Friday, December 18, 2009

For Love or Money

I've been formulating this post in my mind for quite a while now. I feel torn in two different directions when it comes to The Business of Being a Midwife.

On the one hand, this is a ministry for me; to serve couples/families, to show them the love that is within me, to protect their space and experience, to help them bring, as safely as possible, their new little babies into this world.

On the other hand, I can't do midwifery (or even doula) work for free. There is a cost to me, and I do have valuable skills that are worth getting paid for.

There are many midwives who have mentored me and many midwives I look up to very much. Some of them say, "This is a ministry: payment is secondary to service." The other side says, "This may be a ministry, but the worker is worthy of his wage and you need to get paid, and get paid what you are worth. Don't undersell yourself."

Now, as for how I FEEL about it, well, I love this calling so much that I would just about pay people to let me do this for them. But I have seven children, and one on the way. With what Preacherman makes from his weekly job, if I have about 6 births next year (since I'm taking 6 months off, this is optimistic) and what Preacherman gets paid for preaching (a small stipend that is considered housing allowance) our preaching and midwifery income combined will just cover what we pay in taxes and health insurance/medical costs for the year. And his gross income is low enough to qualify for WIC.

A lot of clients have no understanding whatsoever what it costs to be a midwife. They do the math in their head and think, "Wow, 2-3 grand for a birth x how many births per year, MAN, she's ROLLING in the dough." LAUGH OUT LOUD.

A few of the expenses: Professional licenses, conferences, journals, and continuing education; cell phone and internet; gas, insurance, maintenance on a vehicle (and usually payments as well); books and videos both for reference and lending; clothing; childcare; taxes; office supplies, copies, paper; purchasing and maintaining equipment and supplies. This does not even include the TIME spent concentrating on someone else's family during prenatals (an hour each, average), births (can be any length of time!) and postpartums. Obviously, the more clients you have, the less you end up spending per client. When you have a brand new practice, like I do, the cost per client can be very, very high. This past year, I had to get my CPM which is an expensive process. I ended up spending about $1400 per client this past year.

Recently, I changed my financial policy to be more "stringent". I offer a large discount for early payment in cash, and the fee gets higher the longer they take to pay. I offer to take trades and barters, and work with people to help them afford a homebirth. It's hard for many families with insurance to decide to pay out of pocket for something covered completely by their insurance plans.

Doctors have office staff that deal with the money. People are accustomed to paying doctors, and have no problem with the expectation of paying their out of pocket expenses before their birth. But with midwives.... we have to sit face to face and remind them of their financial obligations. This is uncomfortable and something most midwives hate to do.

Sometimes Christians get the idea that it is shameful to make money -- especially enough money to pay for more than the basics of life. But that is not what the Bible tells us. It is NOT "Money is the root of all evil," it is "the LOVE of money is the root of all evil." There is nothing sinful in a midwife getting paid what her skills are worth and even having nice things for her family to show for it. While I don't personally know any midwives getting rich off midwifery, there would be nothing at all wrong with it if there were. And it wouldn't be an excuse not to pay her what she is worth for the skills and services she has to offer.

People will pay for what they value. I have seen families with next to NOTHING pay me my full fee with no complaints and well before their home visit. Other clients with homes that look like they're from a magazine, designer clothes on all their kids, big screen tvs, etc., and they constantly tell me money is too tight to pay me on time. It is priorities.

What is all the rambling trying to say? I guess to all the clients out there who have hired midwives, understand they have families to support, expenses to cover, and skills that are extremely valuable. If you think your midwife is getting rich doing midwifery, 99% of the time, you are very wrong, and good on her if she is. Pay your midwife and pay her what she asks and on time. Don't make her ask for money every time. Value the service she provides, because she probably loves what she does with such passion, and believes every family deserves a midwife regardless of their ability to pay. Sell some things. Ask family for money. Use a credit card if you have to (most credit cards send "checks" with low interest rates that can be paid out to anyone). Eat in for a while. Put off that vacation. See if you have skills for barter or items for trade. If you really, truly can't afford it, discuss with her to find a payment option that will work for both of you. Make a good faith effort to value a healthy birth.


Kathy said...

You are so right that it's all about priorities!! I tend to be frugal anyway (which is a good thing, considering my husband's income and some of the things he considers "necessary" [fortunately, mostly small things like high-speed cable internet, but still...]), so hearing people who have a much higher annual income and lots of nice toys and gadgets complain about "not having any money" sets me off anyway. I can only imagine what it must be like to see opulent "broke" people who can't afford to pay your fee, but *can* afford meaningless toys.

Anyway, we've managed to pay our midwives in full both times, prior to the home visit, just like we had agreed on at the first prenatal. That's just common courtesy, honesty, and fulfilling one's agreed-upon obligations.

There is a book that you might like, called "Thou Shalt Prosper", which discusses at least in part the reality that when you make money on a good or service you provide, that you are not harming anyone or taking money from them, but are actually benefiting them -- so you shouldn't feel guilty about charging money nor about making money and actually prospering.

Laura Hopper, Midwife said...
This comment has been removed by the author.
Mrs. Spit said...

You are much too nice.

The bottom line is this. If midwifery care is important to you, and an "essential" for your birth, like it was for mine, don't have a baby until you can afford to pay for a midwife.

Or, if you can't, go with a doctor, educate yourself, and be your own advocate.

I don't qualify for midwifery care any more, but I so adore my midwife.

One Hot Mama said...

Laura, my intention, since I'm due in April, was to take off from Feb 1 to July 1 (5 months). I didn't get any calls for December or January, but I did get calls from two very dear repeats due within days of each other at the end of June. I took them. They understand I'll be bringing the baby and my older daughter to help with him.

I will also be taking off 5-6 weeks in the summer to go to my niece's wedding out of state. (Need to have due zone clearance)

Laura Hopper, Midwife said...

Sounds like a great plan. My first two calls were from repeaters as well and I couldn't turn them down either.
I was thinking I would want to work closer to my EDD, but now that I am 29 weeks, I am looking forward to being done with birth stuff until after the baby is here.

Kate said...

Priorities is exactly right. My sister-in-law used to have people comment all the time on how "lucky" she was to be able to afford to stay home with her young sons. Luck had nothing to do with it. They decided that her staying home was a priority and did what they needed to do to make it happen which included no expensive vacations (they just took their honeymoon this fall after 12 years of marriage), used cars, and her caring for two other children.

tie-dyed doula said...

I agree with this post, love it! I adore my midwife. She was worth every penny. She did not make it to my birth (but came shortly after) due to a speedy birth and some people commented that "now you don't have to pay her, as she wasn't even there" WRONG!! She was paid in full before my birth and I never even considered that incorrect. She was ON CALL for weeks, available(!) day and night for questions and spent months with me preparing me for a home birth. She was indeed entitled to every cent she was paid and so much more. Shine on!