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Raising my fee

post #1 of 13
Thread Starter 

I'm pretty sure my fee has been a bit more than the other midwives in the area for a while now (or, actually, I know that my fee is currently $200 above what the other midwives' fees were four years ago).  When I did all home visits, I had to charge more because of the cost of gas, so I charged more without any qualms.  Now I have a birth center, which comes with it's own set of expenses.  I've been in the birth center for 18 months now and kept my fee the same as it has been since early 2008 in spite of the increased overhead b/c the extra income from more clients and the lower cost of travel offset the cost of maintaining a building.


Now I'm at the point where I'm busy enough that I am paying a fortune for child care (okay, having two babies in 17 months might have increased the cost of my child care too dizzy.gif).  I'm paying for 60 hours a week of child care for two children, whether I use it or not, just b/c I *might* have a birth and I'm paying for after school care for two children two days a week.  One of those days is b/c of a class (sort of unrelated to midwifery, but not entirely) and the other is because of my prenatal night.  DH is working 50-60 hour weeks right now and so I can't rely much on him to provide care before 5:30pm, unless I have a birth and then he can *usually* pick up the big kids from school at 3pm.  But for the regular schedule, he's not available before 5:30 most days.  The bottom fell out of my emercency child care support system when a good friend recently moved and there's not much family help to be had.


So I'm thinking of raising my fee...not because of overhead or travel expenses but because of the cost of keeping my kids cared for while I'm gone (or keeping someone on call to keep my kids while I might be gone).  I'm looking at a 14% increase, which if three clients a month pay, will cover the cost of childcare.


I guess I'm looking for some feedback.  Is it unreasonable to raise my fee to help cover the cost of childcare?

post #2 of 13

No, it isn't unreasonable. This is a job for you and you need to be able to cover childcare and still make money.


On the other hand, it might be wise to look for a cheaper childcare arrangement. Paying for 60 hours a week even if you don't use it seems like a lot. Could you have on-call people and pay them a little more per hour, but only pay them if you use them?

post #3 of 13
Thread Starter 

Yeah, I've thought of that too.  I'm paying for full time day care and using it two days a week for school and one afternoon for prenatals.  When I was paying a nanny $7.50 an hour, I was paying the same amount as day care for 24 hours or so a week and if I did have to be gone for more than 24 hours a week, it could have potentially cost me a LOT more than the day care is costing.  So paying for it whether I use it or not seems to be worth it in the long run because I'm only paying $3.20 an hour for two kids.  I don't know any nannies who would be on call for me for 60 hours a week for that price (okay, maybe on call, but if I called them in, I'd have to pay more).  Plus I have had a couple of really bad experiences with nannies and actually feel like the care at day care is superior to what they were getting with the nanny, even if there are more kids around.

post #4 of 13

I think it's more than reasonable.  There are many "costs" to evaluate and one of the costs for you is childcare for your on-call job.  Raise the fees and don't feel bad!

post #5 of 13

Very reasonable. I am struggling with this too. I have many sitters who I pay a lesser amount than if I sent my kids to a regular daycare but I am considering paying the higher amount to the daycare just so I don't have to deal with always trying to find a sitter.

post #6 of 13

Completely reasonable. It is a cost of providing care and those costs should help you decide what to charge.

post #7 of 13

Absolutely reasonable.  Your clients will understand that you have a family to care for just like they do.  :)

post #8 of 13


Even if it is not technically the cost of running your birth center, it is a cost for you in order to be the person providing the care.
post #9 of 13

I think each midwife has to set her fees according to associated costs. If those costs are higher for you to effectively work and run a birth center, then that's the reality and you need to set them realistically for yourself.



post #10 of 13

I expect to pay more for a birthcenter birth vs. a homebirth so a 14% increase in cost is very reasonable. I like that you worked the exact percentage needed to offset the cost of childcare, shows you have put a lot of thought into this.

post #11 of 13

Does insurance not cover folks where you are? For me there is a set amount that most insurances will cover so thats about what I can charge...

post #12 of 13
Thread Starter 

Most of my clients are either military (won't pay), BCBS (won't pay in most cases), or are coming to me b/c they are un/underinsured.  So my cash fee is pretty much my gold standard.  When I do get insurance reimbursement, it's quite a bit more than my fee usually b/c I can bill a facility fee for both mother and baby.

post #13 of 13

I think it would be fair to increase your fee to cover childcare... if I had to pay daycare, I would definitely have to increase my fee.  Even without childcare, I'm only netting 40% and that is with me going without health insurance.


Most of my clients are cash-pay too, and it is hard to ask for more because I've been there as the client who could barely afford to pay the midwife even her very reasonable fee.  But as the midwife I have to bring a little money home or else my family is not only sacrificing family time but also financially!

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