Out of hospital Midwife?

CNMidwife2Be · Aug 24, 2015

I personally know about 8 home birth CNMs and I worked as one of their assistants for a little.

Laceyrochelle26 · Aug 24, 2015

I was hoping some of them were on here so I could pick their brain :-)

**LibraSunCNM, BSN, MSN, CNM** · Aug 24, 2015

I don't think we have any regular posters who are OOH CNMs, but maybe some will pop up.

I did my integration in homebirth so I know a bit about it (specifically in the NYC area). Don't know if that would be helpful for you?

Laceyrochelle26 · Aug 25, 2015

I'm just curious what a typical day is like for them.... how many patients they normally take at a time for a solo practice. I have an 18 month old daughter and we are planning on having more children. I am interested in midwifery and the whole natural birth/extended breastfeeding.. "crunchy" community ;-).... I am just really torn about whether I should pursue it now or go back for a post masters later once my daughter (and other children we will have) are older. Money isn't everything... but I am curious at just what a single person would expect to make with 3-4 home births... I know the home birth midwives in my area usually charge between 5,000-6,000. I don't know what other expenses you would have if you don't have a brick and mortar clinic

**LibraSunCNM, BSN, MSN, CNM** · Aug 25, 2015

Well, for starters, I don't think you should even THINK about the possibility of going into solo practice in an OOH setting as a new grad. It's simply not safe. You need at least a few years of experience working in a group practice, OOH or hospital, before you can consider going out on your own. I myself hope to work in a birth center or homebirth someday, but I have 2 years experience and I don't even feel remotely close to being ready for that step, although everyone is different. You will need to know how to manage emergencies like postpartum hemorrhage, shoulder dystocia, a newborn that needs resuscitation, by yourself.

That being said, if you're asking about the possibility of solo practice AFTER you've become proficient, I would say you can make a decent living doing 3-4 births per month, but most of the homebirth midwives I know do closer to 5-7/month to make really good money. The midwife I worked with for integration usually saw about 4 patients/day for prenatal visits (she did those 4 days/week) and visits were about an hour, plus the enormous amount of time spent in the car traveling to patients in all 5 boroughs. She is obviously also on call 24/7 for births. Other expenses include supplies (chux, IV fluids and tubing, butterflies, blood tubes, UA dipsticks, etc.), the cost to pay a birth assistant (she paid her $500/birth I believe), a lot of gas, a lot of tolls, and malpractice insurance, which ran her about $40,000/year. Some midwives do not buy malpractice insurance, save that money and instead accept the risk of liability.

Hope that helps. I would encourage you to speak to midwives in your area and generally do a lot of research before you take the plunge into midwifery.

queenanneslace, ADN, MSN, APRN, CNM · Aug 25, 2015

I'm just curious what a typical day is like for them.... how many patients they normally take at a time for a solo practice. I have an 18 month old daughter and we are planning on having more children. I am interested in midwifery and the whole natural birth/extended breastfeeding.. "crunchy" community ;-).... I am just really torn about whether I should pursue it now or go back for a post masters later once my daughter (and other children we will have) are older. Money isn't everything... but I am curious at just what a single person would expect to make with 3-4 home births... I know the home birth midwives in my area usually charge between 5,000-6,000. I don't know what other expenses you would have if you don't have a brick and mortar clinic

Before I became an RN I worked in an OOH midwifery practices with CPMs.

Typically - we were on call 24/7/365. Radius for attending home births was 30 miles- but that always seemed to get stretched to 60-70-80-90 miles.

The practice had anywhere from 3-8 births per month.

The midwives said it was harder to have fewer births per month, because she was always on call, but not very busy - 1-3 births a month was exhausting, just from being ready and available All. The. Time.

It seemed like there wasn't enough clients for 2 midwives (a partnership) until the practice was averaging 10 or more births per month. Building a practice took a lot of work and a lot of on call time.

If we had a birth at 4 am, we would do all the postpartum care, then return to the clinic at 8-9am and do prenatal and postpartum visits. Sometimes I left for births and didn't return for 2 days. Because we'd have appointments to do, and then 24 hour postpartum visits, and someone else would go into labor.

I came to the point when I realized whatever I was going to get paid to be a homebirth midwife, on call 24/7/365, was not going to be enough for the sacrifices I would make in my personal and family life. I would not go back to OOH birth without some solid and functional professional partnerships. Now that I have children - I can't imagine having 24/7/365 childcare arranged for them. Too stressful.

Starting a business is a job in of itself - and many homebirth midwives do this - but, really, to have a viable business that supports you financially (and is not just a hobby) requires a full-time business manager and financial planner. Many midwives, when opening their freestanding birth center and/or starting a midwifery practice - are not only acting as full time midwife, but full time business manager. Which is, IMO, insane.

But people do it.

Do you have experience working in a homebirth or birth center practice? That might be a good place to start. Get an idea of what it's like.

AspiringNurseMW · Aug 25, 2015

Its a lot. I wouldnt consider going into solo HB practice until my kids are grown/able to care for themselves/eachother when I have to go on call. Even then, I would prefer a partnership or even a group to split the call.

I do billing for quite a few NY HB midwives, and they average about 4-6 clients a month, the partnerships do anywhere from 8-10. The majority do NOT have malpractice insurance.

I am only just starting nursing school but my plan is to continue on the MW school and work at a practice or hospital while I build connections and slowly start building my business. My absolute dream would be to open up a freestanding birth center in my area (who knows maybe plant seeds while working to encourage/engage in a formal transfer protocol with the hospital with admitting privileges).

In my state, PA, CNM's need a practice agreement with an MD, and that I know will be next to impossible to find for homebirth, so I also plan to work on that while practicing in a hospital setting.

Laceyrochelle26 · Aug 25, 2015

Thank for all the responses :-)

Yes being on my own right out of graduate school would make me nervous... the few midwives I've spoken with said that you would transfer a lot of patients in the beginning just because you aren't as comfortable... even then. I would prefer to have another midwife with me. So the thought of being on my own jus isn't comforting. There is only one hospital that is currently utilizing midwives but they are still more like a normal practitioner because it is a very large metro hospital. Not the naturalistic environment I desire but it would give lots of experience anyway.... but not as much as the monitoring without all the equipment, IV, protocol etc that comes with a hospital.

I have been questioning this.... glad some of you with experience address it... seems hard to do this with little ones when I am hoping to still get to work "part time" after... m maybe it would be better to do this once my babe (and potential other babes) are a little older.

I know a midwife who only delivers for the Amish and mennonite community about 20 miles from where I live and she said she wants a partner. I have been on call for her off and on as a labor nurse. I think she prefers that community just because they tend to be very healthy, hardworking etc.... and it seems as the legal/logistical stuff that our normal medication/insured community has isn't as much with them? I haven't talked with her extensively about that part she just has made a few comments about working with that community because of some of those things.