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#1 of 16 Old 12-20-2009, 02:22 PM - Thread Starter
 
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Are there any midwives who offer a sliding fee scale who wouldn't mind sharing it with me? I would like to make my services a bit more accessible, but I really have no idea where to start as far as how much of a discount for each income bracket. Also, did you break it down by numbers of people in their families as well or only the family income regardless of number of family members?

If you would prefer to not share this information publicly, would you mind sending it to me in an email or pm? I would greatly appreciate some help on it.

Thanks,
Erika

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#2 of 16 Old 12-21-2009, 12:42 AM
 
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i have a sliding up scale as a doula (totally different responsibilities and scope, I know, but might at least be another piece of information to have)

from my contract, it says:

My fee for my doula services is a sliding up scale, starting at XX and sliding up to YYY.

The amount you pay is determined by you, the client, and may be based on the amount of time I spend with you, the level of service provided, your degree of satisfaction, and your ability to pay.

I collect ZZ as a non-refundable retainer and the balance is due at the first postpartum visit.


I have set XX as the lowest I am willing to accept, so if someone pays me that, I am fine with it. I do not ask for financial info to determine ability to pay, that is for the family to decide.

I usually get more than my lowest point. this system has worked very well for me.

I know doula to midwife is like apples to oranges but just thought I would throw it out there.

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#3 of 16 Old 12-21-2009, 03:40 AM
 
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Sorry I can't help with sliding fee scale, but I end up accepting barter (I'm having my pantry outfitted with tupperware organizing boxes by one and getting a snowblower from another whose hubby is a mechanic for another example) and sometimes (often) wait until a family gets income tax in to pay and take payment plans. BUT I also don't depend on the income. I'm in a situation where I can afford to do it for the love and little else.
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#4 of 16 Old 12-21-2009, 11:26 AM
 
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BUT I also don't depend on the income. I'm in a situation where I can afford to do it for the love and little else.
Oh golly, do I ever shudder to hear that!

don't get me wrong...in some ways I would love to be in that kind of situation. In some ways I absolutely despise that money has to be part of the equation of doing this work, for various reasons. I really very much hate it when a family just can't have a homebirth because they truly can't afford to pay anyone anything for the service.

And yet this is the world we live in. Many if not the great majority of us DO need the income; and more than that, because this is the world we live in and people have come to attach $$ so closely with 'value', I don't know as I could really let go of the money issue entirely even if I didn't need it. This is because my experience is that those who don't pay, too often also don't value the service OR the provider as much as they should. I don't need to be anyone's hero by any means--but neither do I want to be taken for granted. Also, when people know mws in your situation--who can afford not to charge much, or provide services often for free--then those people tend to think that only the 'most loving/spiritual' of mws will do this....and that those of us who do need (or just want!) the income are not as loving/spiritual as we should be.

Funny thing is, mws who charge little or nothing are rarely women who actually live in the kind of simplicity/poverty that 'doing it for love' might imply. They are most always women who don't have to charge, because they DO live well, sometimes very well indeed, on their partner's income. They are able to do midwifery for little or nothing without shortchanging themselves or children of any of the goods of a comfortable life, but all the while looking (to their clients and others) practically like saints because of free/cheap services. Which can make things harder on the rest of us ordinary mws who need or want to charge a fee in keeping with cost of living and other factors.

See, I think what I do is actualy PRICELESS. So hugely more valuable than mere money can begin to match! And yet I am the sole wage earner of my household, so I have to charge a fee. Again, because of the connection of $$ and value in this culture, I also *want* to charge a fee. Since I also want to be able to offer the service even to those of slender means, I have so far kept my fee low by comparison to national standards, and do accept barter and long term pmt plans sometimes (but only so much, I do have bills to pay that I can't pay with a snowblower). But then came the day when I walked into the million $$ home of 2 highly paid professionals, and the first thought I had was "Crap, do I ever need a sliding scale!"

Back to value, with this family in mind: I could tell that in a definite way they attached the same low value to my services that they perceived I had attached to *myself* (by charging such a low fee): sometimes they deferred making payments to me, so they could spend the money on vet services for an ancient (VERY ancient) dog that they didn't want to allow to die yet! (at least they were honest about it....and to be fair they were very decent people that I liked--I could just see the connection between my fee and their perceptions of me, which was no one's fault but my own for charging so little. You can be darn sure they paid their vet top dollar--because that was what was asked of them).

I hope that makes some sense as an analogy. I really don't mean to be offensive with this little rant--but I do hope you'll consider this, for your own sake as well as for midwives on the whole. To me it is somewhat of a feminist issue--we mws are women providing services to women doing THE fundamental women's work of childbearing. To not charge a reasonable fee is to continue to support the sexist assumption that women's work--both the work of childbearing and the work of supporting birth--is essentially without value, is too unimportant to be worth high $$. It is to affirm our own oppression and poverty, in other words--and women still earn far less than men in this era, still own/control far less of the property and resources than men. Even though mws do the important work of helping keep birth/mamas/babies safe, and even though *only* women can do the necessary and highly valuable work of childbearing! I really do not want to participate in any practice that helps continue to affirm my lack of value as a professional in a particularly female field, which also happens to demean the enormously important and demanding women's work of childbearing.

Anyway, sorry to go so far OT--and jljeppson, while obviously I jumped off of your comment, please know that I am speaking generally about this issue and not meaning to pick on you ...I hope you'll forgive my bluntness here.

I too have been thinking about a sliding scale. Unfortunately I have no idea how to start with this.
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#5 of 16 Old 12-21-2009, 12:30 PM
 
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I do have a sliding fee scale. I charge $1800 for families who make less than $50,000 per year, which is basically, in the best possible year, what my husband and I make together. Essentially, if you are poorer than I am, you get a break, and if you are richer, then you pay full price or full price minus an early payment discount. The average fee for midwifery services in my area is between $3000 and $4000.

I came up with that number a few different ways. I know that the rural midwives in my state charge around $1500-$2000 or so. If that is a reasonable fee for them to work for, then I think I can work for it too. I paid $2000 for my first homebirth 10 years ago and felt like it was a doable sacrifice on my income and so I wanted my fee to be at or below that. In the past year or so, though, I have stopped offering breaks below that number, with a few exceptions (like late entry to care) because l have become more aware of what sacrifices my family makes for my work. My work is far more involved and time consuming than any other kind of service work that I could do and I think that my family should get something out of my absences and stress. Taking pay for my work, even with my poorest clients, shows respect for what they go through because it helps us have the things we need (especially now -- my husband is unemployed and I'm the primary breadwinner).

I do occasionally cut the fee lower, but only for people I have a long-standing relationship with and only with a good reason. I have never done a free birth.

I like barter, but only offer it when I feel the family has something that I need (mostly construction/home renovation stuff lately).

Hope this helps!

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#6 of 16 Old 12-21-2009, 01:30 PM
 
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MsBlack, no worries of offending me. I've read your posts many, many times in the past and always enjoyed your honesty. I suppose I should make myself a bit clearer. I charge an honest wage; a good bit lower than another midwife in the area but I offer less services (I don't currently suture, for example) and am younger in the trade. I expect to get my full fee BUT I'm able to accept a good bit of that fee as barter IF it's services I need (one client is a professional photographer and will be doing a family portrait for us and of course my example of the snowblower, both in exchange for a payment not my entire fee). I also tend to serve a much lower income demographic; students, families just out of school, LARGE families with low incomes etc and know their circumstances and do know what they are able to afford. So it's not couples that are choosing to spend money on something else rather than pay me what I've fairly earned (I have a sister who does a good job of that and don't need clients to do it as well) it's the income bracket I currently work with. The occasional clients I get that can easily afford my fees pay up front or lose my services; my lower income families would lose my services as well if they didn't pay their fees they just have a little bit longer to do so. A few I allow to wait until income tax comes in, though each is expected to pay me a portion of some kind until that happens. ALL my clients are expected to pay me in some shape or form my entire fee and they know and respect that and frankly my husband would ask me to stop practicing if it wasn't so. I just happen to have the luxury (and I truly do know what a luxury it is) to be able to give them a bit longer to do so than midwives that depend on it for their income. In my case my clients know that the other midwife does charge much more since she has more experience etc and that she has NO leniency with payments (can't afford to, and who can blame her?) and so they tend to be a bit more respectful of the options I offer because they know what the alternative is.
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#7 of 16 Old 12-21-2009, 04:02 PM
 
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I have to say it has always surprised me to hear people say that when they offer someone a *deal* that the person values the service less. I'm not disagreeing whatsoever because I've seen it myself! It just surprises me and makes me think that my brain must be from a different era! lol I have had a few barter relationships in the past that I thoroughly enjoyed and valued very highly. I did everything I could and then some to hold up my end of the deal. Whenever someone has given me a price break (I've been low income since I've been out on my own) I appreciate that and value their sacrifice very highly and am usually willing to do something for them with my time to help make up the difference. Why don't more people think this way?? :-(

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#8 of 16 Old 12-21-2009, 10:27 PM
 
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Defenestrator--

thanks for all of that--very helpful! I appreciate the numbers you gave, and I totally agree with your commentary on all of that.

Jljeppson--whew, I'm glad you didn't mind me, I almost deleted before posting And thanks to you, too, for clarifying. Now I understand better, I think we are much more on the same wavelength than I'd originally perceived. I have known the kind of mw I mentioned, and the kind of client who has judged me for needing to earn a living (which especially rankles when I know a particular family is financially better off than I am).

Jessica_anne--I'm with you! When people give me a break such as more time to pay or the opportunity to barter, I'm so grateful and thrilled--and it does raise them in my esteem. And I also wonder why it doesn't work this way for everyone....but I have known too many over the years who look at it just the opposite, being 'nice' seems to mean you are 'someone beneath value', 'a sucker I can take advantage of'. But I hasten to add that I've also known people who did truly appreciate what I offered by way of a deal....it's not everyone who has the bad attitude, just enough to make me wary of it!
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#9 of 16 Old 12-22-2009, 12:10 AM
 
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Jessica_anne--I'm with you! When people give me a break such as more time to pay or the opportunity to barter, I'm so grateful and thrilled--and it does raise them in my esteem. And I also wonder why it doesn't work this way for everyone....but I have known too many over the years who look at it just the opposite, being 'nice' seems to mean you are 'someone beneath value', 'a sucker I can take advantage of'. But I hasten to add that I've also known people who did truly appreciate what I offered by way of a deal....it's not everyone who has the bad attitude, just enough to make me wary of it!
I totally get that. :-/ I hope that I will be able to figure out those who will truly appreciate being able to be a little flexible and those who won't so that I don't get taken advantage of. I'm sure that will be a whole new learning process that may take years to figure out.

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#10 of 16 Old 12-22-2009, 03:19 AM - Thread Starter
 
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I think I came up with a scale I feel comfortable using. A doula let me know she was using the poverty guidelines as the bases for her sliding fee scale and that made sense to me. So, I am giving certain percentage discounts based on where a person falls. I hope this works well

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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#11 of 16 Old 12-28-2009, 01:46 PM
 
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I give a discount to clients who can prove they currently qualify for gov't aid: WIC, medicaid, etc. That way I don't have to ask how much they make and evaluate anything...the gov't has already done that for me. The discount is really small, honestly, but the big change is the payment plan, which allows them to pay out until 6 months after the edd. I'm considering, though, changing it to where the discount is deeper and the payment plan is the same. I think in that case I might actually get paid more because it seems like very few clients actually continue to pay after baby's born .

Charlotte, midwife to some awesome women, wife to Jason, and no longer a mama to all boys S reading.gif('01), A nut.gif ('03) S lol.gif ('08) and L love.gif ('10).
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#12 of 16 Old 12-30-2009, 04:36 AM
 
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Great thread.

MsBlack, thank you for your thoughtful postings. Though most of your posts are....

Charmie, I learned from three different home birth providers that money not paid before the birth is likely money we won't see. The simple fact is that after the baby is born the parents need the money for the baby, and we're not going to repossess the baby. I'd suggest offering a deeper discount but expecting payment in full by 36 weeks.

I don't offer a sliding scale but I do offer a discount if paid by 28 weeks; if they transfer late, I will continue to honor the discount through 36 weeks.

I take medicaid for repeat clients who are willing to pay a little in cash and who have something to barter. I've gotten reiki treatments, yoga classes, and handyman work done in my office.

I decided I don't want to play accountant. I've seen two extremes. On one side is the couple whose warehouse/loft apartment was illegal-not zoned for residential occupancy. (We found out when the baby got an ambulance transfer four hours post birth.) The point is, they were POOR-I didn't know how poor until I saw their apartment, but they came up with my fee.

The other side is the couple who said, "Well, we kinda want a home birth, but we can't afford it so we'll apply for medicaid and have a free hospital birth." (At the time I had hospital privileges.) Over the course of her pregnancy, she and her partner took three trips (involving plane fares) and they frequently ate out at fancy restaraunts that I think I can't afford.

Yes, there are in betweens, and yes, it sucks when a family can't have a home birth they want solely because of money. But I'm totally with MsBlack-I'm doing the work I love but I'm also trying to make a good living. And I'd charge even if I didn't need the money.

Thanks all....

Jen
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#13 of 16 Old 01-01-2010, 01:22 AM
 
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...To me it is somewhat of a feminist issue--we mws are women providing services to women doing THE fundamental women's work of childbearing. To not charge a reasonable fee is to continue to support the sexist assumption that women's work--both the work of childbearing and the work of supporting birth--is essentially without value, is too unimportant to be worth high $$. It is to affirm our own oppression and poverty, in other words--and women still earn far less than men in this era, still own/control far less of the property and resources than men. Even though mws do the important work of helping keep birth/mamas/babies safe, and even though *only* women can do the necessary and highly valuable work of childbearing! I really do not want to participate in any practice that helps continue to affirm my lack of value as a professional in a particularly female field, which also happens to demean the enormously important and demanding women's work of childbearing.


Love this thread, and particularly enjoyed that bit.
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#14 of 16 Old 01-01-2010, 06:50 PM
 
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Originally Posted by Charmie981 View Post
I give a discount to clients who can prove they currently qualify for gov't aid: WIC, medicaid, etc. That way I don't have to ask how much they make and evaluate anything...the gov't has already done that for me. The discount is really small, honestly, but the big change is the payment plan, which allows them to pay out until 6 months after the edd. I'm considering, though, changing it to where the discount is deeper and the payment plan is the same. I think in that case I might actually get paid more because it seems like very few clients actually continue to pay after baby's born .
I like this idea!
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#15 of 16 Old 01-02-2010, 10:35 AM
 
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Charmie--

I like your method of making your assessment based on a family's proof with respect to medicaid/WIC, etc. That is easy enough.

I also agree that it can be very hard to get money after the baby! So far I've had pretty good luck with getting paid--but I can't afford to take many clients on a discount or long term plan in the first place. Maybe if I charged more for the wealthier fams, I'd be able to do that more (and would kind of like to). I have to really really like a family, feel that we are connecting in a very solid way to feel ok about discounts and long term pmt plans. That way, we seem to have no problems with the money after the birth....it is more personal for them. They may ask for my forbearance for more time, or toward a smaller-than-arranged pmt, but they rarely just blow me off.

And I appreciate the appreciation concerning my earlier comments ....and have to laugh at myself right now: because I've been wrestling with raising my fee! At least, for those who ARE at the higher levels of income--I'd probably keep the same fee for the lower end. For various reasons I think I should do so....but I'm having the hardest time actually doing it. So I guess I should read my own speech again....and again, as many times as it takes to really sink in!
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#16 of 16 Old 01-02-2010, 01:54 PM - Thread Starter
 
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And I appreciate the appreciation concerning my earlier comments ....and have to laugh at myself right now: because I've been wrestling with raising my fee! At least, for those who ARE at the higher levels of income--I'd probably keep the same fee for the lower end. For various reasons I think I should do so....but I'm having the hardest time actually doing it. So I guess I should read my own speech again....and again, as many times as it takes to really sink in!
MsBlack, this is what got me really deciding to do a sliding scale. I moved in August and midwives here charge almost double what they were in my previous location. So, with a sliding scale the lowest on that scale can be pretty close to what I would have been paid in my previous location and so i know I won't feel resentful for working for that fee and the higher fees on the upper end make it possible to make a living.

Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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