Independent CNM practice?

Are there any independently practicing CNM's out there? Is it hard to start up your own practice?

[girlmama, MSN, RN, CNM]

I know of one in central Indiana. But mostly just want to follow this topic. :)

I imagine it varies by state.

[DreamerMW]

I know one in Brooklyn, NY. She is extremely popular and her practice is exploding. There are also 2 or 3 midwife groups in my area. Sorry I can't be of more specific help.

[lavenderskies, BSN]

My PCP in Alaska was a CNM in private practice.

[klone, MSN, RN]

In Denver, I only know of one CNM who has a solo private practice. She attends homebirths. As the only CNM in the area who does homebirth (as opposed to CPMs or DEMs) she's quite busy, but is ALWAYS on call.

I imagine having a solo practice is quite difficult, particularly if you have two women in labor at the same time. I think I would much rather be a part of a practice of at least three or four midwives.

[GenSurgRNFA, BSN]

Thats what i would like to do, attend homebirths. And if its expensive to start up as a homebirth CNM. How many patients would i need to break even on costs and profit etc.

[AspiringNurseMW]

Thats what i would like to do, attend homebirths. And if its expensive to start up as a homebirth CNM. How many patients would i need to break even on costs and profit etc.

I assist with billing for some homebirth midwives in NY/NYC. That is going to depend on going rate and your cost of living.

For the most part, most solo midwife practices take on average 4 clients a month. Sometimes I think depending on how early clients register they will actually book 5 or 6 because you will have transfers and abortions so it ends up even-ing out for them.

Also depends on whether you want to carry malpractice insurance. Most don't, except for the one or 2 that have hospital privileges.

[AspiringNurseMW]

I don't think I'd ever go into solo practice because I have a family. I would at the minimum have a partnership, but would prefer a triad.

[cayenne06, MSN, CNM]

I know a ton of former home birth midwives who were quickly burnt out by the neverending call. Being *on* 24/7 is haaaard, even with only a few births a months. It takes a toll on you. I was much happier when I was working at a busy hospital practice, doing 2-3 births in a 24 hour shift and doing 3-4 days a week in the clinic, than when I was doing maybe 4 births a months and one day of clinic as a home birth midwife. The thing about home birth midwifery is that you are doing pretty much everything from vital signs to managing a hemorrhage, to labor sitting a prodroming primip, to post birth laundry. There is so much less ancillary support in the home setting, and those 24 hour births can get rough around 4am, when you know you have multiple postpartum home visits to do that day that you cannot reschedule, and you have to sterilize your instruments and repack your birth bags before you go home, and your 39wk multip has been on the verge of labor for days.

I get stressed out just remembering the feeling of juggling that lifestyle with two tiny kids at home.

Anyway. I do know more than a few midwives (and OBs!) who have happily maintained busy solo practices for 10-20 years. I shudder at the thought, but it definitely works for some people. I adore midwifery, don't get me wrong. But I want to have a few beers and play board games with my friends, and I want to go on vacation without the angst of worrying that my patients will have to deal with a midwife they have never met before. And I want to turn my phone off, and snuggle into my covers knowing someone else is giving my patients as much love and care as I will give, when it's my turn to cover the beeper again :)

Of course, I don't even take call anymore so who am I to comment lol.

[AspiringNurseMW]

I know a ton of former home birth midwives who were quickly burnt out by the neverending call. Being *on* 24/7 is haaaard, even with only a few births a months. It takes a toll on you. I was much happier when I was working at a busy hospital practice, doing 2-3 births in a 24 hour shift and doing 3-4 days a week in the clinic, than when I was doing maybe 4 births a months and one day of clinic as a home birth midwife. The thing about home birth midwifery is that you are doing pretty much everything from vital signs to managing a hemorrhage, to labor sitting a prodroming primip, to post birth laundry. There is so much less ancillary support in the home setting, and those 24 hour births can get rough around 4am, when you know you have multiple postpartum home visits to do that day that you cannot reschedule, and you have to sterilize your instruments and repack your birth bags before you go home, and your 39wk multip has been on the verge of labor for days.

I get stressed out just remembering the feeling of juggling that lifestyle with two tiny kids at home.

Anyway. I do know more than a few midwives (and OBs!) who have happily maintained busy solo practices for 10-20 years. I shudder at the thought, but it definitely works for some people. I adore midwifery, don't get me wrong. But I want to have a few beers and play board games with my friends, and I want to go on vacation without the angst of worrying that my patients will have to deal with a midwife they have never met before. And I want to turn my phone off, and snuggle into my covers knowing someone else is giving my patients as much love and care as I will give, when it's my turn to cover the beeper again :)

Of course, I don't even take call anymore so who am I to comment lol.

That's probably why many/most of the solo homebirth midwives I know have birth assistants!

[cayenne06, MSN, CNM]

That's probably why many/most of the solo homebirth midwives I know have birth assistants!

OMG, hopefully all the homebirth midwives you know have an assistant! I can't imagine attending a birth alone, mostly to have enough hands for two patients in case of emergency, and also because of the need to sometimes catch a nap and to have help with all the busy work that comes after a delivery.

[AspiringNurseMW]

OMG, hopefully all the homebirth midwives you know have an assistant! I can't imagine attending a birth alone, mostly to have enough hands for two patients in case of emergency, and also because of the need to sometimes catch a nap and to have help with all the busy work that comes after a delivery.

Huh. My midwife came to my homebirth alone. They were a partnership but they went on call individually which eachother as backup . Never discussed a birth assistant during prenatals. But I know *now* they have one.