Speaking of payments/refunds?

[txgal]

Here's a scenario for you, opinions please.

Mother hires a CNM with over 1000 births under her belt to attend a HBAC. Midwife has an apprentice with @ 50 births (not CNM). The apprentice attends most of the births with the midwife but also does a few clients on her own, full prenatal and birth. Midwife charges $6,000 for prenatals and birth. If apprentice does all prenatals and birth alone she charges $3,500. When mother hired the midwife she was told that the midwife was scheduled to be out of town the week she was due, but that there was a back up CNM with equal experience with VBAC. Mother was assured that apprentice would only be there to help at the birth, not be the one in charge.
Mother goes into labor on a Monday morning, midwife is out of town. Calls apprentice early in the morning, labor progresses slowly. Tuesday at 12 noon, apprentice checks dialation, 3 cm, (was 1cm at prenatal one week prior) baby very low, but contractions still sporadic at 10-20 mins. Mother inquires about back up midwife, is told that she will be called when things get more "active". Labor kicks into gear around 9 pm. Apprentice arrives around midnight, mother labors through the night, SROM at 4:30 am, wednesday (progresses from 5-10 cm. in under 3 hours). Mother starts pushing at 7:30 am, baby starts to crown at @ 9:30 am and is born at 10:30 am. Apprentice contacted back up midwife at @ 9:45 am, midwife can not get there in time, and so never shows up.
Apprentice does 24 hour post partum visit, midwife does 1 week and 6 week postpartum.

The questions: Should there be an adjustment to the $6,000 fee?

[Veritaserum]

Um, yeah, I would think so....

[Ackray]

Yes.

[MsBlack]

I agree. this was not per agreement w/midwife. I have to wonder why apprentice waited so long to call the backup. But I also wonder why the mother did not insist apprentice call the back up at least at SROM or soon after when clearly, labor 'got active'!

[pamamidwife]

yes, definitely. I would be upset that the apprentice didn't call the backup midwife - because that is what you were paying for.

I think this speaks VOLUMES about the relationship of the apprentice to the CNM. Perhaps opening some discussion about this would be very beneficial.

[bobandjess99]

Definitely. You certainly did not get what you paid for, which was a CNM with lots of experience to attend your birth. You got the apprentice. That is one issue.

The whole apprentice not calling the bu midwife until too late, etc, is seperate, but clearly, something was going on.......but that's really for the midwife/apprentice to hash out.

[Midwife Kris]

There wasn't any bad blood between the CNM and apprentice or back-up CNM and apprentice that I could see in the OP... perhaps this is a really inexperienced apprentice who should not be doing labor sitting yet if she can't assess when to call in the midwife?

Also I am really surprised the back-up didn't come AT ALL. She still had the responsibility to oversee the immediate postpartum care and assessments.

[txgal]

Thanks, that was my feeling too. For the record, the father and grandmother asked mutiple times about calling the back up and were told she would call soon. "Soon" became too late. Now any suggestions on what would be a fair price for services rendered?

[Midwife Kris]

The price of what you would've paid had the apprentice acted as primary seems fair to me... so a refund of the difference between the two. I don't think it's customary to offer refunds for births missed but each circumstance is different.

ps: What do the midwives have to say about what occurred? And what conversation did the apprentice have that the decision was made not to come at all after the late call? (and bummer the apprentice didn't make the call earlier-- she could've had a labor and birth management witnessed )

[mwherbs]

I don't know how the mw will deal with this- and it is a question that should be put to her probably as well as it was written here- including how family asked to call the "primary(backup) midwife" I am sure that this is not per a mw's instructions how it was done
and the issues here is how much does she pay a back up mw?
who did all the prenatals?
the primary mw's costs may have to do with what she pays for everything- and then pays herself and apprentice
when the apprentice charges for a birth maybe it is stripped down to her costs only and a stipend to the teacher for assisting at the birth-- making little to no money for herself at all-- I would say that 50% can easily be dished out for costs--- so if the senior CNM's costs are over $3000- and they easily could be depending on rents and supplies, lab costs, phone, insurance, taxes... and if she showed up to all the appointments money to pay her for her time and skill -- and the back-up midwife who thru no fault of her own missed the birth- then I would give you a - discount on the BIRTH fee only- and the student would get no payment for this birth at all- also I might want to dock her pay until the entire difference is made up-- So even if the beginning difference was about $3000-- your refund would be no where near that amount - it would just be the birth fee difference and first post partum visit fee-- atleast that is how I would break it down...

[txgal]

The primary did all but 3 prenatal visits. When asked about making an adjustment in the price she was unwilling to and said the full amount was owed. I am not sure of the conversation between the apprentice and the back up, I was in laborland when that occured. Plus I am not really concerned about the postpartum care, didn't feel like I needed the CNM at that point anyway. My issue is that the cost to hire this midwife was quite a bit more than other midwives (CNM) in town, we choose her because of her extensive experience and were willing to pay the price for it and the added safety we felt it brought. If I had wanted a midwife that had only attended 50 births I would have hired one. I want to do what is fair, but this is really weighing on me emotionally. My labor and birth went beautifully and I really hate that this has tainted the experience somewhat, I loved my midwife and her apprentice and am so thankful for their help. But I just don't think it is fair that I have to pay $6,000 for a service that others only paid $3,500.

[mwherbs]

the birth is not the only thing you pay for- you pay for prenatals and for the CNM to be on call for you basically 24/7 as soon as you signed up with her- now maybe your pregnancy just sailed by and you had no occasion to call her- but you pay her so if anything were to go on in pregnancy she may be able to serve you and help- like write a RX for a UTI or even to just be reassuring that nothing is wrong-- going in you knew she would not be available for that block of time - and so that was part of the agreement- I think send her an email or letter spelling out the situation the way you have here- and how you feel-- like I said the original charge difference would be that she would have little to no contact and not be on call 24/7 for you from when you signed up- the apprentice would have been responsible. and it sounds like the apprentices judgment is still in question in my mind because she did not get another mw there on time-- I would have contacted the CNM when you first called and then updated her after the exam , updated her when I decided to come and stay and actually I would have expected her to show up when I did-- I work with other mws and none of us labor sit alone- too exhausting- even if what happens is one or both sleep we know what the situation is -- in any case- i would still stand by my original view yes you would get a refund but it would be cost difference on the birth fee and post partum visit ONLY-- because time was blocked out for you including possibly turning other clients away- because you made that choice right to begin with even knowing that it was possible that the mw would not be there- back-up arrangements were made and the rest of the pregnancy was covered by the contracting mw-- she fulfilled her contract- completely- including warning you way ahead of time she would be gone-- her apprentice and back-up fumbled it a bit-but that is not $2500 mistake- the apprentice did not take you on fully as a client - except for the birth...

[txgal]

Sorry, I guess I wasn't completely clear, I don't expect to pay just $3,500. Honestly an adjustment of $500 would make me happy. I just feel like the apprentice dropped the ball. I also had a very experienced doula, so I think that may have made the apprentice feel more secure in not calling the CNM. But the doula was hired as labor support, not as a medical professional. I guess I just need to hash this out with the midwife again. Thank you for you insight.

[Midwife Kris]

Originally Posted by mwherbs

...the contracting mw-- she fulfilled her contract- completely- including warning you way ahead of time she would be gone-- her apprentice and back-up fumbled it a bit-but that is not $2500 mistake- the apprentice did not take you on fully as a client - except for the birth...

I agree after sitting on this. This portion of the dispute is a good place to start.

[Maggi315]

I have to agree with mwherbs about the refund and payment part.

Around here, it is stated in most midwives paperwork that we work with apprentices and that it is possible the apprentice will be with you to laborsit. If the midwife doesn't make it, you would be expected to still pay the full labor and delivery fee.

That's one reason I don't bill as a bundle, but rather bill each prenatal and postpartum visit and then one fee for labor, delivery, and the 3 immediate postpartum visits (extra ones and the 8 week are billed separately). Then, if I need to make adjustments on the labor/delivery fee, I still feel fairly compensated for all the other work I have done.

As for the apprentice: I think she had poor judgement and probably isn't ready to labor sit. Again, around here, if an apprentice is labor=sitting, the midwives are to be called right away, then they will be updated every hour or two and it is the midwife who makes the call when to come, not the apprentice. Also, the families can always call if they feel uncomfortable with the apprentice. They can also refuse to have students or apprentices at the birth, that's in our paperwork too.

[MsBlack]

Knowing more about the situation, I have more agreement with mwherbs and Maggie....but I still feel that a refund is due. AT LEAST $500...maybe more like $1000. Do talk this out w/your mw. I think she has grounds to get that refund from her apprentice, myself. Not to put you in the middle, mind you--I just think in the mw's shoes, I would make a partial refund, and then go about getting that back from the apprentice without involving the client. And not that you need to suggest that to her, either, just thinking about the Whole Picture and how this doesn't have to be a loss for a mw who did do her part but then circumstances were impacted by the apprentice's choices.

I'm saying for you, only that you do have a right to state your reasons for hiring her at her greater rate than other mws, which included your reasonable expectation that you would be served either by her or by someone w/commensurate experience as she stated would happen...and your sense that the apprentice did not act appropriately to meet that expectation when she had plenty of time to do so. This would be different if the birth had gone very fast and there was simply no time for the backup to get there.

[AmieV]

I've been thinking about this and hashing it out with my husband the past day or so, and I think you are entitled to an adjustment. It would be one thing if your labor just progressed too fast, but there was an act of carelessness on this apprentice's part. There were so many opportunities to call the backup!! I would think at the very least at 4:30 when the SROM happened, and if not then then AT LEAST at the very beginning of pushing at 7:30...why on earth would you wait until the baby is crowning??? And, she should have given her a little heads up when you very first went into labor IMO, to let her know that even though it's not imminent, that a baby would be here soonish.

So, I would address with your primary midwife that while SHE fulfilled her contractual obligation, the apprentice in no way did, mention to her what you've said here, the reasons you chose her over an apprentice level caregiver. And all of the chances to call backup as well as the prodding from your family members. Quite honestly, at the very extreme, it's flat out negligence for her to not call. With 50 births under her belt she's not super experienced with VBACs and had things gone wrong she could have been in a world of trouble. besides the fact that it was never her call to make, you made it clear you did NOT want her as the primary.

have you already paid and are looking for a refund or is this still ongoing? Please update us with whatever happens!