Midwives with young children...

[Wittyone]

what does your work life look like?

I will be graduating with my CNM later this year. My son will be 2+ (and at the rate we're going, probably still breastfeeding a lot!). I'm trying to envision what sort of practice I want, so feedback would be great (from all types of midwives!).

I've only ever done out of hospital birth as a nurse and that's where I envision myself as a midwife. However, the lure of a more regular schedule, good pay, and good benefits via the hospital is somewhat appealing for the first couple of years as I pay off student loans....

Do you work solo or in a partnership/group?
Do you do full scope care (prenatals, birth, postpartum) or just hospital labor shifts?
How many clients per month?
Prenatals in a clinic or in client's homes?
And most importantly - who is with your baby/young one(s) when you are not?

I guess what I really want to know is if there is a way to make life as a midwife family friendly?

Thanks in advance for your thoughts!

[JunipersMom]

CPM here - Pregnant so taking time off until my second bean is born. But last year I did one due date a month (except for September when I had three). I tell my clients in the initial interview that my daughter attends all my prenatals and postpartum visits if her dad is working - and I just guarantee she wont attend the birth. I do all visits in my clients homes as I work alone and dont have the $ for any office and dont have the energy to keep my house clean for business type company. I'm due in April and have told anyone who wants me to midwife them after that for the remaineder of this year I will be attending prenatals and postpartums with at least one babe and my newborn will be attending births. If they're ok with it ~ I'm ok with it. Oh and I will be doing prenatals at my house for the three months following my birth in April. Hopefully it works

[Wittyone]

Thanks for the reply, JunipersMom. Can I ask how old your daughter is and how she entertains herself during appointments?

[amitymama]

I'll be interested to hear the replies as I want to become a doula but don't know how I'll juggle childcare when the call comes. I have a MIL who is home most of the time and a couple of SAHM friends who would probably be able to look after my older child, but I'm TTC #2 right now and won't be able to leave him or her obviously.

Have any of the birth professionals here ever taken a babe to a birth? How were the clients about it? Did it make things more stressful? Did it interfere with your ability to provide good care?

[JunipersMom]

My dd is 2 1/2 right now - we bring color books, stacking blocks, and others of her favorite quite toys. There have been several appointments where she nurses through most of it And a few where she just doesnt want to be there and lets it be known. But, I'm a mom first. The only families I even think twice about are the first time parents because my multips kids become my daughters play friends and they all get excited to see each other. First time moms can be a bit tricky - but then I just assume I'm giving them first hand mothering experience.

[dianna11]

I'm not a midwife, but I know that when my midwife went back to work, she brought her DS with her to the clinic so she could breastfeed and her DW would watch the little guy at the clinic for the day

[CarolynnMarilynn]

I am a RM in Ontario and had a little boy last April. I also have two older kids who are school-aged. I stayed home for 8 months (we're not covered by any maternity/parenting leave) and have been on call for the last 5 weeks. Luckily little one drinks expressed bm from a bottle/cup when I am away, and I can pump 8-10 oz when away from him, each pumping session.

I started doing clinic at about 3 months pp. Of course, bb came with me to clinic and I nursed during appts and had my partner or my mom come with and watch the baby in between. I would schedule lots of time in between appts for nursing, and limited my days to only 3-4 hours, max. I started back on call in December and have gone to 4 births so far. Two were daytime-ish and I was away for about 8-10 hours each. During those births my little one was at home with his grandmother, and he was able to stay full with EBM and solid food. When I got home we cuddled in bed (we co-sleep).

Nights have been hard as my little one sleeps in 1-2.5 hr stretches and nurses in between. Some nights have been terrible in terms of total amount that I have slept. I nap during the day 2-4 times a week, as my schedule allows.

My other two clients took me from home from 3pm until 8 am. Luckily, they were both hospital births, at the same hospital, and overlapped a tiny bit. I went from one client 2 hrs post-birth to the other client just starting up. That night was a rough one for my dp as the baby did his usual wakings but needed to be walked instead of nursed, and did accept two bottles of breastmilk.

I have my mom living with me M-F right now, which is awesome. Come the spring she is leaving and we will be doing M-F daytime daycare close by. My other kids went to daycare and I feel ok with the situation. I'll bring breastmilk and my own food for him. None of my kids have had formula, even my oldest who went to daycare at 5 months. I try to nurse them as I drop them off, stop by for lunch and nurse then, and pick them up early. It seems to work fine.

I have also been to several conferences since the birth and just brought my little one. I went to one particularly stuffy (and quiet) risk-management insurance conference (think hospital administrators and lawyers) and was pleasantly surprised that two speakers went out of their way to comment on the podium that they wanted to make sure that I knew we were welcome and that baby noises wouldn't bother them during their presentation. I thought that was awesome.

For my other kids, I pick them up as often as I can, and I bring them with me wherever possible.

I have an incredibly supportive (tho' not always happy) dp who supports me in my work. I can work long hours and he'll pick up the slack. However, when I am home I try to be there with the kids and participating as much as possible. I am human and need a few minutes' peace, like now, and so try to balance everything.

I take liberal vacations: 3 months a year, and work like stink the rest of the time. I am off for 6 weeks soon, after 9 weeks on call, because I wanted to build in time for replenishing my milk supply if it dropped and to reconnect with my home and family if the 9 weeks had been rough.

Anyways, here is my novel. I hope it was helpful.

[amitymama]

CarolynnMarilynn -- thanks for sharing your experiences. You mentioned that your mother looked after the baby M-F during the day if you needed to leave, but what would you have done if she wasn't living with you? My MIL is about a half hour away by car but she isn't always around 24/7, she sits on the board of a local school so sometimes she has meetings or is out doing her own thing. I worry about what I would do if she wasn't available and someone called in labour, needing me. It makes me wonder if I should wait until my kids are in school full time. That's ages away though! I hate to be so negative but I just don't see how it would work.

[doulanichole]

amitymama -
I have been attending births as a doula for over 6 years on and off (having my own babies) and started my mw apprenticeship this past summer. Admittedly, childcare is the biggest stressor for me as well as most, I have learned. To complicate things further, dh changed shifts just a couple of months ago and now works overnight from 6p-6a. Finding someone who is willing to wake up in the middlw of the night to come to the house has been most stressful. Basically, I got in touch with everyone I knew and asked what their availabilty might be or if they knew of anyone who might be interested. Once I had my list together....nobody went into labor overnight! LOL It always seems to work out the way it is supposed to and it has.

I homeschool my 2 oldest so waiting until they start school really hasn't been an option for us either. Of course then you would need to figure out who could get them from school on which days as well. There always seems to be scheduling and timing constraints, but I work really hard not to let that stop me.....and I haven't. I also have a great dh who is willing and able to do whatever he can to make my life easier as well. It helps to have him onboard and fully supportive of what I am doing (even if he does occassionally complain - LOL).

[CarolynnMarilynn]

Originally Posted by amitymama

CarolynnMarilynn -- thanks for sharing your experiences. You mentioned that your mother looked after the baby M-F during the day if you needed to leave, but what would you have done if she wasn't living with you? My MIL is about a half hour away by car but she isn't always around 24/7, she sits on the board of a local school so sometimes she has meetings or is out doing her own thing. I worry about what I would do if she wasn't available and someone called in labour, needing me. It makes me wonder if I should wait until my kids are in school full time. That's ages away though! I hate to be so negative but I just don't see how it would work.

This is the first time she has been able to help. With the other kids I didn't have that kind of help. The kids were in daycare M-F during the day and at night and over the weekends my dp had to do everything if I were called away or sleeping. Some times were very tough, other times the pace was very reasonable. You need to have 24-7 coverage to be on-call. My dp believes that his job was seriously compromised at times when he had to leave to pick up the kids in the middle of a work crisis when I *had* to go. He felt that ultimately his job always came second, and it really does. Fortunately, he feels that the work I do is very important, both for our family and socially, so he is willing to be as supportive as he needs to be.

[amitymama]

Originally Posted by CarolynnMarilynn

My dp believes that his job was seriously compromised at times when he had to leave to pick up the kids in the middle of a work crisis when I *had* to go. He felt that ultimately his job always came second, and it really does. Fortunately, he feels that the work I do is very important, both for our family and socially, so he is willing to be as supportive as he needs to be.

That's wonderful that your DP is so supportive and considers your job first. Something women have been doing for centuries!

I think I could make it work though. I'm TTC my second so it would be at least a year or so before I got into it on a regular basis. I'd like to do the training while I'm pregnant and then try to start taking on clients once that baby is a few months old. By that time, my MIL may well have retired from the school board (she's 62) and I will have more friends who SAH full time who may be able to help out. Also, I talked to DH last night and he said if all else failed on occasion, he would just call in sick or something. So he's being very supportive as well.

Thanks for the encouragement everyone! And sorry to hijack the thread.

[babycatcher01]

We live kinda by the seat of our pants in our house. We, my helpers and I, all have three kids a peice: My oldest is in school, while my helpers are home schoolers. I take my youngest who is 8 months even to births and one of my helpers have a 7month old that also comes, and my other helper have a 18 month old that comes sometimes. We are averaging two a month right now in our small area, but that is always subject to change. My helpers rotate births whos going to what one and we plan childcare on whos going and who ever get to stay home can sometimes get 7 kids. It would be very hard for me without my wonderful woman. I do not like to practice alone, and I believe that I need to pass on the art of midwifery, anyone who is willing to learn I will teach. All of us are just trying to provide a service and a choice for woman since the only other midwife lives two + hours away.

[Peppamint]

I am assisting two midwives right now... I'm very blessed that my mom is a sahw and she is my childcare anytime dh is at work. Once dh gets home, he has the kids. I'm on call for an average of 4-6 births a month and I've been called to 4 a month so far.

I do need to find some backup childcare and that has me a bit concerned but it will work out. My biggest "worry" is once I get into an official apprenticeship, finding trustworthy childcare- we'll have to move for apprenticeship. I might just have to look for an apprenticeship two states away where a dear friend of mine recently moved.

[BetsyS]

I have not practiced since I had my son 16 months ago, but my last practice was pretty "mama-friendly." There were, however, many drawbacks to practicing in this way.

We were a 9 midwife, hospital based clinic, midwifery practice. (also 5 docs). We all worked a 40 hour work week, with the "normal" weekly schedule being one 24 hour shift on call, plus 3-8 hour days. This practice delivered about 130 babies a month, plus saw all the walk-ins to the hospital (you know, the "I don't have a doctor, but I'm 7 months pregnant, nad I have pain"), all the outpatient visits to the hospital, and needless to say, those 24 hour shifts were very, very busy. It wasn't unusual to deliver 4-5 babies, and our record was something like 18 deliveries in 24 hours. If you could find time, you could take a nap. Ha! One of my colleagues pumped for a year, and she frequently had trouble finding time to pump for her baby. The schedule was put out months in advance, so mamas did have time to arrange for child care.

Of those 9 midwives, only 1 had small children, 2 were childless (me included), and 6 were older, with teenagers or empty nests. Those 6 were NOT very understanding of small children. If a small child got sick, that mama couldn't call in herself without being made to feel as if she was letting everyone down, as if she didn't care about her job/career, and it showed up on yearly evaluations. This is calling in one time over the year for a hospitalized child sort of thing. Also, before I took my 12 weeks maternity leave, I was scheduled for 8 of 9 weekends. I didn't go back after my leave, but the schedule was made up already--I had been scheduled for 7 of 8 weekends upon my return. They wanted me to "appreciate" that they had let me take maternity leave, I suppose.

So, while technically the hours were good, the coworkers left something to be desired. Also, it is very hard to practice in this kind of assembly line practice. Our major client base was illegal immigrants. We knew that the care we were giving them was better than the other clinic in town (residents), and it was probably better than what they would have gotten wherever they came from. That was consulation to us, because the sheer volume prevented us from really providing good midwifery care. Our practice had about a 40% epidural rate, and many of those, honestly, were because as midwives, we just didn't have the time to sit at the bedside and help women as they needed to be helped.

The practice was so big that there were a good many rules nad regulations, and it was really hard to go against the grain, so to speak. You had to have a really, really good reason to fight the "normal" things we did, even though those normal things were more lenient than most doctor practices. (We didn't give antibiotics routinely at 18 hours ruptured, but we did with other guidelines. If your patient refused antibiotics when the protocol said to give them, then the midwife would have to answer to a peer-review board about why).

I felt like it was really draining to me to have to work in such a MEDwife oriented practice. But, the hours were the best I've ever seen in the business. So, it was a hard line. In the end, I decided that for my family, at this point, it just wouldn't work.

But, that's the flip side of many hospital based practices.

[Wittyone]

Wow, thanks for all of the feedback! I'm struggling with the childcare issue right now while doing my clinical practicum, so it's brought the issue to the forefront for me. I appreciate hearing about the ways you all do the juggle

[Mrs. Cheerful Face]

I am blessed to have a dh who works out of the home, and can change his schedule at the drop of the hat. I have brought nursing children to a birth but my preference now is to call my wonderful sitter who stays with my four so dh can get on with his work. My sitter is very flexible and supportive of the spontanous life we lead, even the homeschooling gets done! I have some wonderful ladies that love to drop everything and help where they can too. We have been excited to see another midwife in the area with many years experience see more and more ladies here in our town too. Its nice to have another option for care. Lately women have been gathering to share and study too, so it won't be long till there are experienced ladies available to share care and confidences, IYKWIM.

[maxmama]

I plan a group practice, for a lot of reasons, but especially the call issue. Think about all the women birthing in the hospital (99% of all in the US!) who need compassionate evidence-based care. Hospital midwifery is still midwifery.

[Wittyone]

Originally Posted by maxmama

Think about all the women birthing in the hospital (99% of all in the US!) who need compassionate evidence-based care. Hospital midwifery is still midwifery.

So true...and perhaps the good one can do for individuals can balance the struggle to endure working within such a broken system...? I can hope!

[Maggi315]

I realize I'm kinda late on this thread, but this is something I am always struggling with. How to balance family life with midwifery life. Here are some of the things I did to help out. I got sick this fall and HAD to cut back, so that has been teaching me alot!

-I hired another midwife, she moved to the area in October and has truly been a godsend.
-I hired a secretary to help with the massive amounts of paperwork and office work (I don't know about others, but this is always a killer for me, all the paperwork, labs, filing BC's, dealing with state, making new client folders, sending out client packets, returning calls-a big problem for me, having enough time on the phone, I can easily get over 10 calls day and just don't have time to return them all)
-We have been doing homevisits, but since my population is so scattered, we are going to start seeing them at a choice of 3 locations, one in the morning, one in the afternoon-one day per week, then another day at my house for my clients that drive (many don't, they're plain)
-My clientele is not really open to having my kids with me all the time, but I do sometimes bring them to postpartums since they are unscheduled and a long drive and hard to get a sitter for just one visit. My older kids are fine, it's my 2.5 yo that is a handful, getting into stuff, screaming (he loves to screaming), running around, generally causing trouble. I read about others kids who color, play with blocks, nurse, mine doesn't cooperate at all!!!!!
-

I am still working on cutting out the stress, getting rid of all the extra work that someone else can do, condensing my visits into one day or when I am already out.

Having said that, I somehow managed to be out doing some kind of visits every day this week, either prenatal, postpartum, lactation, blood draws. I don't like to do that, it's alot for my husband to leave him with the kids (he works from home during the day), it's hard to maintain a household when I'm gone so much, hard on my health, etc. So most weeks, I really try not to overschedule myself like that.

I love to hear how others deal with this. WE have had some great babysitters, unfortunately not very reliable, they are high school and college students and as soon as something more interesting or fun comes along, they don't show up, can't sit, whatever. and we can't afford more permanent help like an au pair or anything.

[Maggi315]

oh darn, I forgot to answer the other questions. We are doing between 2-4 births per month, but expect to get to about 6-8 births within a year. We rent clinic space from a nurse practitioner, however, we aren't using it enough, so we will probably drop that next month. I have a home office, it is sometimes hard to do in my home because I have to clean up, get my kids all organized and I've found people don't leave!!!!!! The other midwife is single and we are using the front bedroom and her living room to do prenatals in her area. Still looking for that perfect location, if we had the money, we'd buy a house and use it for all kinds of things, but we just have enough money for that kind of overhead yet.

I think I've answered all the questions now