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having a midwife just to "catch" the baby? - Page 5

post #81 of 102
I guess I should also say that it never hurts to ask what a midwife might be able to work out with you financially, just like any other care provider, but you shouldn't hold it over her or her global profession if she isn't able to do just what you want for exactly the price you want.
post #82 of 102
I just wanted to chime in that I, too, felt like I was buying insurance for my midwife's skills and expertise. I was a very low-maintenance client, very rarely called my midwife, had my daughter on her due date - the MWs were at my house for less than 12 hours.

I knew when I signed on with my midwife that I would be paying the full fee for her services, regardless of what actually happened. I knew her services to me could range anywhere between doula in the event of an unforseen hospital birth to catching a vertex baby to delivering a baby that turned breech in labor to a million other scenarios.

I expected my midwife to commit to me for any and all circumstances, so I did not find it unreasonable or unfair to pay her for that commitment. If every birth went like mine, my midwife could schedule a birth seven days a week. They don't, so asking her to have time set aside to provide me with her skills and expertise was worth her price.

I paid less for my midwife's complete package than I would have for a birth alone at the hospital, so I really can't imagine complaining about the cost. I also find the use of words like "forced" offputting when it comes to describing a midwife-client relationship, since nobody forced you to use a midwife in the first place. If you don't like the terms of a midwife's services, don't contract with her. It seems really simple.
post #83 of 102
Quote:
Originally Posted by nashvillemidwife View Post
They may be rare in the general population, but we're talking about pregnant women and postpartum mothers. No offense, but tired, anxious, sleep deprived, and sometimes depressed women sometimes experience reality a little different than the rest of us. Circumstances and agreements that were okay during pregnancy are often not okay once the baby is here. Disagreements and disappointment with the midwife are quite common for clients who did not really get to know her. I can tell you this with absolute confidence; you are one woman with your experience with your midwives, or perhaps a few friends with their experiences. I am a midwife with 300 clients under my belt. Taking clients under the circumstances we are discussing imposes inherent risks.

Your explanation is clear and makes sense even though I do not agree with how you pictured pregancy/ postpartum emotional state. But I take your word for that because of your experience.

One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?
post #84 of 102
Quote:
Originally Posted by mandib50 View Post
if a woman is not wanting the more intimate care of a midwife or if she does not want to pay for full services, then it would seem that she could find a physician or OB who would be more of a philosophical match to her needs.
Have you heard about an OB who is willing to attend a homebirth?
post #85 of 102
Quote:
Originally Posted by GoBecGo View Post
I. If i wanted an impersonal medical back-up i'd UC and call an ambulance when i was pushing. That is not nearly as safe, even for low-risk women, as homebirth with an experienced midwife with whom they have a pre-existing relationship, but if i wanted it that's how i'd get it.
Why would you do something you consider unsafe: UC or an ambulance (unless you consider childbirth an emergency)?
Even for the most independent woman safety would be higher on your her list than impersonal care, don't you think?
post #86 of 102
Quote:
Originally Posted by olstep View Post
One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?
THere are risks for an OB who is oncall and has women walk through the door with no history, no prenatal care, etc. However, as midwives and depending on the states we are practicing in, we run the risk of jail or prison time if things go poorly. Not just a lawsuit, but time behind bars. OBs do not have that same kind of risk.
post #87 of 102
so in our state people have a "right to sue"part of our constitution in any case- we now have recent- legislation to limit liability for delivering docs for non-established patients, additionally you have docs who refuse to see pregnant patients if they have not established care by 12 weeks- they will end up seeing them in the hospital for delivery but then their liability will be limited- the other thing is that docs do respond to this danger by pro-actively and inapproprately doing the most that they can do - thus elevating the c-section rate beyond what is safe or healthy for moms or babies
post #88 of 102
Quote:
Originally Posted by olstep View Post
Why would you do something you consider unsafe: UC or an ambulance (unless you consider childbirth an emergency)?
Even for the most independent woman safety would be higher on your her list than impersonal care, don't you think?
Perhaps, but if you ask a midwife to care for you properly in a way which is safe, she is going to get to know you. She is going to NEED to get to know you. I don't want impersonal care; it isn't safe. Asking the midwife to show up, catch the baby and go away again, and charge a fee reflecting those few hours of work, would be dangerous.

Incidentally i had my baby, after a long stop start labour we managed to get the midwife there about 45mins before the birth. Contractions became regular about 55mins before i was pushing, i pushed for 6 mins. Baby had a true knot, but apgars were 10, 10 and 10. My midwife didn't *even* catch my baby (we had already discussed that i wanted to and in the moment i did it without thinking), i did, but having her there, and knowing her, and her knowing me, meant that she was able to support me through the labour (we called her several times for input) i was able to trust my body and the process and my baby was able to get herself out safely. I doubt a hospital would have been able to tell there was a knot from the pattern (my MW suspected but didn't say lest she frighten us) and i'm sure augmentation would have caused major problems, possibly death. I am very grateful for the months of groundwork my MW put in with us, and i believe it made what could have been life and death difference for us and our specific baby.

Each to their own, i can only say that for us to ask our midwife to only "do the birth" wouldn't have been safe, and i would not blame any midwife for declining to take on a client with that request.
post #89 of 102
Quote:
Originally Posted by olstep View Post
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.

Well, first of all, when you're on-call you can't go further away than an hour from your client (or sometimes less depending on her history). This means for me, no trips to Denver, no trips to the mountains, etc. Speaking of the mountains, you can only go places where you have adequate cell-phone reception. If you do venture an hour away or go on any group outing, you need to take two cars and arrange for back-up transportation and childcare for your kids in case you have to leave mid-way. You can't ever have more than one small glass of wine, and need to get to bed at a reasonable time. You don't sleep as well, because you're on-call and expecting the phone to ring at any time. You don't volunteer to do anything like volunteer for your kids' events during this time, because you may not be there. When your client is in rumbly, but not even early, labor you decline invitations to movies and parties, and holiday gatherings because she is so close, and then two days later you still are waiting. And your kids wonder why you weren't at Easter Dinner when there was no baby.

Being on call 24/7 is brutal. No one, NO ONE, but hb mws in the US do it this way. But we know, more than anyone, the importance of continuity of care, and that is why we do it. And that is also why care throughout the pregnancy is ideal. It's part of the Midwives Model of Care, and if you believe that a mw does nothing more than show up and catch the baby, then you are discounting the very model that your intended practitioners believe in with their hearts and souls.

If a client has had prior prenatal care, I will discount a portion of each prenatal visit. If she comes late to care with no prenatal care, there is no discount.
post #90 of 102
I have not read all the responses, but my personal feeling is that a discount should be offered for each prenatal that has been done with another provider. If the midwife feels that she'll spend extra time "catching up" on care or that extra prenatals will be done to get to know the client, then that could be explained. I am 19 weeks pregnant and have had two prenatals with a homebirth midwife. I will not be seeing her again for reasons that I won't go into here. If I hire another homebirth midwife, it doesn't seem right to me to have to pay the full fee + the two prenatals I've already had to pay for. There's no issue of "catching" up...it would take 5 minutes to read the records from my previous visits, and no need for extra prenatals either. I understand that midwives don't charge a great deal (relatively speaking), but at the same time anyone I hire from here on out will have spent less time on me than on someone who hires them during the first trimester, and I feel that the fee should reflect that. If we had insurance I might not feel so strongly, but when the cost is already an issue, having to pay a couple of hundred extra IS a big deal.

Also, for me there's a possibility of hiring a midwife who won't be in the area until I'm roughly 30-32 weeks pregnant. Now I'd prefer to have some prenatal care in the meantime, but if we hire her and she won't discount for prenatal visits done with someone else, then I can't afford to pay for other prenatals.

And I would say that we hire (IF we hire this time, DH doesn't see the point of paying someone to "do nothing") a homebirth midwife as insurance at this point. I've had two completely uncomplicated pregnancies and homebirths. Birth #1 midwife was there 20 min. before baby was born, less than 3 hours total. Birth #2 midwife was there 60-90 min. (can't remember) before baby was born, about 3 hours total. They really didn't do anything besides one heartrate check per birth and some after care. But I am perfectly fine paying for that. I want someone there in case something does go wrong. I like doing prenatals with a midwife I trust. I like being able to process the birth afterwards with a midwife and seeing them for well-baby visits. I wish it were cheaper because it's going to be a stretch to come up with the money (assuming I can convince DH to hire someone) but it's worth it.
post #91 of 102
Quote:
Originally Posted by ginapueblo View Post

If a client has had prior prenatal care, I will discount a portion of each prenatal visit. If she comes late to care with no prenatal care, there is no discount.
It is fair. But when a women come to a MF late in her pregnancy with a file of prenatal records and all labs done, to expect her to pay the full fee?
It is what I am trying to understand. Because that "catch up" work involves working on very delicate things. It can't be accelerated, can they?
Yes, you can dig more holes in an hour if you try harder but you can't built a relationship during a week or two doesn't matter how much harder you try.

I am irritated with that "catch up" talk because it sound like an excuse for me to get more money. Nothing wrong in the last - a healthy desire. But I hate hypocrisy, I am sorry.
post #92 of 102
Quote:
Originally Posted by GoBecGo View Post
Each to their own, i can only say that for us to ask our midwife to only "do the birth" wouldn't have been safe, and i would not blame any midwife for declining to take on a client with that request.

I would not too. But when I found that there are other midwives who would agree to attend just the birth and charge less than half of their fee, I started questioning the reasons of the first ones.

The problem is that the first ones are NOT declining a client. They will take you if you pay the full fee. They want the same money as if they provided full care.

Some justify it by having to do "catch up" work: dig harder, dig deeper.

Others would want the full fee for the risk coming across a weirdo.
I just wonder wether they are going to reimburse a woman if she turns out to be one of the normal ones?
post #93 of 102
Quote:
Originally Posted by olstep View Post
Have you heard about an OB who is willing to attend a homebirth?
i haven't heard of OB's but i know in my province there are family physicians who have done so in the past, although i am pretty sure their association really frowns on it. and in Canada, the OB association fully supports midwifery care and place of birth, however i do not think the system is set up for OB's to attend homebirths. what about michel odent though? i wonder if he would be willing and i'm pretty sure there is one in the US ... michael rosenthal or something like that.
post #94 of 102
Quote:
Originally Posted by olstep View Post
Your explanation is clear and makes sense even though I do not agree with how you pictured pregancy/ postpartum emotional state. But I take your word for that because of your experience.

One question: do all those risks that you mentioned exist for an OB on call? If they do, why they do not seem to be concerned about them?
i think part of it is that OB's are trained to deal with high risk situations and so it's really not out of the scope of their care. i'm sure they prefer to have seen women prior to birth, but it certainly isn't unusual for them to be called into emergency situations where they haven't dealt with a woman who has had prenatal care from a physician or midwife.
post #95 of 102
Quote:
Originally Posted by olstep View Post
But I hate hypocrisy, I am sorry.
I don't really feel that it is hypocrisy. I mean, in midwifery, we don't exactly charge by-the-hour rates for the birth. So maybe some midwives would feel it would be hypocrisy to charge by-the-appointment rates?
post #96 of 102
Quote:
Originally Posted by olstep View Post
I would not too. But when I found that there are other midwives who would agree to attend just the birth and charge less than half of their fee, I started questioning the reasons of the first ones.

The problem is that the first ones are NOT declining a client. They will take you if you pay the full fee. They want the same money as if they provided full care.

Some justify it by having to do "catch up" work: dig harder, dig deeper.

Others would want the full fee for the risk coming across a weirdo.
I just wonder wether they are going to reimburse a woman if she turns out to be one of the normal ones?
Just don't hire them if you have another option. It's their practice, they can set the rules whether or not you like them, agree with them, or even understand them. One of the midwives here charges $4000 for a homebirth...no one else in the area charges more than $2800. Now she's a CNM and the others aren't so I guess that's where the fee different comes in, but I certainly am I not paying an extra $1200 to hire a CNM vs. a CPM, and I can't imagine too many others around here are jumping at it either (unless they have insurance that would cover it if a CNM attended, then maybe). Not to mention she runs a birth center too and tells you that if you hire her for a homebirth and someone else goes into labor at the same time you have to go to the birth center...really I can't imagine why anyone would go for that if they want a homebirth knowing that could happen, but hey, her practice and we can (and do) choose not to hire her knowing her policies.
post #97 of 102
I've only read through page 1 and 5, but I'm really surprised.

I can see asking a midwife to work with me because I can't afford to pay her fee, but NOT because she didn't do enough "work" for me.

I have not had any prenatal care as of yet. I'm 30 weeks on Thursday. We are moving, and I spoke with a midwife in the town where we are going when I was around 6 or 7 weeks. We have emailed a little bit, but not much.

She was okay with me not doing anything here (I offered to do prenatals with a mw here), and she said her fee would be less. I asked her if she was sure...I thought it would be HIGHER because she wouldn't have had time to get to know me as much, or to build mutual trust.

So, to think that her fee should be less is appalling to me.

The job of a midwife is SO much larger than the job of an OB. And, a mw in our country is starting at a large disadvantage because she is forced to run her practice as a business. She isn't just the lady in town who helps when a baby is due, you know? She has a very delicate and difficult job of melding the ob world with the mw model of care.

That's worth my respect, not my quibbling of fees.

Sure...ask for help because you can't afford it, but don't ask her to change her fee because of who you are or because you've already had prenatals or read a book or seven.
post #98 of 102
Quote:
Originally Posted by Just1More View Post
I have not had any prenatal care as of yet. I'm 30 weeks on Thursday. .

Obviously the above is not appalling to you.

Quote:
Sure...ask for help because you can't afford it, but don't ask her to change her fee because of who you are or because you've already had prenatals or read a book or seven.
I will expect a MW to change her fee because I have had prenatals, even if you tell me not to. No need to ask or tell her what to do. We all have right to do what is right for us: to have no prenatals at all at 30 weeks or find a MW who matches us better.
I am not telling you what to do but it seems to me that in your case it would be a good idea to pay your MW her full fee and even something on top. It looks like she WILL be doing much more work with you plus it is what you believe is right, isn't it?
post #99 of 102
Frankly, I have a set fee for the birth and the amount I charge for prenatals and postpartum is per visit. For example, (just going with easier math for the numbers) if I see you for 10 prenatals and postpartum visits at $50/per you would owe me $500 for those visits. I roll the fee for the first three postpartum visits into my fee for the birth (day 1,3,7) to make sure that moms don't skip those first few really important visits due to trying to save money (if something is going to go south, that is the general time period it's going to happen). I would feel I wasn't providing adequate care for my clients not being there those days. Yes, it's possible to "play" my system so you don't pay as much out of pocket, but seeing as how I offer the most lenient payment plans in the world it would take a particularly shameful person to do so. If a mom has prior prenatal care before transferring to me, she's not going to get charged for work I didn't do. However, if a mom comes to me well into her pregnancy without any care I'm going to want to know why and if the answer isn't one I can live with then I'm not going to accept her as a client. As for the birth, yes some moms will require less care and some will require more. I just can't charge by the hour for something like that, no midwife can, so we charge a rounded fee that will even things out as best as possible. Frankly, that's pretty much the way everyone does business. A doctor has a set fee that he charges for a birth and everyone pays at least that fee or more, depending on if they need extra services (such as a c-section). It all comes down to we do the best we can to ensure we provide safe, affordable, care to our clients while still covering our needs as well.
post #100 of 102
Quote:
Originally Posted by olstep View Post
Obviously the above is not appalling to you.



I will expect a MW to change her fee because I have had prenatals, even if you tell me not to. No need to ask or tell her what to do. We all have right to do what is right for us: to have no prenatals at all at 30 weeks or find a MW who matches us better.
I am not telling you what to do but it seems to me that in your case it would be a good idea to pay your MW her full fee and even something on top. It looks like she WILL be doing much more work with you plus it is what you believe is right, isn't it?
Whoa. Firstly, I discussed this with said midwife ahead of time (and offered to have prenatals here with the midwife for my last pregnancy). Secondly, I have a mw HERE and THERE to answer my questions as needed. Thirdly, this is my fourth baby, and I (like you claim to be) am highly read on the subject. Fourthly, I don't believe in routine labs and testing. Stuff that's symptomatic, sure...but most tests are unnecessary for the regular, healthy mom and pregnancy. (And don't get me started on how gestational diabetes isn't symptomatic. I don't even care...). Fifthly, it is possible, because of the unpredictability of birth, that the midwife could have a big job at the birth, BUT, I've had three very easy and uncomplicated births. My last midwife was here 2 hours.

AND, my situation IS different than showing up last minute and wanting care. I began developing a relationship with this midwife at SIX weeks pg.

However, the point of my comment wasn't to be bashed for my lack of BP readings over the course of this pregnancy, or my undocumented fundal height. The point was a midwife is due the respect of the fee she charges, and should not be made to feel guilty because someone has already had a few things checked out. Prenatals aren't the be all end all of a midwife's relationship. It's WHOLE body, TOTAL patient care. It's a RELATIONSHIP. And it's value isn't based on hours. (Either during prenatal care OR the birth).

I am probably going to see my midwife a total of 10-15 hours...prenatal, birth, and postnatal. And, yes, I still believe she deserves her full fee.

But this whole thread makes me want to stick out my tongue and holler "nananabooboo".

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