client expectations of midwives - Page 2

[sevenkids]

YOu have to have regular office hours or you'll go insane.
We have one day a week when we see working clients late, we start at 11 am Friday and sometimes finish up at 10 pm, seeing the last client at 8 and then doing paperwork. We have a regular 10-5 day. We have one day for 36 week home visits. We have one Saturday per month. Figure in your problem visits, postpartum visits, paperwork/chart audit day, and you're STILL busy the entire week.

[amymaew]

My midwives have regular office hours, and I go to them to see them. I couldn't imagine them having to drive 1 hour each way to come to my house for my appointment, and then add in all their other clients! They'd never see their kids! They come to my house for the 37 week home visit, and I think 2 times postpartum (I can't remember off the top of my head). Once I went to one of their homes on a non office day b/c I hadn't been feeling Henry move for a day or two and they were very accommodating, but all of my regular appointments were during office hours. I felt it was on me to make it work, after all, it was MY pregnancy!

[nashvillemidwife]

Originally Posted by Apricot

Re: PKU - that's just the way my state has it set up. There are certain disorders that are easier to detect after more metabolizing has occured, and some that are detectable just hours after birth.

My state lab told me recently there's research in the works showing that you catch more disorders when re-tested at 2 weeks, and depending the outcome of the study it may become required.

[MidwifeErika]

I think the boundaries are needed.

When I was having babies and hiring midwives, I assumed that I would be the one to travel for my prenatals. It just makes the best use of the midwife's time. If she traveled to me then that could eat up her whole day for one appointment. I expected that she would have days she prefered to work and hours she had set aside for it. I prefered if those hours worked so my DH could come with me without having to take off work, but understood if they didn't.... my dh could adjust his schedule at least a few times in my pregnancy to be there for a few of the appointments. I would never expect that a midwife could just work around whatever my personal schedule is as she would have a life and a family outside of work as well.

I think you HAVE to have time set aside for your family and yourself that are not work hours. If not, then you can never plan to do anything with them and then you are just missing out on so much! You need to have days you can make your appointments for health or nights that are planned family dinners. Enough events will get cancelled due to births, you can't cancel everything because of prenatals as well.

[ZoeyZoo]

My mw has office hours too during the week only on one week day. The issue is I wanted to hire her but I just started a new job being pregnant and it's difficult for me to take time off at this point during the week - especially on the day of her office hours.

I'm glad I discussed this with her because she agreed to do home visits at that point. I don't have an issue with going to see her, it's just the day she does appointments is the hardest day for me to take off. I would have had to go with another midwife if she wasn't open to being more flexible. Several of the other midwives do their appointments on a weekend and i would have had to use one of them.

Now on the flip side, I try to let her tell me the best time outside of work for her and accomondate her.

[Megan73]

Your hours sound more than fair to me.
Where I live, midwifery is publicly funded and covered by universal health insurance.
The practice I use has office visits only except for a single third-trimester home visit and post-partum visits during the first week.
Also, most of the midwives work in pairs, alternating weeks of clinic duty and births (both at home and in a hospital birthing centre).
As a consumer, I think this is a fair way to balance care AND allow the midwives to have a life. I do wish they would have evening visits once a week, though.

But when you say that you "forget" to look things up for clients or bring them books, I think a daytimer would be a simple solution. No one should expect themselves to remember that much stuff!

[momileigh]

Originally Posted by nashvillemidwife

My state lab told me recently there's research in the works showing that you catch more disorders when re-tested at 2 weeks, and depending the outcome of the study it may become required.

Good to know, thanks ladies

[lirpasirhc]

I'm a consumer

OP, I think your new office hours are more than reasonable. My m/w has office hours Mon and Thurs from 8:00-5:00. If she cancels due to a birth, she makes up the appointment during her normal office hours on another day. I drive 45minutes to see her, and she charges more than most m/ws in the area. Like you said in one of your posts, she will drop everything to be with my during my entire labor, so I can make some scheduling sacrifices for my prenatal appointments. I chose her despite her fee, scheduling, and distance b/c I love her birth philosophy and b/c she makes me feel calm. She gives out her pager # instead of her home #. I've had some problems twice, and she has called me back within 10 minutes both times. She has seen me on time or a little early every visit but one, and for that one she was only 10 minutes late. Her birth philosophy, professionalism, and personality were much more important to me than her office hours or home prenatal visits. I hope that you enjoy your new found scheduling freedom and organization.

[homewithtwinsmama]

Originally Posted by nashvillemidwife

homewithtwinsmama: how long do you think is reasonable to wait for postpartum office visits? I don't know any clients who aren't out and about with their babies after 2 weeks (my next routine appointment after the 1-2 I do in the first week).

Seriously, what do they put in the water there? Are you advising them to jump out of bed and resume their normal schedules that fast? Most women we serve HATE that the pediatrician wants them out at 2 days and 2 weeks (and often our clients won't even call the ped until 3 weeks and just let midwife and assistant keep tabs on baby, nursing, weight gain, do the metabolic screens, etc.). The midwife suggests they stick close to home and rest a lot for a minimum of two weeks after an uncomplicated birth. I am having number six and I did not personally begin to feel ready to be out driving, waiting for appts. etc until at least the 3rd week postpartum. We usually do two weeks in-home for most mamas unless they seem to be struggling where we will go out during week three if needed. The first midwife I apprenticed with didn't require mamas to come in until 6 weeks. She went to them as needed until then. She however had an office policy where they came to her office until week 37, then she did weekly in-home visits until birth. Both midwives were doing between 80-100 births per year as solo practice midwives with one or two assistants.

[Dov'sMom]

What about early mornings?

I'm a consumer, and I couldn't go with a midwife for this birth because of scheduling -- the only midwifery practice that would have been practicable for me has strict office hours 10-4. Well, I work over an hour away from there, so even if I had the first appointment of the day every time, it would mean missing more than 1/2 day of work every appointment...which gets to be a lot the last few months. My ob/gyn practice has appointments from 7:30 a.m. some days, and while I don't always get the 7:30 appointment, I can mostly get in to work by 10 a.m. I'm really unhappy about going with an ob/gyn, and I'm glad that at least my first birth was with a MW so I know more about what to expect and can be more assertive, but I really wish there was more accommodation to working schedules.

[the_lissa]

I'm a consumer, and I think you are being very reasonable.

My midwives visits are at their office during weekdays. they do a 36 week home visit, and all the postpartum visits but the 6 week visit are home visits.

[jengacnm]

Echoing what most have said here-your boundaries are quite reasonable. You may have a handful of potential clients chose to go elsewhere, but it sounds like you're busy enough that you're not begging for business.

I had a situation just a few weeks ago where a client who is in a family business can ONLY have evening appointments. (Apparently this business will fall apart without her.) My office hours are rountinely until 7 pm, last appointment at 6:30. She had made a 6 pm appointment, I think, because it was the only opening available. So she just showed up at 6:30, when the woman who had a 6:30 appointment was already there. I couldn't reschedule her ANYWHERE else, so I stayed late and ended up being late for something in MY personal life that's important to me.

Through an interesting set of circumstances, she was responsible for keeping my partner over late on another appointment last month.

I've prepared a speech of sorts when she comes in for her next visit: if she wants the benefits of a small and intimate practice, then she needs to be willing to accept our limitations also-and office hours until 7pm two days a week is not a severe limitation. If her schedule is so inflexible that our hours don't work with hers, then she needs to find a bigger practice with more extensive hours.

I have no issue going above and beyond for women who have a problem or complication. But persistently keeping us over our scheduled hours for a normal pregnancy is not a trend I'm willing to continue.

Thanks for letting me vent, gang.

nashvillemidwife, you are a commited professional who is providing a highly specialized service. Congratulations on recognizing what you need to do to stay happy and healthy, and for averting burnout before it happens.

[dianna11]

I think the expectations you are setting up are VERY reasonable! By setting office hours, you are freeing up your travel time to dedicate more time to your clients. Although it would be "nice" for a mom to not miss much work, they would have to miss work for an OB appointment, and their employers I'm sure would expect that! Not only that, they are often kept waiting for hours for a 7 minute appointment at an OB's office!

The midwife clinic I go to gives the expectation that all, but one of your prenatal appointments will be in the clinic and one (close to the due date) will be in the client's home, usually to discuss home birth, check the place out, and because it is such a luxury to have the midwife come to your home! After the birth, they come by the next day, then 3 days after, then 10 days after. After that, there are two more postnatal visits at the clinic.

You are providing an amazing service, but being self employed myself, I am well aware that the more you give, the more people will take.

By setting up your outlined expectations, you will be doing a greater service to your clients, and really if someone has a problem with you not traveling 90 minutes out of your way for a 30 week check-up, then it's their loss!

[mwherbs]

I think for a small or beginning practice doing home visits is a way to grow your practice without alot of new overhead--

once you are busy enough it isn't efficient to go to everyone's home for every visit unless you live in a small village and can walk or ride a bike --

as for hours depends on your clients, you will figure out if you have enough clients to keep your practice operating with the hours you have--
we have so many more working moms now that having atleast some evening appointments usually offered 1 day a week has become important- but we also rarely have early morning appointments -- other than ruling out some urgent problem--
as for differences between you and your partner it is ok to have different needs - the trick is to figure out how to both get what you want- and still get along/work together-- if she wants to make the effort to stay late then that is something she can do, unless the clients figure out how to come in when regular office hrs are she is only going to meet you at the home visit --
and speaking of home visits, what seems to work out is to just schedule them in during your regular appointment hrs- but you have to block out a bigger time slot than normal for travel--

how do you handle phone calls? do you have a rotating first call? how I have seen it done in busy practices is the first call/oncall phone is passed from one to the other so you don't both have to be on call for all the after hr questions but everyone can still be reached for births--

[nashvillemidwife]

Originally Posted by mwherbs

how do you handle phone calls? do you have a rotating first call? how I have seen it done in busy practices is the first call/oncall phone is passed from one to the other so you don't both have to be on call for all the after hr questions but everyone can still be reached for births--

Now that my partner and I have split up it's pretty much just me. I have two assistants to help me at births but they're not in a position to field phone calls; the clients meet them, but they are not at all responsible for client care, their jobs are just to assist me at births.

I give out my home phone number to the public but I turn the ringer off when I'm not "working". When a client hires me I give them my cell number and ask them to reserve it only for urgent calls (I tell them that I often desperately need a period of good quality sleep and I want to know that if phone rings it's worth being woken up, only I say it a little less bluntly). When they reach about 36 weeks I give them my super secret pager number that's only for emergencies.

When I'm not on call for a birth and able to put my cell away I give them the number of another midwife they can call if they have prenatal concerns. She is a lot like me and we have the same backup doctor so it works perfectly, though has never been needed. She also has my super secret pager number.