The beginning of October found us celebrating “National Midwifery Week”, and the posts on social media about midwives and the personal care that they provide to so many moms and families got me thinking about the investment that midwifery care requires, on the part of both midwives and clients. Of course, one of the biggest investments that clients make is the cost involved. Sadly, many insurance companies are not willing to cover the costs of midwifery care, especially when it comes to delivering at home. This means that families have to weigh the costs, and determine if they can afford care out-of-pocket.

Oftentimes, it is easy to see the price tag (midwives are good at giving you all the costs up front, so you know what you are paying for at the beginning!), and think that a midwife must be making pretty good money.  But I wonder, have you ever stopped to think about all the “hidden costs” that are involved with midwifery? It’s easy to think that the only time the midwife is investing is the time you are with her…your appointments, your birth (and maybe you’re one that has quick births, so it doesn’t seem like THAT much time!), and a handful of home and postpartum visits. In communication with other midwives, I have realized that many clients don’t realize all the “behind the scenes” time and costs that a midwife incurs in order to offer safe, up-to-date, competent  & individualized care to each of the families she serves. So here’s an attempt to help you realize how much you are actually receiving in return when you choose to invest in midwifery care:

• TIME: and not just the time you see her for your appointments and birth. On average, I spend about a minimum of 20-24 hours total with a client in-person (8-10 prenatal visits, 3-4 postpartum visits, and the birth…and of course, this amount of hours can be much more than this depending upon many factors!). However, there
  

  After-birth paperwork

  are many hours spent on each client that you don’t see: writing notes about your history and ongoing care, filing paperwork for records, birth certificates, & tests, research when clients have questions or develop issues, answering questions via email, text & phone, submitting reports when required, attending state-required conferences, creating handouts with updated information, and the list goes on…

• ONGOING TRAINING: if you stop and think about it, you don’t want to trust your life and the life of your baby to someone who practiced something 10 years ago, but has never reviewed her training OR has not continued learning, right?? But ongoing training takes time & money, especially when it oftentimes requires traveling for classes. Maintaining current CPR, Neonatal Resuscitation Certification and accumulating the needed CEU’s to keep your NARM certification current, CPM re-certification fees, and regular peer reviews are all ongoing commitments and costs that a midwife must stay on top of.
• COLLABORATING CARE & NETWORKING: When a client develops a complication the requires more medical intervention, it can take a number of hours to locate medical professionals willing to see them, copy and fax records, contact the proper offices, and obtain referrals.
• COMMUNITY RELATIONSHIPS: Another aspect of good midwifery care that is oftentimes overlooked is that of having good relationships with the local midwifery community. In order to have back-up arrangements (both for planned trips AND for unpredictable emergencies, which will occur at some point in a midwife’s career), a midwife MUST have a solid relationship with other midwives, and facilitating these relationships doesn’t just happen. Another aspect of community relationships is the side of the local medical community. To facilitate good transports when needed, a midwife needs to have a good relationship with local care providers.
  

  Grateful to have good relationships with my back-up and colleague, Rose Marie!

  This translates into taking the time for peer reviews, staff meetings, staying up to date on local situations and politics, taking the time take thank you gifts and notes personally when services are received, and so much more. Having a positive relationship with local hospitals and doctors translates into better, quality care for clients, so it is a very worthwhile investment of the midwife’s time and energy.

• OFFICE FEES: These costs are more obvious, but real nonetheless. You want to be able to reach your midwife anytime, ASAP, right? So she must maintain cellphone service and a working phone. Then there is the fax service that most medical offices require for sending/receiving medical records. Internet for research, copier for providing records for other medical providers & clients, ability to print forms, handouts, etc. I might also add that most midwives are doing all of their own office work, too, so time to order supplies, keep track of bills, payments, answer inquiries and all the paperwork that is required to run a business has to happen at some point!
• EQUIPMENT & SUPPLIES: quality equipment must be purchased and maintained in order to provide excellent, safe care. Dopplers, birth stools, testing machines, ability to sterilize instruments, repair of equipment when needed…all of these go into maintaining a midwife’s supplies.
  

  Birth supplies ready during a labor

  Medications also need to be purchased in order to always have them on hand (even if you don’t use them frequently, you want your midwife to have them-and many of these items are not cheap!). Keeping emergency supplies to deal with the unexpected is also a real cost, as these things need to be keep up-to-date, which mean some items need to be purchased regularly, whether they are consumed or not.

• RELIABLE TRANSPORTATION: You want your midwife to be able to get to you anytime…which means she needs a reliable vehicle in working order. Just last month we replaced all the tires on our vehicles, as my husband felt they were getting too thin to count on them during the winter weather. We also pay more to run an AWD vehicle as we have lots of snow & ice in PA. A midwife always needs to keep her gas tank full, and regular maintenance is a must.
  

  A flat tire meant new tires for the vehicle had to be purchased ASAP!

  Oftentimes a midwife will routinely drive a separate vehicle to events in order to be able to leave at a moment’s notice, instead of driving with friends or family. This is additional expense she must pay for!

• HOME & FAMILY COSTS: Another aspect of midwifery life, especially if your midwife has a family, is that of having reliable and available babysitting at a moment’s notice. Meals that can be prepared quickly, or household help during times when mom has missed lots of sleep attending births are also very real costs. A family certainly must work together in order to let mama help other families, and I am blessed to have this type of support from my husband and family. But we do pay for it-bringing in food/eating out at times and getting regular cleaning help are two ways our family has made midwifery life sustainable.
• ON CALL STRAIN: The last item I will mention on this post is the physical, emotional and mental strain of being on-call. While most midwives stay in this field because they genuinely love serving families as they bring their babies into the world, there is the very real downside of always being on-call. If a midwife has a small, independent practice, this generally means that she is the one who always answers the phone unless she has arranged back-up. No matter how much you love what you do, there is a toll that it takes on your body to always be available. You honestly never know when the phone will ring, and you will need to totally re-arrange your plans and be ready for whatever is at hand, day or night. Most midwives’ friends get used to all plans being made with the contingency of “unless I’m at a birth”, but the honest fact is that sometimes it’s not a birth. Sometimes a client has an emergency right when you’re in the middle of a much-anticipated event, or right as you closed your eyes after being up for 40 hours, or…you name it! I’m not sure how one can put a price tag on this aspect, but it’s well worth whatever your midwife charges!

My hope is that this post can encourage families that they are making a wise investment when they utilize midwifery services, and perhaps give you a greater appreciation for all your midwife is doing to ensure that you receive quality, informative, excellent care. I’d love to hear your thoughts as you’ve read through this. If you’re a midwife, what would you add to this list (I know I haven’t covered everything!)? If you are a client who has benefited from midwifery care, what would you add or comment? Did any of these factors surprise you? Thanks for sharing your comments!