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Midwife Fees?

post #1 of 51
1/29/08 at 9:44pm
Thread Starter 
What is a normal fee? I'm curious in different areas of the US what Midwives charge?
Thanks!
And how would a MW charge for a transferred birth?
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post #2 of 51
1/29/08 at 9:55pm
I think it really varies with the region. In CT I think the average is about $3k.
I don't know about transfers, though..
post #3 of 51
1/29/08 at 10:28pm
Here in Las Vegas, NV normal can vary - from what I know anywhere from $2500 - $3500

I'm not a midwife, but I believe the fee is still the same regardless of transfer (if the mom transfers while still in labor or after birth).
post #4 of 51
1/29/08 at 10:30pm
It varies HUGELY by location. Last I compared, here in Houston the range is from around $2400- $6000+

-Angela
post #5 of 51
1/29/08 at 10:41pm
In central VA mine was $2500 if paid by 25 weeks (and up to about $3000 if not until 36 weeks I believe). If I had needed to transfer any time before the birth, they would have prorated the visits I had, but the full charge would have applied had I needed to transfer during labor. The idea being that they would have stayed with me and advocated for me at the hospital and would already have done a lot at home probably. They would also have done the pp vidits too. Another mw I interviewed in the same area had similar prices and policies.
post #6 of 51
1/30/08 at 12:41am
$3500, no refund for transfers. My job as a midwife is to make sure that the client's baby is delivered safely, and sometimes that means using my skills and expertise to recognize the need medical intervention. When this happens, I have lived up to my obligation to their safety and I deserve to be paid in full. I do attend the delivery, even if I am no longer the primary attendant, and I continue to provide postpartum care.

I don't give refunds in arbitrary amounts. If someone transfers out of my care the only fair way to assess fees is to itemize and charge for each service, including an hourly rate for time spent during labor. Transport situations usually require more time and energy than if I had just delivered the baby. If I were to add all those fees up they usually come to much more than what they have already paid me. If they don't, I will give them a refund, but that's only happened once; we decided to transport as soon as I arrived, she delivered immediately at the hospital, and chose to continue seeing the doctor for followup. Even then the refund was only $400.

What blew my mind about that situation was that if I weren't there she would not have gotten the only doctor in town who delivered vaginal breeches to come in on his day off to go out on a limb for someone he had never met. Can you put a price on avoiding an unncessary c-section? I guess you can: $400.
post #7 of 51
1/30/08 at 2:15am
2000-4000$ in the area for homebirths--

depends on the practice and when you transfer out of care- an early transfer for PTL or other problems or a move- some refunds usually-- transfer of care during labor- usually no( you are not promised a home birth the work is to support a reasonably safe birth)
post #8 of 51
1/30/08 at 3:28am
nashville midwife - I'm surprised you were willing to refund at all? As you said, you had done what you were hired for...

My mw charges $3500. If you transfer prior to 34 weeks, she only charges you for the care you have received ($250 for the initial prenatal visit and $125 for each regular prenatal visit). If you transfer, for ANY reason after 34 weeks, the "package fee will be considered earned in full and no part of it will be refunded."
post #9 of 51
1/30/08 at 2:09pm
Our region is on the low end--about $1500., with a couple of mws actually charging as low as $1000 or even $500. But one of those makes it up by taking on more clients than she can really serve well; the other is well taken care of by her husband financially, considers her midwifery work to be a ministry that she cannot demand fair market payment for. I am strongly considering taking my fee up a good notch, since I mainly travel for prenatals and put a LOT of time into visits, ph calls, etc.

My contract states that in event of transfer to med care at any time before labor starts, they will receive refund prorated to number of visits and various specific charges that are on the fee sched. If transfer happens AFTER labor's onset, then I get full fee.

But I think maybe I should charge a refundable $500 fee for 'in case of transport'! (refunded after normal homebirth). Because for one thing, transfers are MORE work and worry for me, both during and following birth. And for another, it would weed out those who want to 'try' homebirth but aren't committed to the self-care, self-informing, and responsibility involved. I'm getting better at weeding those out before choosing to work with that kind of fam....but I'm only 1/2 joking about that refundable transport fee!

Anyway, remember that fees will vary not just by region and general economics, but for other reasons as well. Some mws who charge more, are also able to offer more services--suturing, labs, whatever, the expenses and time investment of which are part of that global fee. Some mws who charge more, are charging on the basis of their reputation, whether or not they offer more services (and thus incur greater expenses with those added services).

I would say, look around at what is being charged in your region...and what is offered by those mws for their fees, along with cost of living there, and such other related financial considerations.
post #10 of 51
1/30/08 at 7:55pm
Quote:
Originally Posted by mom2mializ View Post
nashville midwife - I'm surprised you were willing to refund at all? As you said, you had done what you were hired for...
My partner consented to give them a refund before discussing it with me. That's when I started taking care of our finances...
post #11 of 51
1/30/08 at 8:02pm
Thread Starter 
Quote:
Originally Posted by nashvillemidwife View Post
$3500, no refund for transfers. My job as a midwife is to make sure that the client's baby is delivered safely, and sometimes that means using my skills and expertise to recognize the need medical intervention. When this happens, I have lived up to my obligation to their safety and I deserve to be paid in full. I do attend the delivery, even if I am no longer the primary attendant, and I continue to provide postpartum care.
Transport situations usually require more time and energy than if I had just delivered the baby. If I were to add all those fees up they usually come to much more than what they have already paid me. If they don't, I will give them a refund, but that's only happened once; we decided to transport as soon as I arrived, she delivered immediately at the hospital, and chose to continue seeing the doctor for followup. Even then the refund was only $400.

What blew my mind about that situation was that if I weren't there she would not have gotten the only doctor in town who delivered vaginal breeches to come in on his day off to go out on a limb for someone he had never met. Can you put a price on avoiding an unncessary c-section? I guess you can: $400.
Well, avoiding an unnecessary c/s would be worth much more than $400 to me!
Your refund policy makes sense to me. I can see it would be more work. The political climate is not friendly to midwives in my state, so I don't think any wuold accompany a transfer. So that would be somewhat different.

Quote:
Originally Posted by MsBlack View Post
Our region is on the low end--about $1500., with a couple of mws actually charging as low as $1000 or even $500. But one of those makes it up by taking on more clients than she can really serve well; the other is well taken care of by her husband financially, considers her midwifery work to be a ministry that she cannot demand fair market payment for. I am strongly considering taking my fee up a good notch, since I mainly travel for prenatals and put a LOT of time into visits, ph calls, etc.

My contract states that in event of transfer to med care at any time before labor starts, they will receive refund prorated to number of visits and various specific charges that are on the fee sched. If transfer happens AFTER labor's onset, then I get full fee.

But I think maybe I should charge a refundable $500 fee for 'in case of transport'! (refunded after normal homebirth). Because for one thing, transfers are MORE work and worry for me, both during and following birth. And for another, it would weed out those who want to 'try' homebirth but aren't committed to the self-care, self-informing, and responsibility involved. I'm getting better at weeding those out before choosing to work with that kind of fam....but I'm only 1/2 joking about that refundable transport fee!

Anyway, remember that fees will vary not just by region and general economics, but for other reasons as well. Some mws who charge more, are also able to offer more services--suturing, labs, whatever, the expenses and time investment of which are part of that global fee. Some mws who charge more, are charging on the basis of their reputation, whether or not they offer more services (and thus incur greater expenses with those added services).
I'm curious where you are! Wow! The one midwife I've heard much of anything about has fees close to that and the mom who hired her said it was low, so it got me curious.
I like your refund for not transferring idea, it does make sense.
post #12 of 51
1/30/08 at 9:17pm
The practice that I am with we charge 2500 plus 100 for the first intake and if you want a waterbirth, another 200 for pool rental. Prices vary here from 2500 to 6000.
post #13 of 51
1/31/08 at 11:52am
Quote:
Originally Posted by MsBlack View Post
Our region is on the low end--about $1500., with a couple of mws actually charging as low as $1000 or even $500. But one of those makes it up by taking on more clients than she can really serve well; the other is well taken care of by her husband financially, considers her midwifery work to be a ministry that she cannot demand fair market payment for. I am strongly considering taking my fee up a good notch, since I mainly travel for prenatals and put a LOT of time into visits, ph calls, etc.

I'm "next door", the next state over and $1500 is the going rate for a DEM/CPM as far as I've seen.

I don't think I would refund for transports considering how low the birth fee is here... and the one labor I've been to that ended in transport was definitely the longest/hardest labor I've been to so far.
post #14 of 51
1/31/08 at 12:48pm
Quote:
Originally Posted by iemaja View Post
Here in Las Vegas, NV normal can vary - from what I know anywhere from $2500 - $3500
I interviewed one at $1200 and another at $4000... none of the MW fee's included tubs or 'medical' supplies for birth, that added on $60-500 depending on what we choose.
post #15 of 51
1/31/08 at 8:25pm
This is directed more toward the midwives, but when you made the decision on what to charge, what did you base that on?

Did you have a business plan/budget (3 or 5 year) with all expenses figured in, including a salary for yourself, or was it more what everyone else is charging/what the market will bear?

How did you decide which one to use?
post #16 of 51
1/31/08 at 8:25pm
duplicate post-sorry!
post #17 of 51
1/31/08 at 10:48pm
Mothercat--

Mine was based on what had been agreed upon by other mws in the region. Now that I have actually worked with it, I see that it falls a bit short of covering the bases and affording me a reasonable living. I had nothing do to with the amt set--it was done just before I returned to practice. And later I realized that the great majority of mws charging that fee (or less, as I indicated earlier) were not actually NEEDING to make a reasonable living; they rely on a dh's paychecks to cover their real living expenses. That fee has no bearing on any sort of reality, other than a shared feeling among the mws that we have to keep it affordable for people.

I do agree that it makes sense to set a fee in accordance with local standard of living and so forth....but as a mw without a dh-paycheck to live on, a mw who MUST make a living at midwifery (or find a new job), I am in process of rethinking this whole thing.
post #18 of 51
1/31/08 at 11:01pm
MsBlack, wow! we are in the same state, but I payed $3000 for care and birth pool rental. The cheapest MW I interviewed was $2200 I think. I guess even within one same state it depends greatly on the area.
post #19 of 51
2/1/08 at 12:31am
Quote:
Originally Posted by mothercat View Post
This is directed more toward the midwives, but when you made the decision on what to charge, what did you base that on?

Did you have a business plan/budget (3 or 5 year) with all expenses figured in, including a salary for yourself, or was it more what everyone else is charging/what the market will bear?

How did you decide which one to use?
Not a midwife yet, but I have wondered about that very thing.

I'm surprised that with gas prices the way they are, that more midwives aren't charging a "gas surcharge" or just increasing the rates a bit because the midwives I know do a *lot* of driving. While I see midwifery as a calling- midwives have bills to pay too! OTOH, I understand that since many families will have to pay out of pocket, the market can only bear so much- particularly in rural areas.
post #20 of 51
2/1/08 at 1:39am
I'm not in the US, but in my area in Canada midwife fees have just gone up to $3000. They were around $2000 a couple of years ago but increasing insurance rates and (if I'm not mistaken) the enforcement of taxing has pushed the fee higher.
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