Midwife policy question - Page 2

[Greaseball]

I asked about that, and one midwife said if 2 clients are in labor at the same time she sends her unpaid apprentice to one of them.

[pamamidwife]

Well, if my apprentice is experienced enough to attend a birth, I am paying her. Plus, I do NOT do births alone, nor would I expect my client to have an apprentice (read: not a primary midwife) do a birth on her own. Not only is that dangerous, but it's totally NOT what my clients would want - if they wanted a student attending their birth alone, then they would not have sought me out.

An apprentice and an assistant are two different things - in my practice, an apprentice is a student midwife that is working towards becoming a primary midwife. An assistant is typically another midwife that I bring to births with me...and pay $350 to assist.

I do pay my apprentices once they start attaining skills that are valuable to me and my clients at births. (Starting from $25 a birth to $250/birth)

I have never had two clients birth at the same time (knock on wood), but when I was an apprentice - even with primary skills and getting to the end of my apprenticeship - the agreement with clients was that whomever the primary midwife was with first, she would stay, then I would go to the second clients. She'd call in another senior mw to be with me, while she would call in another assist to help her.

Most of my clients have met both my apprentice and my assistant midwife - therefore, the assistant mw could call in her own assist and the apprentice could stay with me - it would depend upon client choice.

I would not, however, have a student attend a birth for one of my clients alone. Never intentionally.

[BirthTender]

midwife policies/mary-Beth

Mary-Beth & all, I am also a homebirth midwife in NC & I have been in midwifery for 22&1/2 years. Being paid in full has always been my policy. I used to have a set fee, but decided about 10 years ago because of the illegal staus of non-CNM's here in NC & other states that I practice in that I would only charge a set fee for each prenatal & the birth fee is totally on a donation basis. (as an RN, i can legally do & charge a fee for prenatals, because it is assessment & education). Since I changed from having a set fee for everything to separate fees for prenatals & the birth fee a donation, I have been paid fairly well by most clients. Not comparable to some other areas of the USA, but comparable to this area. Most clients ask during the initial no-strings-attached consult what most folks are donating. I inform them of the amount range that folks have donated in the previous two years. Most folks keep that range in mind & at some point in the pregnancy tell me what they expect to donate. They are informed in considerable detail (from reading my Informed Choice Document & during the initial consult) what being a readily available, transportation dependable, certifications kept to date, freshly supplied, etc., etc. midwife means in terms of my monetary costs & most are paying very appropriate amounts. Also, most of my clients are lower to middle class.
Before I made the change of making the birth fee a donation, I was regularly unpaid by a lot of folks. I have to work (as a nurse) in between due times to pay bills & of course, that means that I go off call w/ the nursing agencies at 3 weeks before someone's due time & dont' accept nursing work again until after they've had the baby. We have 4 children & some are jsut finished w/ post high school education & some are just getting ready to go on with post high school education. Now, i expect the donation amount to be paid by 37 weeks and if folks want to give more after that, that's fine with me. I have invested and continue to invest alot of time in midwifery/my clients. I let folks know at the initial consult that if I'm not paid the donation by the 37th week, then I will have to take on nursing work from the agencies & that means that once I'm on the floor for a 8 or 12 hour shift, I will not & cannot leave the floor. Some folks have said, "well just call in sick or say that you have an emergency & that you have to leave the floor." I will not lie & I believe that God would not honor that & I have His blessings & want to keep His blessings in my midwifery practice and my life.
I also don't give refunds once i receive the call from a client that it's time to come, even if a transport during labor becomes necessary for all the reasons that previous midwives have given. I do transport with clients & stay w/ them during birth & I also provide continuity of care during the postpartum. I also don't give refunds if the baby is born before I get there. This has rarely happened as i have a small practice & i encourage my folks to call in ealry labor to at least give a "get ready". I keep clothes laid out at night, in my car & my car packed w/ birth bags when i have someone due (except in the hot weather & then i bring in weather sensitive items inside wherever I am).
If i have two women in labor at the same time, I call in a similarly practicing midwife (not an apprentice) to attend my client & i pay that back-up midwife a prearranged fee out of what I have been donated. The going rate around here for back-up is $300-350. My client/couple is informed at the initial consult what the rate is for the back-up in the event that i'm at another birth, horribly ill, incapacitated (due to medical emergencies, i don't drink & i don't travel out of range of my cell phone when i have someone due) and would therfore call in the back-up midwife. I also inform the client/couple that the back-up is paid out of what they have donated to me.
I have now practiced in 14 states over these years & one foreign country. I know many midwives & most midwives have a policy of full payment at some point before the birth.
Many Blessings, Karen Valcourt of BirthTender

[BirthTender]

RE: midwife policy/Mary-Beth,

HI, again, i forgot to add that if it becomes apparent, after someone has paid the donated birth fee, but, before labor starts that homebirth would not be wise choice, or if a client were to decide that they didn't want to have a homebirth or use my services, then, I give a full refund of the donated birth fee. The prenatals have already been paid for, as the prenatal fee is due at each prenatal, so everything is even. The few times that it has become apparent pre-labor that homebirth would be unwise, my clients have always wanted me to go with them to the hospital as a doula. I also work as a doula & i tell them what that fee is and they have all willingly complied with that set fee, which is lower than what most folks donate for the birth fee. Warmly, karen of BirthTender

[Peppamint]

My midwife actually didn't want to talk about birth fees, she said she hated the money part of it. I emailed her regarding the birth fee (I switched to her at 20w) and she emailed me an amount. We never talked about it again until after ds was born. At my pp visit one week after ds was born she asked me if I had the birth fee. I gave her half then and the other half a few weeks later (4w pp). I would have had the full amount at the birth, but we had a large car repair that ate up some of the money, so I had to wait for the money that I was expecting from refinancing the house. There was a delay in getting the house refinanced because someone messed up.

I felt terrible that I didn't pay her the full amount right then, but she was very understanding. I apologized over and over, but she told me she was just glad to get it at all! Seems that a lot of the time she doesn't get the full amount.

We had a verbal agreement, no paperwork at all. Midwives aren't legal in Indiana (the exception is CNM in a hospital or birthing center and there's only one BC in all of IN).

Of course, next time I will have the full amount for her at the birth (well, the pp visit anyway) even if I have to get a short-term loan. I feel she deserved that money asap because she was always available to me via phone, email, pager and cell phone.

edited to add: since we didn't didn't really discuss the money part of it I'm not sure what would have happened if I had transferred. Since I had state insurance that would cover a hospital birth, I would have wanted to go ahead and pay her. I got my money's worth in having a wonderful midwife available to me 24/7!

She did continually remind me to call her asap because my first birth was only 8 hrs from start of pitocin IV to birth and we knew it could go fast. I had ds four hours after I decided maybe it was the real thing and called the midwife. Three hours after she arrived.

[bloodrayne]

My midwife's policy was that she wanted to be paid in full before he was born.

If I was transferred out of her care before I went into labor, we get a pro-rated portion back.
If I went into labor and was then transferred out (to the hospital), we did not get any of our money back.

[Sustainer]

My midwife asked to be paid in full by 36 weeks gestation. Seemed reasonable to me. I would never dream of asking for a refund under any circumstances!

[Mary-Beth]

I just want to thank everyone for sharing your thoughts!
The conversation has really developed and I'm thankful to all of you who addressed my initial questions and to all of you who extended the conversation and gave me new ideas and issues to think about.

For me, I think there is an underlying issue of trust here. If I agree to pay a midwife in full weeks before having my baby then I am left to simply trust that this midwife truly is honest and dependable. Some women are comfortable enough within themselves to have UC and others (more like me) really feel like they want and need the support of an experienced professional in order to feel comfortable and safe...with a hospital or birthing center that is staffed with several mw's, nurses, etc. it seems hard to imagine ever being in the position of not being able to reach anyone but with a single midwife the possibility that she might somehow or someway not answer her phone- or for some other reason be unavailable- becomes more real. I have heard stories of mw who are at other births or underestimate how far along the mother is and as a result are not there to provide the mother with the labor support she wants. If I simply wanted someone to walk in on the last 5 minutes I could get that from any M.D. at any hospital. I want support, insight, advice, experience...I want my mw to show up in time to help me get through a lot of challenging moments and hard work. So....that said, I guess this issue has given me the opportunity to see the valaue of building this deep trust with my mw so that I know she'll be there for me! I know money isn't the magic "thing" that makes people reliable.

Thanks again to every one of you!

[Greaseball]

OK, here's another question:

Why require payment at 36 or 37 weeks instead of sometime during the first month? If there are flaky clients who wouldn't pay after the birth, wouldn't there also be some who would not have the money by 36 weeks as well?

I guess a midwife could just refuse to see the client if she didn't pay on time, but that's still hundreds of dollars she would be out.

[birthinglau]

for me, the first weeks PP were alot busier than before the birth, when all that is done is preparatory. once pea was born I was otherwise occupied, and my husband is not great about paying bills, etc so he would not have remembered to pay her on time.

I also want to make sure she has $$ to pay for supplies she may need for my birth. my midwife does not take on many clients, and does not charge much, so much of the money she makes goes back out for supplies and certifications. things like O2 tanks, positive pressure ventilation devices, etc cost quite a bit.

two more reasons advanced payment seemed like a good idea.

-Lau

[Worldshakerz]

The birthing center I went to had that same policy. We are lucky, our HMO covers birthing centers and homebirths (it is a LOT cheaper than hospital births, so insurance companies don't mind paying the lesser fees). We had like $150 copay that covered prenatal, birth and postpartum. We also paid an additional $150 to reserve the tub for the waterbirth, so I would have first dibs if another lady went in labor at the same time as me. We paid that I think by 38 weeks. After the birth, we found out there were a few copays that we missed but it was only because the insurance company didnt let the birthing center know about it. We havent paid those yet....but I fully intend too. I feel bad, my baby is 4 months old now, I havent paid them back yet! It's about another $150, plus we owe the pediatrician about the same. SAHM makes it hard, but worth it. They will get paid, but it might take a few more months.

[Carolinamidwife]

Why require payment at 36 or 37 weeks instead of sometime during the first month? If there are flaky clients who wouldn't pay after the birth, wouldn't there also be some who would not have the money by 36 weeks as well?

We don't require a full payment all at once at 36 weeks, a client has until 36 weeks to make her payments. She is expected to make a payment at each visit which will bring her to fully paid by 36 weeks. Besides, a lot can change during the course of a pregnancy, it doesn't make sense to expect payment before any services are rendered. Plus, the vast majority of our clients could not afford to pay the midwife's fee all at once, we do want to work with women so that they can afford quality care. 36 weeks is not an arbitrarily set date, here in Texas you cannot dismiss a woman from care after 36 weeks whether she has paid or not.

Amy