Am I Paying for Two Midwives?
Recently a doula contacted me to sweetly let me know that my pricing is nearly twice what another midwife in their area charges. She is excited for me to serve her area and was offering ideas to cut my costs so her clients could afford my pricing. One idea was to work without my partner so I wouldn’t have to charge as much.
It was shocking-not because the doula said anything wrong but because I had no idea that it appeared to anyone that having a team with two midwives doubled the price. In reality, Nichole and I make half the profit because (once she’s licensed) the profit is divided between us. Pricing for a birth with our team is consistent with solo midwives’ pricing in our area.
So there are several things to unpack here. Let’s start with pricing in general.
In the North Texas area, the normal rate for care by a home birth midwife is around $5500-6500 and maybe even higher. As of this writing (which is subject to change), my pricing is $5800 for local families and $6200 for families outside of our area. The extra covers the expense of driving to the home visit, birth, any false alarms, and the postpartum home visit. Sometimes we may need to rent a hotel room and pay for more meals out than usual if a labor goes long.
The main expenses of a practice include rent for office space, electronic medical record software, website, fax, advertising, maintenance of licensure that includes mandatory CEUs and additional certifications (so many additional certifications!), medications that, according to federal law, have to be bought in bulk, medical supplies, trainings, and payment to birth assistants.
In the DFW area, birth assistants are usually plentiful and a midwife has a pool of midwives to choose from for any given birth. The rate for a midwife to assist is $500 and a non-midwife $300-$400.
In our rural area, there is literally no pool of assistants. Instead of using a pool, I have a select few RNs I’ve oriented to my practice and, if I’m lucky, one other midwife at a higher rate than that since they are asked to be on call for five weeks. Now that Nichole has joined, we will pay an RN $500 to be on call and attend our births.
When you hire a midwife, you are hiring a guide for your pregnancy and birth. As a guide, I am available 24/7. I can’t let my phone die in case a client needs me. I have to plan vacations 9 months in advance. When retreats or events come up with only a few months notice, midwives often can’t attend. We take two cars to events with our families or friends in case we need to bail and tend to a mom in labor. We fret about snowstorms, power outages, and flat tires. We often have contingency plans for our contingency plans. A midwife friend told me to set my pricing at what would allow me to get out of bed at 2am in frigid weather without grumbling. I’d say that is key, along with all the other things listed here.
It’s every midwife’s own business what she sets her prices at, but most of us aren’t getting out of bed at 2am, carrying the mental and financial load I just detailed, missing birthdays, wondering if the phone will ring while we’re having sex…for a few thousand dollars.
So now that you get the gist of midwifery pricing in general, let’s talk about Providence specifically. Our team is somewhat uniquely formulated to avoid two things: A midwife having to attend a birth alone (with no second midwife or very well trained assistant) and burnout.
Some midwives practice with only one assistant. Most of the time, in DFW, that assistant is another midwife from the pool I mentioned above. However, as midwives are (finally) learning about being sustainable, they’re saying “no” to assist jobs. Therefore some DFW midwives are pairing up with other midwives to be dedicated assistants for each other or they’re training lay-women to fill the role.
I prefer two midwives at every birth plus a well trained assistant. Most of the time we won’t have an emergency, which is when we need a team of three. But it does help avoid burn out as obviously the work shared between three women is much less than the work shared by two-especially in a long birth.
When an emergency does arise, I absolutely want three sets of hands. You can read the post about my first private practice birth to see exactly why I feel that way. But it wasn’t that birth that made me design a team of three. I was taught that by a midwife way back when I was a new doula. There was a student midwife in our town whose preceptor confided in me that the student was dangerous and liked to call the preceptor late to births so she could catch the babies alone. Later she would become a midwife who some might say is dangerous and she regularly practiced without a skilled person assisting. One birth I attended (as a doula) had a teenager as the assistant. Later she secured a dedicated assistant but when I asked if she was CPR and NRP (neonatal resuscitation program) certified, she said she’d have to ask her. These certifications are the most basic preparation to assist in a birth. The wise midwife who confided in me instilled in me the importance of two midwives at every birth and I’ve adhered to it as a standard to follow ever since. When you have a mom hemorrhaging and a baby not breathing, you need two midwives and they need the help of at least one more person.
Do I know of amazing midwives who practice without a second midwife? Yes-and I’m glad they can. I am still a relatively new midwife and I am in a rural area that may be as far away as an hour from emergency medical care with few/no midwives in my area to call to help. So it is obvious that to best serve my community with high safety standards, I must be joined with a second midwife and we prefer a well trained third team member. We feel it’s the best way to take care of moms and babies.
At this time, the reality is that without Nichole as my partner, there is no option to offer home births. Two midwives for the price of one is great for the clients and strong assistants are great for my mental health. It’s a win-win.
