompany on the journey into motherhood. This is the tradition and professionalism of midwifery care--it's what it IS.

A midwife IS being a professional by getting to know her client's needs and wants. What make a midwife a professional care provider is her ability to provide you with safe, effective care. What makes her able to do this is her ability to discern your eccentricities and needs. Getting to know you, getting to know your partner and your family are all aspects of midwifery care. She is not being a babysitter, but rather a guardian of your needs.

There's a midwife for every woman, so I'm sure it's not asking too much to just want an experience like the shallow one I described above, but it is not typical for a midwife/client interaction.

Olstep, I'm curious about your birth experiences. Have you had a baby before? If so, was the experience what you are describing that you desire?
post #38 of 102
Olstep,

I mean no disrespect, but it sounds like what you are asking for is what many women have been fighting against-standard OB practice care.

You show up at ANY given hospital, regardless of prenatal care, and whomever is on call will catch your baby. They have no desire to get under your skin or develop a relationship.

Why would you even want midwifery care then? Not everything can be on these blase kind of terms. This is a big deal for midwives...I am having an "illegal birth" and I give major credit to the woman who is attending me...anything goes wrong and she's up a creek. She believes in me, though. Otherwise, I could just go to the hospital again and have standard OB care. No one would care one bit about my nutrition, the things you call "holistic", my overall health and well-being, my spiritual self that can be harmed via a lack of connection to birth, etc.

It's all choices. You can't always have things both ways...women who have tried to have OB care with a personal connection/relationship are often let down...please don't expect home midwives to go that way, too!
post #39 of 102
Quote:
Originally Posted by olstep View Post
I wasn't aware that my needs are that abnormal. At least I am quite straight as for what I am looking for. And it is up to a MW to decide whether I fit in her model of care or not.
No hostility towards midwives. I am sorry if I sounded so. I did have a very ideal image of what a Midwife is till I came across a couple of them who hide their monetary interests behind the holistic talk. Nothing wrong with the first but I can't stand hypocrisy.




Wouldn't it make a MW's life easier to be just a professional? Mindful, careful but a professional not a babysitter? Or am I asking too much? She needs to get under my skin to provide a quality service?
Midwifery and holistic care are about your whole being. She cares about more than your physical changes but your emotional changes. She's not only midwife she's a couselor, she's there to see that you are as healthy mentally as you are physically. If the state of your mental or physical health changes at any point she is there to help you back to normal (or refer you to those that can, severe pre-e or PPD) and support.

Why seek midwifery care if you don't want midwifery care?
post #40 of 102
Quote:
Originally Posted by onlyboys View Post

Olstep, I'm curious about your birth experiences. Have you had a baby before? If so, was the experience what you are describing that you desire?
I have a son. I was very happy with my birth experience till I became pregnant and did all the reading again. Paid attention to the things I missed when I had first pregancy, looked from different perspective, after I had given birth.... I am still happy with my birth experience but I would do some things differently. Nothing major though.

But lets talk about OP.
Can she see an OB for the prentals, get a copy of her medical records at the end of the pregnancy so that the only midwife who lives 1.5 hour away could look at them. See the MW a couple of times and birth at home? Would it mean more work for the MW? (providing the labs are fine) Should she be prepared to pay the full fee anyway?
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