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Sunday
Mar142010

Why Midwives Ask for Payment

A comment thread in another blog post included a woman bemoaning the fact that she couldn't find a midwife to work for free, that she was dirt poor broke and had to make the choice to birth in the hospital on Medi-Cal (she didn't mention the UC option). She says women need to have more options for midwifery care, for midwives to travel to those who need help and more ways to get what they need.

Every once in awhile, it's important to mention why midwives need money for their services.

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As a midwife, I feel compelled to defend our need for payment. Doctors, the utility company, the grocery store and the insurance companies do not accept deferred or dismissed charges if we can’t afford them. If women don’t pay a midwife, we can’t pay our bills. Many midwives live hand to mouth, just as the women who utilize them do.

We’ve tried to be allowed to take MediCal (Medicaid) for a decade, but our government here in CA deems a CPM not qualified to do so unless we have a doctor to sign off on our charts -and the doctors’ insurance company will cancel their insurance if they sign off on our charts.

I have traveled as a midwife, but charge more for traveling costs plus living there during the end of pregnancy and the first week postpartum. In my case, I am almost double the cost of a local birth, so asking a midwife to come to you from afar for free would require the midwife to be independently wealthy to fund her faraway birth. By taking the distant client, she also closes off her opportunities to make money by clearing her local calendar which, in a typical midwife’s practice, would be 4-6 clients a month.

I had my daughter UC 25 years ago because I couldn’t find a midwife to take me for no money and late in my pregnancy. It sucked and, having a serious complication, she could have died if EMS hadn’t gotten there quickly to help. I was indignant that midwives, who I’d previously thought were in a noble (read: giving all of themselves) profession yet could turn away someone in need. Once I started doing birth work myself, I realized childcare costs money, gas costs money, eating at the hospital costs money… and then, as a midwife… sutures, oxygen, instruments, on-going education, NRP re-training, CPR re-training and even our bi-annual license renewal costs money. It can be flippin’ expensive to be a midwife.

It is worth the personal cost. I am not whining. I am illuminating. I barter my care, I take payment plans, I take credit cards, I discount my care, but as I get older, I get braver to expect money for my extensive education and life-saving skills.

Our culture runs on money; shouldn’t my business, too?

Reader Comments (14)

Hear, hear! As much as I would love to find a free midwife (hey, who doesn't enjoy finding good stuff for free??), that's just not the way life works. I'd also like to have a live-in chef and housekeeper and a chauffeur and free tickets to any zoo, museum, movie theater, or other entertainment/attraction in the country, but that ain't happening either.

March 14, 2010 | Unregistered CommenterKathy

AMEN and AMEN, again, Barb!! See my blog on the same topic!
<http://insidethemidwifesbag.blogspot.com/2009/11/frustration-you-get-what-you-pay-for.html>

March 14, 2010 | Unregistered CommenterKim Mosny, CPM, LM [VA]

Yes, and (even as a doula before becoming a midwife) I realized that it was unfair to give to others at a cost to my own family. If I don't make money doing birth work, I have to do other work, and thus spread myself all the more thin. So, I don't work for free at all anymore--not even to my friends and family. I'm worth it, though. ;)

March 14, 2010 | Unregistered CommenterGina

BTDT and I would never expect a mw to work for free. Its not the mws fault I was broke. She should not be expected to suffer the same as I just because of her profession. This isn't volunteer work.

March 14, 2010 | Unregistered CommenterMichelle

Hear, hear! I agree completely.

March 14, 2010 | Unregistered CommenterDiana J.

it felt very good to pay my midwife- i only wish i could have given her more. ;)

March 14, 2010 | Unregistered Commentertori

Understood...although I wish in my perect world Medi-cal and insurance companies would pay for midwives. In our current system, I expect that few folks outside the middle/upper classes hire a midwife...it's just too hard for the poor to save a midwives fee...but then again, it's not easy for the middle class either.

March 15, 2010 | Unregistered CommenterJill H.

I once had a young lady come into my office for her first exam. She told me right away she could not afford to pay me and asked if I would deliver her baby anyway. During her exam, I asked her about herself. She stated she just got her degree in management and had not found a job yet.
After the exam I asked her if she would like to come manage my office. I went on to tell her the hours and the work that needed to be done. She asked what the salary would be... I told her I would like her to just work for FREE.
She was totally disgusted that I would ask such a thing and went on to tell me, in great detail, how much work she put into her classes to get her degree. She even worked along side a manager for 4 months to gain experience.
Once she finished I explained that I would never de-value the hard work she poured into obtaining her degree and gaining experience in her field... I told her I would never bring up her working for free ever again, if she promised to hold my education and 17 years experience, as a midwife, in the same reguard....

She had a beautiful baby girl and ended up paying me $200 more for my service than my fee... She said never again will she view the profession of others with less than the respect it deserves.

March 17, 2010 | Unregistered CommenterDarlene

As a doula and midwife assistant, I absolutely agree. And just for reference: I had a client give birth at a local hospital. Long labor, but completely natural -- nothing extra, not even an IV until the last 15 minutes (read "no extra charges"). She had decent insurance, but her 20% co-pay for L&D *only* was *still* MORE than area midwives charge for the complete package (prenatals, birth and postpartum).

I have to say, too, that I haven't had good experiences, for the most part, with births I've attended for free or for a drastically reduced rate. In one case, I only charged about 1/4 of my usual fee and bartered 75% of it . . . and I never saw that last 25%. Granted, it wasn't all that much money (> $50), but at the time, it was my grocery budget for a week.
I have had some great mamas who were so planful and consistent in paying me, and I deeply appreciate them, but sadly, they were the exception.

March 17, 2010 | Unregistered CommenterProbirthassist

The midwifery care is received from my home birth midwife was the best value I have ever received for the money in health care or any other realm. It was an honor and a privilege to pay. The sensitive, intuitive, non-interventive care she provided and the lessons learned from her and my perfect birth continue to inform my parenting and my life. It is absurd to expect midwives to work for free. Sliding scale is nice. But midwifery care is valuable and deserves compensation, not only because they need to provide for themselves and their families but also because their work is inherently valuable. People often don't value what they can get for free.

March 20, 2010 | Unregistered Commenterawakeman

You get what you pay for, whether you pay out-of-pocket or acquire decent insurance, and whether you're dealing with a midwife or a hospital. Someone enlightened enough to seek out midwives should also be enlightened enough to seek out a job that can afford them the out-of-pocket or insurance coverage if it's important enough to them. That's the only planning one can really count on in pregnancy/childbirth anyway!

March 30, 2010 | Unregistered CommenterCathy

:) I cannot believe that midwives charge as little as they do! If you're paying out of pocket, you get soooo much more than you would at a hospital. I would LOVE if medicaid would pay for homebirth (how many women do I know that could have had the birth they wanted if this was so?!)...we'll just have to keep pushing for this :)

April 2, 2010 | Unregistered CommenterNicolette

When I had my last baby I desperately wanted an out-of-hospital birth. I found a homebirth midwife who I loved, but paying her fee would have been extremely difficult for my family. She asked me what her services were worth to me, with the implication that she would consider reducing her fee for me, but I couldn't do it. The honest answer was that her services would have been worth the world to me, absolutely worth every cent she charged- but, just as her fees were critical to her family, that money was critical to mine. I had nothing to barter, no real option to make it happen, so I went back to the hospital. It was an incredibly difficult and overwhelmingly emotional decision.

I wasn't lacking in enlightenment! And I absolutely *hated* it when the people I turned to for support and advice suggested that because I wasn't willing to sacrifice my own family's financial well-being, I essentially *deserved* a poor hospital birth. "You want a $500 {my copay} hospital birth, you get what you pay for" was the most common response. I get that, I really do, but the fact remains that for a huge number of women, paying $3-4,000 out of pocket is NOT an option. Suggesting we are not enlightened or we aren't making our births a priority- or, worse, that we shouldn't even have babies until we can get a job and pay for the birth we want- is just as insulting as expecting a midwife to work for free.

I don't think there is an easy solution to this. Advocating midwifery and homebirth is huge, but so is advocating change in the insurance industry so that more women have more options for delivery.

April 11, 2010 | Unregistered CommenterPam C.

I think that for us, being very low income and hiring a midwife was THE ONLY option. I absolutely did not want to have my baby in the hospital. My husband worked 2 extra jobs for a few months to make sure we had the payments on time (about 500.00 a month for 5 months). I am so grateful for his sacrifice and his hard work. Now we have these amazing memories of the most beautiful birth!
It breaks my heart when a client really wants a homebirth and she works and her husband works, but he is *not* willing to get a second job for a few months to make it happen for her. I used to think that anyone could have a homebirth- "yea, just get a second job!"Um yea the reality is I know my husband is one of a kind.

May 10, 2010 | Unregistered Commenterchandra

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