Wanting to pursue a career as a midwife, but...

[DreamsInDigital]

My husband and I were having an interesting discussion last night before bed. I mentioned to him that I was considering applying to AAMI next year to pursue my lifelong dream of becoming a midwife. So he says, of course, what does this mean in terms of us TTCing? And the more I thought about it, the more I realized that having another baby doesn't exactly fit in well with an apprenticeship, attending births and doing book work. So we are trying to decide. Do we TTC now and put my schooling on hold? Do we put TTCing on hold so I can go to school?

And honestly, being a Gemini, I cannot make decisions like this, especially when there are clearly only two options.

At his current job, he makes about $30,000 a year. And we live on that, though not comfortably. We live mostly paycheck to paycheck, juggling bills and barely staying afloat. I could pay my tuition and buy my books with next year's tax refund and if I juggle it right I could pretty much solely depend on my family to watch the kids if I'm away while Jim is at work. As a midwife, I have earning potential way beyond what Jim can make at his job, even if he got a promotion (which he won't because of being written up when he was just an agent) and got a good raise every year.

And, let's be honest, working for a big corporation sucks. Being your own boss rocks. I've wanted to be a midwife since I was a young child. This is my dream. I can remember playing "birth" with my dolls and my friends. I have a burning passion in me for birth and babies. I want to serve a very underserved area here in Southwest Washington where there are literally NO homebirth midwives licensed in Washington that will attend births this far south. Some midwives licensed in Oregon will cross the border but they are doing so at serious risk to themselves. I feel like I could really do some good and make a difference for healthcare for women.

I want to do this so badly, but I don't want it at the expense of having another baby. But I don't want to have a baby at the expense of pursuing my dream.

How can I decide this?

[MamaRabbit]

That's the beauty of doing AAMI. You can get extentions for cheap. And you get automatic ones for having babies. You can't take like 10 yr to finish but up to about 7 years yes.

I decided that even if I'm not sure I want to have more children or not, I had to start pursuing my dream. Even if that's just 10 min a day! I can go slowly and I can wait for an apprenticeship. I figure I just try to line one up when my babies are weaned. An apprenticeship can even go at the end after I've done all of the book work.

Does that help?

[Valerie]

Ok -- this is likely to be fairly lengthy, so bear with me! First, a little background...I started practicing homebirth midwifery in 1983, when I was 31. I had three young children at the time, with a fourth who was born the following year. But, like you, it was my dream, and I pursued it with a passion. I attended/taught/led endless study groups. I went to conferences. I attended classes. I became an EMT and eventually a CPM and an RN. Through it all, my children sort of took a back seat to my midwifery. After all, it was MY DREAM. While I was at births (and there were a lot of them -- in almost twenty years I attended just over 1000 births) my children were shuffled through a variety of babysitters. Eventually my oldest son took over babysitting duties "when Mom was at a birth." Even when I was at home, there seemed to be an endless stream of women coming through my house for prenatals, post-partum visits, and initial consultations. And my children? Planted in front of the TV, or holed up in their rooms doing homework.

Originally Posted by DreamsInDigital

My husband and I were having an interesting discussion last night before bed. I mentioned to him that I was considering applying to AAMI next year to pursue my lifelong dream of becoming a midwife. So he says, of course, what does this mean in terms of us TTCing? And the more I thought about it, the more I realized that having another baby doesn't exactly fit in well with an apprenticeship, attending births and doing book work. So we are trying to decide. Do we TTC now and put my schooling on hold? Do we put TTCing on hold so I can go to school?

And honestly, being a Gemini, I cannot make decisions like this, especially when there are clearly only two options.

But there aren't "clearly only two options." There is a third. You can wait until your children are old enough that they don't need you quite so intensely. Things are rarely as black and white as we think -- there is a whole range of gray. According to your blog, you are only 26. You literally have YEARS to become a midwife, but you only have a relatively short time to mother your children as closely as you do now. Your midwifery dreams will still be there, really. If anything, I believe that being older and having raised a family will give you a lot more stability and credibility as a midwife. And believe me -- doing it when you are older is not that big a deal. I am almost 56 and just finished my 3rd year in law school. A dream will wait until you are really ready.

At his current job, he makes about $30,000 a year. And we live on that, though not comfortably. We live mostly paycheck to paycheck, juggling bills and barely staying afloat. I could pay my tuition and buy my books with next year's tax refund and if I juggle it right I could pretty much solely depend on my family to watch the kids if I'm away while Jim is at work. As a midwife, I have earning potential way beyond what Jim can make at his job, even if he got a promotion (which he won't because of being written up when he was just an agent) and got a good raise every year.

I think you are being a bit overly optimistic to believe that your earning potential as a DEM/CPM is "way beyond" your husband's income of $30,000. I was divorced in 1992, and my income as a midwife barely kept us afloat, and that was combined with fairly generous child support payments and considerable assistance from my mother. And bear in mind -- I had a very busy practice of 4-6 births a month. The problem is that setting a fee is one thing -- collecting it is another. And unless you are willing to send past due accounts to collection agencies or take your clients to court, you are not going to get paid a lot of the time. Or you may get paid a fraction of what you are owed. Or -- like me -- you might occasionally barter. And while barter can be a great help to the client, vaccuum cleaners, wallpapering, tree services, and parrots (all things I got through the years) are not going to pay the bills. The bottom line is this -- we do homebirth midwifery for the love of it, NOT in order to make big bucks.

And, let's be honest, working for a big corporation sucks. Being your own boss rocks.

Oh, working for a big corporation does indeed suck. But have you ever actually been your own boss? It may not "rock" quite as much as you think. A midwifery practice takes years to establish, and even then it ebbs and flows. There might be some months when you can actually pay the bills, and some months when you wonder how you are going to buy food. And in a sense, with midwifery you really aren't your own boss. You are the employee of the women who hire you, and your life has to conform to their needs. Are you ready to run off to a birth on Christmas morning? How about missing a child's birthday, a school play, or a graduation? Will your children really understand how you "following your dream" requires you to abandon them?

I've wanted to be a midwife since I was a young child. This is my dream. I can remember playing "birth" with my dolls and my friends. I have a burning passion in me for birth and babies. I want to serve a very underserved area here in Southwest Washington where there are literally NO homebirth midwives licensed in Washington that will attend births this far south. Some midwives licensed in Oregon will cross the border but they are doing so at serious risk to themselves. I feel like I could really do some good and make a difference for healthcare for women.

I understand that passion, I really do. And there is no question that you have the potential to make a difference for the women in your area. My point is this -- the women will still be there. There will always be women who need competent, passionate midwives. But your children must be your first priority. The time they need from you is so little in the great scheme of thngs.

I made a mistake in pursuing midwifery while my children were so small, and I will always, always regret the amount of their childhood that I lost because I was so busy caring for other people. One of my daughters is your age, and I missed so much of her childhood and her teen years, and I can never get that back. Yes -- I have a whole string of other peoples' births to look back on, but at what cost? I have a twenty year midwifery career behind me, bought and paid for with my childrens' time. I understand now why "granny midwives" became midwives when they were grannies.

I want to do this so badly, but I don't want it at the expense of having another baby. But I don't want to have a baby at the expense of pursuing my dream.

How can I decide this?

You don't need to do it now. Read books, become a childbirth educatior or even a doula. Study herbs, and breastfeeding. Study a foreign language. Learn CPR. Do the preparatory things that will someday augment your study of midwifery. But for now, be a mother. Make that your primary job. The midwifery will wait until your own children are old enough to understand why mom "has to go to a birth."

Valerie
Former CPM
Former RN
Current law student

[dewi]

Valerie,

((((((Biggest hug))))))

What a beautiful honest post. I hope she understands and listens.

[Georgetown HB Mom]

Hi,

I have two children a 12 year old and a 3 year old. I am a midwife student with six months left of my apprenticship. I will take the NARM in February of 2009. I thought about waiting to pursue my midwifery education until my children were older but decided my dream could not wait that long. I also would love to have another baby but we have put that off until after I am doing taking the NARM. Luckily for me my husband works at home and my mom lives close by so both can take care of the kids when I have to be at a birth. I also got my BS degree in Respiratory Therapy when my oldest was a baby. You do make sacrifices but for me it has always seemed to work out. If this is truly what you want to do then I say go for it but I would put off trying to have a baby until you are done.

Good luck,
Lisa

[Defenestrator]

Valerie's post is 1000% true and I think that it definitely represents some of the major downsides of a life in midwifery.

I did choose to train and practice as a midwife with little kids and I haven't regretted my decision, even though the hours are crazy and the pay is very variable and not all that much. One legacy of my apprenticeship and first two years in practice, though, is a huge amount of debt.

I think that it is easy to underestimate how expensive it is to do an apprenticeship. No midwives in your area? That means either moving to a place where there are midwives to train with or driving long distance to work with someone in Oregon. I put about $300 worth of gas/maintenance into my little car (that gets 35 miles to the gallon) every month. I pay for childcare because I found that was the only way to make it totally reliable. That is about $600 per month now and was a bit more when I was apprenticing because my midwives were not interested in altering their schedules to minimize my childcare. This is with a lot of bartering and childcare exchanges in the mix. Equipment, books, food on the road, and licensing/certification fees are all big expenses too. I found myself having to work other part-time jobs to support my midwifery habit. Still do, to an extent. The first year that I was in practice I lost about $3000. The second year that I was in practice I made $7000. The third year I might make about $15,000 (haven't finished my taxes yet -- too busy being a mom and catching babies!). My version of a full-capacity practice (with about 30 births a year and fertility work and a handful of doula births) will probably net me about $40,000. That's an ok salary, but it will probably take me another year or two to get there. Also, that salary is not including some of the things that people working for corporations take for granted -- health care, retirement plans, lower taxes, etc.

I think that starting with AAMI is a great thing -- it will help you get an apprenticeship when you want one and can be a great thing to do with a small baby -- I loved reading while nursing. But, I would probably not be putting other parts of my life on hold to pursue midwifery if I were you, especially with the goal of improving your financial picture. The more likely result is that for a good 3-6 years it will make it worse.

[Hallielynn01]

Originally Posted by dewi

Valerie,

((((((Biggest hug))))))

What a beautiful honest post. I hope she understands and listens.

Thank you Valerie, the original posters dilemma is one I find myself in as well, and this has helped clear it up for me. I think for now, I'll stick to being a doula and finish by CBE stuff and raise my family. Who know, a few years down the road there me be more options for us aspiring midwives here in FL.

[Valerie]

Originally Posted by Hallielynn01

Thank you Valerie, the original posters dilemma is one I find myself in as well, and this has helped clear it up for me. I think for now, I'll stick to being a doula and finish by CBE stuff and raise my family. Who know, a few years down the road there me be more options for us aspiring midwives here in FL.

I think you are making a wise choice.

Please don't get me wrong here -- I am certainly not judging anyone who makes the same choices I did, nor am I criticizing anyone who simply can't wait to begin a midwifery apprenticeship. We all make our own choices, and we all deal with our own consequences.

What I tried to say in my unfortunately long post was that in looking back over the years, I really do regret some of the choices I made in order to follow MY dreams and MY goals and MY visions of becoming a midwife. One of the previous posters stated that "you do make sacrifices." It is only now that I realize that a lot of the sacrifices being made were really not mine to make. What I was sacrificing was the time my children should have had -- DESERVED to have had -- with their mother.

Valerie

[DreamsInDigital]

Originally Posted by Valerie

What I tried to say in my unfortunately long post was that in looking back over the years, I really do regret some of the choices I made in order to follow MY dreams and MY goals and MY visions of becoming a midwife. One of the previous posters stated that "you do make sacrifices." It is only now that I realize that a lot of the sacrifices being made were really not mine to make. What I was sacrificing was the time my children should have had -- DESERVED to have had -- with their mother.

Valerie

Valerie, I appreciate your honest post. I truly do. I think perhaps I can start on the book learning and pursue an apprenticeship when my little ones are older?

[MidwifeErika]

I just wanted to share a bit about the cost of apprenticing, just so that you can way it all out and make a more informed choice.

This last year I have been apprenticing with one midwife who is 25 miles away and another who is 43 miles away (they work as a team), and it has been fairly low volume (I went to 15 homebirths this year). I live in the midwest and have a scholarship for cheaper daycare for my children (so we pay $4.85/hour for all 3) and drive a car that gets 40mpg. I spent over $5,000 this last year on my apprenticeship. That is for gas, food while gone at births, some basic equipment, guild membership, temporary license, NRP, CPR, and childcare. I did not calculate the wear and tear on my vehicle.... mostly because I didn't want to cry.

This is not including my AAMI education or books. That would be roughly another $4000. (although I started back in 2006, so it is more spread out than just the last year).

This next year I will be spending about double (I am guesstimating right around $10,000) what I spent this last year as I am heading to a high volume birth center for 3 months as well as finishing up an apprenticeship here and I will be getting the rest of my equipment so I am ready to start my own practice. Oh poop, I forgot to add in the cost of PEP and NARM... so add to that another $1400.

So, I guess just becoming a CPM will cost me about $20,000.

So, if you are currently in a situation where you are barely getting by, this is something to spend a lot of time thinking about. I don't tell you this to discourage you at all, but just because now I kinda wish I would have had these numbers to look at before I started. I had no real idea how much it was going to cost.

If you are really feeling the need or desire to have another baby, I would go for that right now. Self study or doing AAMI while caring for a baby are totally do-able. I also wish now that I would have done more of my AAMI work before starting an apprenticeship as I am now reading about things that would have been useful for me to know 6 months ago

[Valerie]

Originally Posted by Valerie

What I was sacrificing was the time my children should have had -- DESERVED to have had -- with their mother.

Valerie

One last thing. There was a time probably more than fifteen years ago, at the height of my midwifery practice. I was busy -- I was swamped with clients.

And my 7-year old daughter approached me, holding a board game in her hands.

"Mama, will you play a game with me?"

"Aw, I can't honey, I have a lady coming."

"Ok," she said, and sadly walked away. I went on to more ladies and more years and pretty much forgot about the incident.

But you know what? She is almost 24 now, and she still remembers it. She remembers the day that Mama was too busy with ladies to play a simple game with her that probably would have taken all of fifteen minutes. And she resents it, even now.

So what I am saying is this -- midwifery and midwife-attended homebirth is really really important. If midwifery is to become the basis for maternity care in this country, we need more passionate, skilled midwives. We need them by the thousands. But at the same time we have to be so very careful about putting our own families first.

In my years as a midwife I served many, many families. I had the privilege of being part of their lives at wonderful, intimate moments, and I will always be grateful for that. But the trade off was leaving my own children alone while I cared for those of others. And that wasn't fair and it wasn't smart. It was twisted prioritizing at best, and at worst...well, at worst it was a form of negligence that I can never erase.

But hindsight is 20/20, I guess. I can only move on now, and try to create a close relationship with my adult children. But sometimes I still look at photos of them as young children and I wish...I wish so much that I had postponed my grand dream of midwifery for just a few years, just a few short years.

Valerie

[Ruthla]

Couldn't you do something in a related field right now, when you have small children, then pursue midwifery when your kids are grown?

I'm thinking childbirth education, lactation consultant, etc.

[DoomaYula]

Thank you for this topic and post. It's also very timely for me. I have an opportunity to begin the academic journey toward midwifery, and I'm deep in thought over whether to do it now or wait.

[Jane]

If I had it to do over again - I'd pursue CNM rather than CPM certification. Having an RN cert would be really beneficial in the not-a-midwife stage for the potential of earning money with short work hours.

CPMs usually start their own business. CNMs have the ability to be hired by someone and have someone else do all the paperwork/insurance/malpractice payments. Malpractice at $10K + per year is not insignificant in Washington State.
As an employee, you have lots of options that are more family friendly, like call once a month, or clinic only work at family planning clinices.

That said, CPM is my path - it's where my heart lies, and I'm in deep here anyway. I have no desire to return for 3 more years of schooling - and pay for that, too!

[Defenestrator]

I totally get what Valerie is saying and admit that I've had the same kind of conversations with my own kids, but the most likely choice for me was not between not working at all and being a midwife but instead between being a midwife and working some other job. Before I was a midiwfe I worked at a publishing company 40+ hours a week -- with my liberal arts background it was one of the better jobs I could find. They let me flex-time for a little while after my first son was born, but they were reluctant and it was hard. I got up at 5:30 am so that I could be to work by 7 and then worked until noon, picked him up and hung out with him all afternoon, then went back to work at 9pm and worked 3 more hours (usually at home, but sometimes at work). Add into that a baby who slept no more than 90 minutes at a time and you had one tired mama. In contrast, the 15 hours or so a week I work seeing clients and answering phone calls and emails + the one birth or less I attend a week is not too bad. I have those "mama's gotta go" conversations, but I'm there to have them. I'm sure that if I hadn't become a midwife I would have broken down and found a way to work less while being a mom because I enjoy my time with my kids too much, but my not working is not an economic reality for my family -- even a few years of earning less than what I did before (I used to bring in about half of the family income) has put us on really shaky ground.

[BirthFree]

I'm choosing to have my kiddos first, grow them up some (so that they are in a season of life that my immediate attention is not as 100% needed as it is now) and THEN I will peruse the MW dream that is in my heart.

I did not come to that decision until I was 2w away from starting my first year at Seattle Midwifery School... but I came to it all the same and with a heavy heart, I passed my place to someone else.

At the time it felt like a stupid choice in some respect knowing that I may never get back to that... but at the same time I felt strongly that I needed to honor my children and who they are/will be before I pursue a dream that can wait. I don't feel that that will be (or was) a wrong choice, it was just an extremely difficult choice.

For me, even book learning that is related to school has to kind of take the back seat... I still am a doula at times and I assist a few MWs when my family season allows, but aside from keeping my foot in the door and my spirit fed with what I love, I try to keep it rather balanced.

I want my kids to rejoice when I go to births and not feel neglected because of it. Not that there won't be times they'll have to have me miss things like birthdays or whatever, but I hope that putting things into the best order for us will be a good thing - and show them that dreams are to be pursued, but they came first.

I don't know... that's just how I've had to look at it and go about it.
We are having our last baby now, but I'm still looking about 8 years out...
I know that part of what makes a MW is the road that takes her there... so I try to focus on that too.

[wolfmom]

Valerie - thank you, thank you, thank you!

I have been having this dilemma with myself for some time and I loved your post. I have such a PASSION for mammas and babies but my own babies need to come first. and like you said - i have so much time left for midwifery. I already feel guilty when I tell my kids that I can't do something 'cause I'm too tired or have to get ready for work. I just can't do that to them. I want them to say when they are older: 'my mom loved me and was there for me when I needed her.'

besides - I can work in l&d if I need to the get the birthing experience. (I'm an RN.) in fact, I'm going to put in my resumes this week!

thank you again!

[Hallielynn01]

Valerie, I don't think anyone looked at your post as judgmental in any way. It gave another great perspective to look at while we all try to make huge decisions. Here in FL, AAMI isn't accepted, you have to go to an "state approved school" Which is a big financial cost as well as some commuting. And your right, you don't get that time back that you loose with your kids, even if its doing something you love and feel passionate about. I know how it is to have some resentment towards my parents for being "too busy" or not around. And its all from those younger years. When I hit middle school, I could have cared less!

This was a great thread to start!

[Charmie981]

I have a very slow practice right now...about 6-10 births a year and I'm planning an indefinite maternity leave starting after my June client has her baby. What everyone has said about the cost of apprenticeship is true. What people have said about having a busy practice is true. Even in a small practice, I miss things. I spent 16 hours away from home yesterday and didn't see or speak with my children AT ALL...on Mother's Day. There's always the potential that I'll miss a birthday party or a birthday or that I'll be gone on Thanksgiving. I intentionally don't take December or January clients because right now I can't miss Christmas....I'm just not up for explaining that. In the future I hope to be a little busier, but I honestly can't see having 5 or 6 births a month, not without a partner or help. Right now we miss a lot as a family because I'm on call. We haven't been able to go visit for Thanksgiving or go on vacation or go on the family mission trip...all because I'm on call.

But there are things that my children have experienced that they wouldn't have had a chance to experience without midwifery. The pictures of them in the Pacific ocean in my signature? A result of a midwifery-related trip. The most memorable family vacation we've ever taken? When I went to Boulder in September 2005 to take NARM. They don't remember that I spent 6 hours at a test, they remember the week surrounding the test...the hiking and exploring and seeing waterfalls and visiting a long-lost cousin. Getting to pet baby goats, only hours old? Seeing the chickens that their eggs come from? All because of going with me on prenatals. Exploring a client's pond in a paddleboat and seeing a peacock in all of his mating-display glory? All of that happened because of midwifery and they know that. There are some things it's not fair to ask them to do, so they don't go to EVERY prenatal with me, but they do meet each of my clients a handful of times and learn from each of them.

My goal as a mom and as a midwife is to always keep it in perspective, to always know that my kids DO come first and if there comes a time when they don't, when they aren't benefiting from my midwifery, then it's time to take a break...like the indefinite maternity leave coming up.

The problem, though, is that during an apprenticeship you're on someone else's schedule and at the mercy of someone else's priorities and perspective. My apprenticehip was in a VERY busy practice 1.5 hours away. There were weeks where I was gone more than I was there. When I think of Atley's first year, I remember births, but not his first steps. I remember the stress of literally going bankrupt to become a midwife, but I don't remember when he said his first word. Midwifery was not the only stress in my life at that time, and it probably wasn't the most major stress, either. But I have no doubt that without the stress of midwifery, the other stresses...the ones that caused a dark time in my marriage...would have been easier to manage. So, while I enjoy my midwifery "career" (so part-time I hesitate to even use that word!) right now, if I could go back, I'd choose a different path to midwifery. And that path might be the one that takes a lot longer and involves waiting until your children are older .

[rnchrista]

I don't think it has to be an all or nothing type thing.

When I first started apprenticing, my youngest was 12 weeks. I know that sounds crazy, and I wouldn't have been able to do it if my then preceptor wasn't so generous about letting me take on as much or as little as I wanted. If I only wanted to do one birth a month for the time being, that was fine with her. We did a lot of prenatals at mine or the other apprentices house, so many times 2 of my children were with me, and it was fine. I am now at the point where I almost always have to leave them with a sitter for prenatals…. my youngest is almost 2 and into everything, and it does not take long for her to find a pen and color the walls lol.

The thing is, if I wasn't apprenticing, I'd probably be working part time anyway, because I like to. I tried completely staying home for a while, but found just working 1 or 2 days a week made me a much happier Mom. The big difference is the loss of income. Not only did I loose what I was making, I end up spending about $800 - $1000/month to apprentice. Gas and babysitting really adds up quick. I initially planned on family babysitting too…I have a great family, but you quickly realize that plan doesn't always work out great. They've got a life too. They eventually get tired of the calls or start feeling like they are being taken advantage. The welcome really only lasts so long.

Midwifery is a constant balancing act for me. It would be so easy for me to do more and more and more. And some months I do do that. Then others are a little lighter. Obviously my children can't always have my undivided attention, but I make a huge effort to give it to them as much as possible. That has meant I have given up some of the things I did before I started apprenticing. I might not go out as often with my friends, because my family needs that time from me now. I don't do as much volunteer work as I used to. My family knows that there are days and times when I generally don't have appointments and that I am all theirs, as long as I don't have a birth. I also try to take a weekend and go away every once in a while too. I actually think I spend more quality time with my children now, because I've got the "every moment counts" attitude. I think my family does ok with everything but that is because it is always at the forefront of my mind. There have been times when things seem stretched at home, and I try to recognize that and cut back. It's just a forever balancing act.

So I guess I am saying the key to making it work is knowing what will work for your family, being able to recognize your limits, and having a fabulous preceptor, that is considerate of your time and other obligations, like mine is. I could not do it othewise.