Why are Nurse-Midwive's so expensive? It is really frustrating to me to want a home childbirth but I can't afford it! - Mothering Forums

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#1 of 67 Old 03-03-2010, 02:07 AM - Thread Starter
 
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After having a less then peaceful natural childbirth at the hospital, I am now convinced that for my next I want to have a home birth. When I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money.... I asked one of the ladies how many she has a year and she said 24.. 24x $4,000 equals sitting pretty. I need to just breath about it, but right now I am so turned off. Does anyone have any suggestions for me?
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#2 of 67 Old 03-03-2010, 02:31 AM
 
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No suggestions, unfortunately, but commiseration. My guess is that they have to charge a lot to cover their own insurance costs, and most areas/ health insurance plans don't cover home births so they don't get benefits that hospitals do. But I too find it very frustrating... we spent a long time trying to figure out a way to afford a home or birth center birth, but are ultimately going to go for the hospital. I think it's going to be $500 through our HMO instead of $4000-5000 .
We're having a doula and working to make the best of the birth situation we can afford, but it still sometimes frustrates and disappoints me. I heard over and over again that midwives try to be flexible and that there are payment plans available - but if you don't have the money, and won't later, a payment plan can't do much. One area doula actually told me that we should really NOT have a hospital birth, we should have a home birth unless we wanted to end up with a C section. One grouchy old woman's opinion but it still made me really mad and turned me off.
I think it's the tricky situation home birth midwives are in because of our country's crappy health care situation and the fear people have around home births, but it is so frustrating! I know in our area there are very few home birth midwives available because they are restricted from having hospital transfer privileges - so most of the area midwives are associated with a hospital and forbidden to attend home births. We need new laws!!
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#3 of 67 Old 03-03-2010, 07:33 AM
 
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That actually isn't a lot of money. They have huge overhead, and work a ton of hours for that money. And it's way, way, way less than an OB and hospital birth costs. It feels like more because insurance doesn't always cover it. But that midwife isn't taking home nearly what you think, and she's not just working a 9-5 office job to get it, either.

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#4 of 67 Old 03-03-2010, 10:54 AM
 
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It's not a lot when compared to how much a Dr charges added to hospital costs but for most of us insurance will cover those costs whereas they won't cover a homebirth midwife.

It is a business but most of the midwifes I interviewed were willing to work with me. One told me she would never deny someone a homebirth because they couldn't pay. We didn't end up with her because she ended up being pregnant and due around the same time as me And the midwife I have now at a birth center, is going to work me in terms of money because my insurance is being a PITA. Not many drs. around here would be willing to do this.

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#5 of 67 Old 03-03-2010, 11:09 AM
 
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My hospital birth, insurance paid $12,000. My homebirth, they paid less than a third of the $5000 my midwife was asking. I paid the rest out of pocket. $4000 isn't a lot when you consider the overhead and insurance and all that. Ask about a payment plan or see how the midwives can work with you. Most midwives are willing to help.

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#6 of 67 Old 03-03-2010, 11:10 AM
 
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Moved from I'm Pregnant.

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Nirvana is . . . the living happiness of a soul which is conscious of itself and conscious of having found its own abode in the heart of the Eternal. --Gandhi
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#7 of 67 Old 03-03-2010, 11:15 AM
 
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To me, a net of 96k isn't much considering she's a business owner. With that money she's working long unpredictable hours, often overnight, and even when she's not actually with a client she must answer their calls/emals promptly. She must provide her own healthcare ,must pay for updating her skill set with classes and such, must keep medical equipment up to date and dependable. She must deal with babies who die. There's ton more too.... Oh and taxes!!! That takes out a nice chunk right away.

IMO midwives are underpaid but they aren't in a position to charge more because for most people, like me, the current rate of about 4k is as much as a family can spend.

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#8 of 67 Old 03-03-2010, 11:18 AM
 
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As a previous poster said, that midwife isn't taking home as much as you think. $4,000 x 24 = $96,000. Figure 40% of that gone for taxes and another big chunk if she needs to pay for her own health insurance...don't know about Sacramento's cost of living but I can tell you that here in the Boston area, that's a fairly modest take home amount.
Be frustrated with insurance companies that won't cover out of hospital options. THEY are the problems, not the midwives that are merely trying to do what we all want out life - to put food on the table for our families while doing what we love to do.

ETA: there's something to be said for the risk that they take, too. To me, paying my midwife $3500 is nothing compared to the political and social risk she takes to even PRACTICE homebirth in an environment that is fairly hostile towards homebirthing. If I could afford it, I'd give her a big fat tip on top of what I'm paying her. She does not NEED to do what she does, she could make more money elsewhere, she does what she does because she is driven to make a difference and because she believes that *I* should have choice as to where and how I give birth, and IMO, that's priceless.
/soapbox

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#9 of 67 Old 03-03-2010, 11:25 AM
 
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Originally Posted by elliottyellow View Post
After having a less then peaceful natural childbirth at the hospital, I am now convinced that for my next I want to have a home birth. When I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money.... I asked one of the ladies how many she has a year and she said 24.. 24x $4,000 equals sitting pretty. I need to just breath about it, but right now I am so turned off. Does anyone have any suggestions for me?
I'm in your area and I'll agree with others that say that a gross income of $96,000 before expenses is not unreasonable AT ALL. They work hard, long hours, take big risks, have valuable skills and they deserve to be paid for what they do. Also, for context here are the costs of unmedicated, uncomplicated hospital births in our area http://www.betterbirthsacramento.com...omparison.html

Also, it probably won't save you any money, but the most experienced midwives in the area aren't CNM's. If I were planning a homebirth, I'd hire Tosi Marceline http://www.birthstream.com/index.html. For reasons I won't get into here, I'm driving across the causeway to the cheapest hospital on the list above (even after carefully considering the Birth Center, which is pretty close to me.) Birth tubs, volunteer doulas, reasonable c/s rate, policy of delayed cord clamping, staff that didn't blink an eye when I said I wanted to go home a few hours after the birth, etc.
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#10 of 67 Old 03-03-2010, 11:45 AM
 
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I know nothing about CA law but CNM's generally charge a little more than CPM's. So you may want to check out midwives in your area that are not nurse's.

Mom of 3.
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#11 of 67 Old 03-03-2010, 11:48 AM
 
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You can add into those lists of why they deserve what little they make the incredible personalized care you get with a midwife versus a hospital OB. I have had many friends complain that they don't feel like they have time to ask questions in appointments because they only see their doc for ~10 minutes. Every appointment I've had with my midwife has been 45min-1hr most of which is just us talking through my questions.
When I go into labor I am going to feel so much more at ease because I actually have a relationship with the person who is there to support me. Fortunately my insurance does pay half the midwifery/birthingcenter fees but I still had to shell out $2k, which I did gladly (even though it was a stretch) to avoid a hospital birth and to assure that labor support relationship would exist.
Mainly, I just agree with previous posters who pointed out that this is something to be pissed at the insurance companies for, not the midwives.

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#12 of 67 Old 03-03-2010, 11:50 AM
 
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It can frustrating for some but they really don't make that much at the end of the day. I am friends with 2 MWs in my town, one really struggles to make ends meet, the other does "ok" but still qualifies for low cost health care for herself because despite doing many, many births a month, it isn't enough with all the overhead.

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#13 of 67 Old 03-03-2010, 12:02 PM
 
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I agree that's not much money for what they do and the overhead. But I also completely commiserate on the price to the family. I wish insurance would cover it. It's completely too much for most families.

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#14 of 67 Old 03-03-2010, 12:16 PM
 
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Just want to say--this mw's heart has been thoroughly warmed by all the affirmative commentary here about the work, risks and committment of midwifery, and how little we do actually take home after our costs

I do know some mw's who make a fairly pretty penny (taking home way more than the mw the OP mentioned), and feel they should make as much as anyone else and be as comfortable as the 'American Ideal' promises. I don't judge them for it...but I will say that more of us DO live on pretty darn little take home pay. And we do so because what with the hostility of the med profession against hb, and the insurance companies therefore being so stingy about paying us, we mws try to keep it affordable for as many fams as possible. We work mainly for love of this work and the families we serve. But we do live wherever we live, with the associated cost of living and all--and can't work if we can't pay for groceries.

OP, keep looking, and keep working on it! You may just find the perfect mw for you, with a pricetag and terms you can meet along with the kind of personality and practice approach that you most desire.

good luck!
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#15 of 67 Old 03-03-2010, 12:23 PM
 
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She probably only brings home about 50% (or less) of that as income, which makes it a much lower income. Keep in mind that she has a master's degree and to make about 40K with that much education really isn't very much at all! Midwives deserve to make an income. there are long hours and a whole lot of responsibility that comes with the job. It isn't just some expensive hobby, it is work. I just did my taxes and for last year I brought home only 6% of my gross due to the costs of getting a practice going, paying assistants, miles put on my car, overhead expenses (rent, utilities, phone), and advertising. goodness, I barely broke even!

Generally, a vaginal birth in the hospital with all the prenatal care and such will end up being about 20K, so 4-5K is a really reasonable bill. However, I totally understand where 4,000 is hard to come up with as well (I would have a hard time trying to find that in our budget... ok, an impossible time). I think rather than being upset at midwives for their fees, we should take issue with not having insurance better cover midwifery services. Write and complain to your insurance company or start working for action for midwives to be covered by any universal healthcare that may go through in the future. It takes consumers taking action to make things change!

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

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#16 of 67 Old 03-03-2010, 12:51 PM
 
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I know nothing about CA law but CNM's generally charge a little more than CPM's. So you may want to check out midwives in your area that are not nurse's.
I know this certainly isn't true in all cases, but my cnm was MUCH more medical minded than my cpm. Like night and day. I agree with pp to shop around.

Are there things that you can cut from your budget? Things have been tight for us each time I got pregnant and we don't have insurance and yet have been able to (barely!) cough up the 3,000$ for our midwife each time. In fact, the first two were 3800$. We've cut eating out, texting, and other wants.
DS has sacrificed Legos, lol. "Mom, I really want the new Atlantis legos"
"Well, honey, legos are expensive and we're saving for the baby. Wouldn't you rather have a brother than more legos?"
He thinks..., "I'd rather have both, but I can wait til after the baby's born".

Keep trying!

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typos likely

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#17 of 67 Old 03-03-2010, 12:55 PM
 
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DS has sacrificed Legos, lol. "Mom, I really want the new Atlantis legos"
"Well, honey, legos are expensive and we're saving for the baby. Wouldn't you rather have a brother than more legos?"
He thinks..., "I'd rather have both, but I can wait til after the baby's born".

Keep trying!
Oh my goodness, that is ADORABLE!

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

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#18 of 67 Old 03-03-2010, 12:58 PM
 
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I agree with PP. Try and find a midwife that would be willing to work with your budget or a payment plan. Most of them are willing to. Also, does your insurance have any flex-spending (or something like that?) money you could use towards the bill?

Mama to three

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#19 of 67 Old 03-03-2010, 03:19 PM
 
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We are also struggling with the choice. I am in my first trimester and DH and I are talking about a homebirth. Sometimes it is hard for me to justify. I briefly talked about this with my very crunchy hospital midwife (last breech preg she highly encouraged me to travel to The Farm for my birth). She sees this as a political issue that we all need to get involved with.

We don't always have enough money for the right or best kind of food. We are in the red many months. Our hospital birth could cost us $0 (we pay a lot monthly on insurance). We are still leaning towards a homebirth. DH said it was our last chance to do it the way we want.

We still don't know and I feel so angry at the insurance companies for putting us into this situation.

Children deserve the respect of puzzling it out.
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#20 of 67 Old 03-03-2010, 10:02 PM
 
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CPMs are cheaper, but e.g. my insurance only covers CNMs, I guess that is the case with you too. Is there a birthing center and is it covered by insurance? I lucked out that my insurance covers a birthing center with CNMs just 2 hours South of us. Otherwise, it's everything out of pocket. I hope it works out for you.
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#21 of 67 Old 03-03-2010, 10:21 PM
 
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AWhen I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money....
Well, that's a fair assessment-- it *is* the nurse-midwives' business! Their education and continuing training is expensive, and they have to keep pretty odd hours. They have a huge responsibility getting to know the women in their care and screening for any abnormalities the pregnancy and birth. They make far less than doctors, and if you want a natural birth it's much more likely you'll be successful if you are under the care of a midwife. I could never complain about what I'm paying my midwife ($4200, about one-third of which *might* be reimbursed by insurance) because now that I've been seeing her for seven months I know just how much better the care is than that of the OB.
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#22 of 67 Old 03-04-2010, 10:05 AM
 
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Where I live CNM's are not an option at home. I have hired a CPM at about $3000. Very cheap in the spectrum of things. Insurance coverage is not an option here either, and I am getting dual care with a hospital based midwife as well. My insurance didn't even want to cover her without a doctor hovering over her. I am just grateful to still have the option of birthing at home available to me.
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#23 of 67 Old 03-04-2010, 12:41 PM
 
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I switched from a hospital birth to a HB a few weeks ago. I stuggled a bit with the money too however when I sit down and really think it through I feel that I am getting my monies worth even though we joined late in the game. In my area CPM seem to go for 4500. That is for the ENTIRE birth! So had I started my care with her at 10 or 12 weeks I would pay the same as joining at 28 weeks. My CPM has, in 2 meetings, spent more than 4 hours with me! Her fee also included the 2nd MW which will attend out birth. It is a shame that we have to pay out of pocket for this since the insurance companies pay HUGE sums for natural births in hospital but that is where we are at the moment. I agree that 4500, while being a lot when you look at the number, really isn't a lot when you look at the time and effort the CPM puts out.

Best of luck to you all.

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#24 of 67 Old 03-04-2010, 01:13 PM
 
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I'm a student midwife and a midwifery client for the fourth time right now, and I am definitely in the camp that they get paid way too little for what they do. 96,000 before taxes, insurance, rent, travel etc etc etc is nothing. Even if they were making say 60,000 dollars after all of that (which I would bet they are not coming close to) 60,000, while a lot more than DP and I are living off of now, is not the same as a business person making 60,000 dollars. They aren't working 40 hours a week... they are working long, unpredictable hours and are on call 24 hours a day.

All that being said, if you can't afford 4,000 dollars then you can't afford it. I 100% know that is a reality for some. But for those who could but don't because "it isn't worth it"... I wonder how much it would be worth to save oneself a c-section, or not having your baby put through unnecessary tests (which even if you refuse cause stress etc for you), or being able to actually get the birth you hoped for instead of the birth you settle for.

If I had a quarter for every time I heard someone say in hindsight that they wished they had just stayed at home with a midwife while they were healing from a c-section or fighting for a VBAC the next time, or healing from an episiotomy without consent, or any number of other scenarios I'd have a lot of money. Not that midwives can't let you down at home, of course they can and sometimes do, but if you look at the percentages, I'd say sometimes some things are worth it even if on the surface they seem like a lot of sacrifice or not worth it.

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#25 of 67 Old 03-04-2010, 02:23 PM
 
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Her fee also included the 2nd MW which will attend out birth.
This is a REALLY good point. The fee I'm paying my midwife also covers her assistant, whatever she might pay her.

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#26 of 67 Old 03-04-2010, 02:55 PM
 
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This is such a tough issue. On the one hand, many families don't have thousands of dollars to pay for midwifery care and it's really frustrating not to be able to have the birth you want because of financial issues.

On the other hand- this argument smacks of sexism and disrespect for midwifery and midwives. These arguments often end up devaluing women's work and the notion that female professionals should somehow be comfortable not being paid fully for their important work. Rather than getting angry at midwives trying to support themselves, I think we (in the US) need to look at insurance carriers and the medical lobbyists and ask why midwifery isn't covered? CNMs require a lot of education- often 6 years (4 for BSN+ 2 for their midwifery training) which requires a lot of money. They have terrible hours and their jobs require a great deal of wear and tear on their cars. If a CNM has children of her own, she's probably got huge childcare bills. Expecting midwives to cut you a deal or not make money really bothers me. It's like a business because it is a business! Why shouldn't they get paid?! They have a great deal of expertise and do a very important job.

My midwives charge what looks like a lot of money but barely make anything. In fact, one of them didn't get paid for the first 4 years she was in practice so she could pay her staff and fellow midwives. Her husband's a physician and floated the entire practice for years. None of the women in the practice are getting anywhere near rich and they're not greedy or wrong for expecting to get paid for their work.

I strongly encourage everyone who wishes midwifery was more affordable to get involved with midwifery advocacy and to write your insurance providers and local representatives about the importance of insurance (and Medicaid!) covering midwifery services. Please don't take it out on midwives though- they're professionals and have every reason in the world to be treated as such and be compensated for their work.

Healthcare is a human right!
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#27 of 67 Old 03-04-2010, 03:21 PM
 
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This is such a tough issue. On the one hand, many families don't have thousands of dollars to pay for midwifery care and it's really frustrating not to be able to have the birth you want because of financial issues.

On the other hand- this argument smacks of sexism and disrespect for midwifery and midwives. These arguments often end up devaluing women's work and the notion that female professionals should somehow be comfortable not being paid fully for their important work. Rather than getting angry at midwives trying to support themselves, I think we (in the US) need to look at insurance carriers and the medical lobbyists and ask why midwifery isn't covered? CNMs require a lot of education- often 6 years (4 for BSN+ 2 for their midwifery training) which requires a lot of money. They have terrible hours and their jobs require a great deal of wear and tear on their cars. If a CNM has children of her own, she's probably got huge childcare bills. Expecting midwives to cut you a deal or not make money really bothers me. It's like a business because it is a business! Why shouldn't they get paid?! They have a great deal of expertise and do a very important job.

My midwives charge what looks like a lot of money but barely make anything. In fact, one of them didn't get paid for the first 4 years she was in practice so she could pay her staff and fellow midwives. Her husband's a physician and floated the entire practice for years. None of the women in the practice are getting anywhere near rich and they're not greedy or wrong for expecting to get paid for their work.

I strongly encourage everyone who wishes midwifery was more affordable to get involved with midwifery advocacy and to write your insurance providers and local representatives about the importance of insurance (and Medicaid!) covering midwifery services. Please don't take it out on midwives though- they're professionals and have every reason in the world to be treated as such and be compensated for their work.
Yes! I totally agree!
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#28 of 67 Old 03-04-2010, 04:30 PM
 
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Originally Posted by elliottyellow View Post
After having a less then peaceful natural childbirth at the hospital, I am now convinced that for my next I want to have a home birth. When I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money.... I asked one of the ladies how many she has a year and she said 24.. 24x $4,000 equals sitting pretty. I need to just breath about it, but right now I am so turned off. Does anyone have any suggestions for me?

And what is wrong with this being a business? If you're hiring her, it is a business! Do you really think that a person would devote as much time to training, skill building, taking time with expectant mothers, being on call 24/7 as their due dates approach, and NOT get paid?

Further, people have already mentioned as a self-employed person, she's carrying her own health insurance. The other insurance that she's almost certainly carrying, thanks to lawsuit-happy people who think that every problem with a birth is the fault of the birth professional in the room, is liability insurance, which is *incredibly* expensive.

She has to pay for supplies and travel, and whatever advertising she does above word of mouth. If she has an assistant, she has to pay the assistant. She may have to pay for childcare for her own children, or pet care for her animals when she is at long labors.

Compared to what my insurance was charged for the CNM and labor nurse at my VERY uncomplicated hospital birth, $4000 is small change.

savithny, 42 year old moderate mom to DS Primo (age 12) and DD Secunda (age 9).

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#29 of 67 Old 03-04-2010, 04:39 PM
 
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Originally Posted by freestylemama View Post
This is such a tough issue. On the one hand, many families don't have thousands of dollars to pay for midwifery care and it's really frustrating not to be able to have the birth you want because of financial issues.

On the other hand- this argument smacks of sexism and disrespect for midwifery and midwives. These arguments often end up devaluing women's work and the notion that female professionals should somehow be comfortable not being paid fully for their important work. Rather than getting angry at midwives trying to support themselves, I think we (in the US) need to look at insurance carriers and the medical lobbyists and ask why midwifery isn't covered? CNMs require a lot of education- often 6 years (4 for BSN+ 2 for their midwifery training) which requires a lot of money. They have terrible hours and their jobs require a great deal of wear and tear on their cars. If a CNM has children of her own, she's probably got huge childcare bills. Expecting midwives to cut you a deal or not make money really bothers me. It's like a business because it is a business! Why shouldn't they get paid?! They have a great deal of expertise and do a very important job.

My midwives charge what looks like a lot of money but barely make anything. In fact, one of them didn't get paid for the first 4 years she was in practice so she could pay her staff and fellow midwives. Her husband's a physician and floated the entire practice for years. None of the women in the practice are getting anywhere near rich and they're not greedy or wrong for expecting to get paid for their work.

I strongly encourage everyone who wishes midwifery was more affordable to get involved with midwifery advocacy and to write your insurance providers and local representatives about the importance of insurance (and Medicaid!) covering midwifery services. Please don't take it out on midwives though- they're professionals and have every reason in the world to be treated as such and be compensated for their work.
Great post!

Lytorre, wife to one wonderful man. Mommy to two naturally-birthed, rough-and-tumble little men.

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#30 of 67 Old 03-04-2010, 04:43 PM
 
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Well, of course it is a business. They get paid 1/3 to 1/2 what an OB would for a MUCH higher quality of care to you the consumer too! And if you did the math on what comes out to pay taxes, insurance, rent on office space, marketing, supplies, travel expenses, childcare expenses, assistants, lab fees, and on and on and on - I doubt they are rolling in dough. I know quite a few midwives and I don't think any of them are rich. They do it because they love it, not for the money.

My insurance paid for my homebirth. I would go through a appeal process to see if you can make any progress if you've originally been told no.

But I can't understand complaining over a cost that is SO much less than what an OB gets for the same job. Complain about the insurance company that won't cover it if you want, but the midwives work hard - and look out for YOU - for every penny they get.
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