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.
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?