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#1 of 35 Old 10-07-2006, 11:23 PM - Thread Starter
 
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Around here homebirth midwives charge around $4,000. So if they take 5 clients a month, that's $240,000 a year! I know they have some expenses, but still, that sounds like a lot of money!

ETA: (post #29) Would everyone stop getting so hot and bothered about the "implications"?! I was just really surprised, because that seems like a lot of money to ME, and it is more than I would expect. I wish ALL midwives made one million dollars plus, then we'd have lot more midwives and fewer OB's.
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#2 of 35 Old 10-08-2006, 12:09 AM
 
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I don't know of any homebirth midwives who take 5 clients/month, except perhaps at a place like The Farm.

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#3 of 35 Old 10-08-2006, 12:13 AM
 
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Yeah, I think 5 clients would be a lot for one midwife. You have to consider they are paying for all the following:

Taxes
Health insurance
Book keeping (unless they do it themselves)
Possibly liability insurance
Rent on office space (unless they work out of their home)
Paperwork and office supplies
Birthing supplies
Transportation
An assistant if they need one
May still be paying off their education (student loans)

So, really, I doubt midwives are getting into the business for the money! But, I do think they deserve a comfortable living! When I'm in labor, I want a well paid, happy midwife by my side!!
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#4 of 35 Old 10-08-2006, 12:20 AM
 
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A solo operating midwife could not handle 5 deliveries a month and keep up with 45 other pregnant clients' prenatal care. Malpractice insurance alone probably takes a large chunk of every medical practice's budget. They're not pocketing it all!! Taxes take atleast 35% off the top!
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#5 of 35 Old 10-08-2006, 12:24 AM
 
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1) That's a lot of clients. There may be midwives (actually, I know there are) who take that many clients in a month, but to get that many every month is an unreasonable expectation (and also assumes no vacations).

2) That's assuming everyone can, and does, pay. I'd bet even if that were her standard fee, only a minority of families could actually pay it, and realistically she's getting 2-3K/birth on average.

3) It's before taxes - huge for a self-employed individual - and before expenses. When my mom, a family doctor, was in solo practice, her practice might bring in a quarter million in a good year (there were only a couple years that good), but she brought home, before taxes, maybe 2/5 of that. Her overhead was probably higher than the average homebirth midwife's (more employees), but it's completely unrealistic to look at a midwife's practice's gross and assume it's her take-home pay.

And to the above list of expenses, I would add licensing, certification, and continuing education, which are thousands of dollars a year.

Finally, yea, I do want my midwife to be well paid, to be able to support herself and, if she's doing well, her family. Midwives SHOULD be making good money - they deserve it.
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#6 of 35 Old 10-08-2006, 12:47 AM - Thread Starter
 
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The midwife I'm thinking of DOES have 5-6 clients a month, works out of her home, and does not have liability insurance because the insurance companies require a doctor backup, and there are no doctors around here who will be a backup for homebirth midwives. I assume that in this area, the vast majority of clients pay the full $4,000, and I am not aware of any discounts that she offers. Everyone pays taxes. I do realize that self employed people have to pay around 7.5% more in taxes, (only up to the first $90,000 of earnings) but STILL!!! $240,000 is a lot!

Now I realize it would take many, many years to get that kind of client base. I certainly wouldn't expect to make that much out of midwifery school, LOL.

ETA: transportation--everyone has to drive to work, and some people have quite lengthy commutes! The difference is, a self-employed person gets to deduct that, while everyone else cannot.
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#7 of 35 Old 10-08-2006, 01:04 AM
 
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I'm thinkin your average mw working solo makes somewhere in the $30,000's- easily less, but conceivably more.

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#8 of 35 Old 10-08-2006, 01:05 AM
 
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The Social Security tax rate for 2006 is 15.3 percent on self-employment income up to $94,200. If your net earnings exceed $94,200, you continue to pay only the Medicare portion of the Social Security tax, which is 2.9 percent, on the rest of your earnings.
Most medical professionals that I know estimate that their office expenses are 40% of their income. That seems to have been true for me. I have a part-time bookkeeper, and 2 part-time employees. I am generous with them.
My two best midwife friends work for a hospital practice and make about 65k/year full-time, are not on call 24/7, and have benefits.
Health insurance for my family (myself and 2 children) is about 6k year. The expenses go on and on.........
Carla
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#9 of 35 Old 10-08-2006, 01:32 AM - Thread Starter
 
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Originally Posted by mendomidwife View Post
The Social Security tax rate for 2006 is 15.3 percent on self-employment income up to $94,200. If your net earnings exceed $94,200, you continue to pay only the Medicare portion of the Social Security tax, which is 2.9 percent, on the rest of your earnings.
Health insurance for my family (myself and 2 children) is about 6k year. The expenses go on and on.........
Carla

Yes, but the social security tax rate for non-self employed people is 7.65%, so self employed people pay only 7.65% more than everyone else. Self employed people pay 2.9 percent for medicare, but everyone else pays 1.45, so it is just 1.45% more. Lots of people don't get health insurance with work. My husband gets pretty affordable health insurance at his work, but if any family members want to be on the plan, it is VERY expensive. So expensive, that it is cheaper to get individual coverage for me and our daughter.
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#10 of 35 Old 10-08-2006, 02:10 AM
 
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I don't know any midwives who are doing it for the money, and if the midwife you know really can't get liability/malpractice insurance, she'd best be stashing every penny she gets. Midwives are sued way less than docs, but it can and does happen.

I know that for a staff nurse with more than five years' experience in my area, it's actually a pay cut to work as a CNM or ARNP. It ain't the money.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#11 of 35 Old 10-08-2006, 03:29 AM
 
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all the midwives I have talked with consider 50% for expenses, actually have looked at the actual bills... now maybe this midwife you mention does make a good living- she doesn't pay for coverage? does she pay any office help? also I am wondering about billers and you must live in an amazing area where 5 couples / month can afford $4000 out of pocket for birth- and they pay the entire bill... just amazing
so depends on the area you live in- I know an excellent, experienced midwife in Portland who charges $1800 or less
another very busy mw in Penn who charges $300-600
even these gals who get low pay- do not always get paid.. on average consider that you will have 1-3 non-payers/year and more than that may ask for reduced payment.
realistically look at travel expenses- I assist at an average of 2/mo and in 3 months I put 10,000 miles on my car... that is 40,000 in a year --- someone doing 5/mo must have even higher mileage -- if you are driving and out that much you are also eating out more- can't immagine the amount of time this gal must have off. there is one gal who will do 4/month tops and she has 4 assists and pays for another on call midwife when she has this many in a mo so that no one will end up birthing alone.
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#12 of 35 Old 10-08-2006, 10:01 AM
 
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amen to the above! I know I do not do it for the money. As stated above, my autos...You go thru a lot of them. High milage. tires, with nails in them on a regular basis from those back roads, food on the run, even if you buy it and 'pack' it as a lunch.... cost of making charts, giving handouts as you educate your clients, esp the amish who have no internet service to look up and 'read to learn'... clients who dont pay... clients who cant pay (there is a difference).
we only get about $1300 (or more if very at a greater distance from us) around here for a birth. I use about $200 for gas in my auto a week...if not more. 3 births a month, that is really not very much income after expenses.
Yes there are some who make more, and are a little more busy, but not too many.
Midwifery is a calling...a service to the community that chooses the best way for their little one to come into the world. Home.

Midwife, Wife, Mother of 5 (6) and "Ga-Ma" to 5 adorable grand children...
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#13 of 35 Old 10-08-2006, 10:15 AM
 
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More power to her!

I am happy to see one of my sister midwives make an excellent salary for her hard work. Obviously $4000 is not too high of a fee -- the market seems to bear it well if she is busy. I also think that 5 births a month is a totally reasonable amount as well for a midwife who is well-organized and who has a good backup system or good helpers.

I am getting this weird vibe from this thread that it is not ok for midwives to make above a certain salary. I think that this line of thinking comes out of some dark, patriarchal places. This midwife has built a successful business, she is being well-paid for her work, and people are happy enough with her work to refer her to others and to come again. Sounds like a win! win! situation to me.

Maybe the OP is just amazed at the fact that a homebirth midwife's salary could be so high. I certainly won't be on the sunny side of six figures for quite a while, if ever, but there is a long, long history of women taking traditionally low-paying occupations (like housecleaning or craft work) and turning them into profitable businesses. Sometimes, too, people can charge a premium when they convince others that they have a skill or product that is unique in their market.

Stacia -- intrepid mama, midwife, and doula. Changing the world one 'zine at a time.
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#14 of 35 Old 10-08-2006, 10:37 AM
 
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Originally Posted by janellesmommy View Post
Around here homebirth midwives charge around $4,000. So if they take 5 clients a month, that's $240,000 a year! I know they have some expenses, but still, that sounds like a lot of money!
Why do you care? She is a professional providing a skilled service. If people are willing to pay her fee, then she must be worth it. Most importantly you are paying for a mw to be on call 24/7. It's a sacrifice to leave your family at unexpected times, even it's a holiday, birthday or other special occasion. She deserves what ever compensation the market will support.

BTW I'm not a birth worker, just a hombirthing mama who thinks my mw is worth every penny I paid.
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#15 of 35 Old 10-08-2006, 11:11 AM
 
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I think you are deluding yourself that she makes this much money as profit on a consistent basis. However, if so I wish more midwives made what you estimate your local midwife is taking home as profit $240,000. a year.

I'm curious Why you post it like there is something wrong with making money for work she loves providing a professional service to her community. Do you think it is wrong that because a woman loves their work or feels it is her calling to serve other women it excludes her from making a very good living?

ITA with OP why do you care what she makes, we all deserve to make a good living.
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#16 of 35 Old 10-08-2006, 12:56 PM
 
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btw, if the average midwife made $240K/year, wouldn't EVERYONE want to become a midwife? Forget Donald Trump and buying property! Go to midwifery school!

More thoughts after sleeping on it...

(1) After reading all the posts above me, it apears that her overhead is really low for some reason, and the fact that she doesn't have liability ins seems very strange to me. But whatever -- I'm not a midwife so I don't know how it works.

(2) Okay, let's assume that she DOES make $240K/year. Or maybe that she clears approx. $150k/year. Do you think she's just in it for the money?

(3) What's wrong with a midwife making good money? As many have mentioned, midwifery is NOT a minimum wage skill! Doctors make good money, so why shouldn't a midwife?!?!?!?!?

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#17 of 35 Old 10-08-2006, 01:25 PM
 
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Most importantly you are paying for a mw to be on call 24/7. It's a sacrifice to leave your family at unexpected times, even it's a holiday, birthday or other special occasion. She deserves what ever compensation the market will support..
very true.

by my post, I hope that none of you got the message that I do not agree with making money from doing midwifery. I think that is fine, its a wonderful way to make a living!
I just hear this same type of thing from being a nurse, when I use to do nursing. People would say they wanted to become a nurse for the money, and I would tell them, that is not why you become a nurse. It s a calling, a service. It is a bonus if you make good money from it! Same is true with midwifery. And I agree that some do take on more clients a month, Some choose not to. Both are fine. Making money from it is fine too. We should take care of our midwives.

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#18 of 35 Old 10-08-2006, 01:34 PM
 
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You're assuming that every client actually pays her bill, and that all the insurance companies pay-up after the birth. Most midwives I know are actually paid by about 2/3 of their clients, and very very few midwives do 5 births/month. Most I know do 1-3.
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#19 of 35 Old 10-08-2006, 01:48 PM
 
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My midwives do not carry liability insurance either. I don't think that this is uncommon in my state.
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#20 of 35 Old 10-08-2006, 01:59 PM
 
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$4,000 per birth is very high, and 5 clients a month is burnout level. Most midwives do not make that much. In my area the going rate is about $2,000 per birth and most midwives take 2-3 clients a month. Works out to about $60,000 a year before expenses and taxes. Possibly $40,000 after. It's enough, but not affluence by any means You also have to count on a few people not paying, and paying another midwife to back you up if you go out of town or have two births at once (and with 60 births a year this is more likely).
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#21 of 35 Old 10-08-2006, 02:04 PM
 
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Midwives in Ontario are reasonably well-paid, and get paid somewhere between a salaried family physician and a nurse. We also have to pay professional fees of about 4k/year. I would estimate that the average full-time midwife here earns about 75k (less experienced midwives with the same caseload make 55K and more experienced midwives about 90k. AMost midwives in Ontario have been practicing fewer than 5 years.

Most weeks I would estimate that I work 50-80 hours a week (not including on-call time, I am just counting actual work time), with a few 110+hrs/weeks a year, and a couple 30+ hour weeks a year. When our professional association did research into the average work of a full-time midwife vs. pay it was less than 4 bucks per hour. We got a raise, so now it is more like 5 bucks an hour, after 11 years of no raises. I am self-employed so I have expenses that are write-offs, and that helps my take home pay. I also take off 8 weeks a year vacation (unpaid) and 10 weekends a year. I look after 38-45 women a year as their main midwife, and another 40 as their second midwife. I go to about 2 births per week, and run a full-time clinic. There is a lot of non-clinical work that I do as a midwife (hospital comittees, volunteer programs, outreach, public education, business admin, and tons of paperwork and billing stuff. It adds about 10 hours a week to my clinical work mentioned above.

It was very hard to get a mortgage as a self-employed person. At 34 and 40 we just bought our first, and very modest, home. I live in a urban/semi-urban area and houses sell for 230k-400k. Everything is expensive and we watch our money very carefully.

I think that relative to other people, like those in the retail sector, I make great money. Compared to others who are primary care providers, we earn pennies. One OB I worked with pulled in over 500k a year, and had his office and admin paid for by the hospital that he worked in. he had a house in Bermuda, and lived in a mansion. I would guess that most OBs around here take home 200K+ after expenses.

In all, I have a roof over my head, can feed and clothe my kids, and eat out once in awhile. I am satisfied with that. We don't take vacations (ok, one big road trip in 10 years), purchase modest things, and need to watch our money very carefully. I feel like I earn every penny, and would feel better compensated with a higher income. I feel like my work deserves more, but when I think of people who are starving and working their tails off full-time or more, and can't feed their kids, I feel like a shcmuck for thinking I need more.

That is my perspective.
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#22 of 35 Old 10-08-2006, 02:18 PM
 
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i know that where i live midwives are charging aroudn $2600 a birth. like the others said though, they are responsible for regisration, insurance as well as their office space etc etc. i know the one midwife working at the shared care community program makes $60/hr (i just saw an ad, they are looking for a new midwife) along with benefits, which actually is not too bad.

i think midwives are underpaid like carolynnmarilynn was saying. midwives are specialists in normal birth and any other medical "specialists" get paid a whole lot more than a midwife.

but ... midwives are not valued as highly as other specialists where i live. it seems their salary really depends on where you live.

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#23 of 35 Old 10-08-2006, 11:37 PM
 
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The midwife I apprenticed with was very busy 8-12 births per month. But don't forget about all the fees that are associated which others have mentioned. Plus she usually has a student or two.

Plus continuing education, supplies, conferences, subscriptions, you want the midwife to be well-educated and up to date, right ?

I think someone else mentioned insurance for self-employed. We easily spent 10,000 on health insurance and costs for our family.

And the driving: As a midwife in this area, I travel many more miles than most people who have a "regular" commute. I might travel one hour one way, turn around come home, go 1/2 hour another way, back to the first one, back home, back to second. You get the idea. Both my husband and I put about 30-40000 miles on our cars per year (he also has a job that requires alot of driving). And many companies reimburse for mileage, wear and tear, etc.

If she is getting that many clients per month, then I would think that is a reasonable fee in her area. And considering the fact that with 5 clients per month, she is on-call 24/7, does all the prenatal/postpartum work, zillions of calls at all hours of the day/night, beepers going off constantly, inability to make any real plans or commitments, etc. then when you break it down by the hour, it isn't unreasonable at all.

Plus, one more thing, where did we get the idea that midwives should not be well paid? Or that if you want to make money and run your business like a good businesswoman that is a bad thing? I don't this for the money (right now I am making more teaching college part time) but I darn well need to be making enough to pay the bills, etc. And my husband expects me to contribute something if I am out there running around all the time.

Someday, I hope to be as successful. Maybe this midwife needs to do some conferences or articles on running a business successfully. Lots of midwives would benefit and quit burning themselves out!
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#24 of 35 Old 10-08-2006, 11:53 PM
 
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Around here homebirth midwives charge around $4,000. So if they take 5 clients a month, that's $240,000 a year! I know they have some expenses, but still, that sounds like a lot of money!
I hope you're right and that they really do make that much! That would be great.
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#25 of 35 Old 10-09-2006, 01:12 AM
 
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My MW takes 2 clients a month and her rate is 2000.00 a birth. Even though she will barter and work around what you can afford so she doesn't even get that at times. She is WELL worth that and WAY more IMO.. So she doesn't have a glamourous (sp) sallary, but this is what she loves and I'm assuming to her that is worth more then the money.

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#26 of 35 Old 10-09-2006, 01:17 AM
 
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I SHOULD be paid $200,000 a year!

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#27 of 35 Old 10-09-2006, 01:26 AM
 
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I would also imagine at least part of that $4K goes to supplies and whatnot? I mean, not that they cost THAT much but it's not as if she's taking your 4 g's and socking it all away.

I wish midwives made that much money. What's actually criminal is that my old OB was billing my insurance $250 an appointment (that lasted 15 minutes, tops). Do the math on a guy making $1000 an hour with god knows how many patients. Considering I had about 15 appointments with my midwife, most of which lasted over an hour, not even counting the birth she's coming up short.

I really don't like the implications here. If you don't feel like her services are worth what she's charging something is wrong and you should find someone else. My midwife was worth every penny and then some. If I were to have another baby I would happily pay whatever she wanted to charge.

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#28 of 35 Old 10-09-2006, 01:29 AM
 
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I SHOULD be paid $200,000 a year!

Bah, you're only a $150k midwife, tops. :




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#29 of 35 Old 10-09-2006, 01:39 AM - Thread Starter
 
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Would everyone stop getting so hot and bothered about the "implications"?! I was just really surprised, because that seems like a lot of money to ME, and it is more than I would expect. I wish ALL midwives made $1,000,000+, then we'd have lot more midwives and fewer OB's.
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#30 of 35 Old 10-09-2006, 11:00 AM
 
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I was shocked when I found out that while the midwife might *charge* $4000, the insurance company decides what is a reasonable fee and pays her accordingly.

For a state health care policy, I think this ends up being about $1000 per birth + minimal exam fees.
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