Re: [ozmidwifery] Obstetric Perception - Your thoughts?

[Marilyn Kleidon]

Dear Sally and all:   I think I am going to get flak from you all for this response but here goes. I can only comment on what I know, and what you describe Sally, 20 births/month sounds ideal but at least on the West Coast of America, wher I lived until recently,  (including  California and Washington USA and British Columbia, Canada) it would be a part-time practice and could only happen financially in either a very rural area or if the midwife had a partner who was basically supporting the family. In the USA we carried a number of emergency drugs  such as pitocin, merthergine, Mg SO4, adrenaline, IV fluids, that apart from the oxytocics were never used (thankfully) but dates expire and the drugs have to be replaced, so we had a lot of supplies that needed to be replaced continuously, not to mention stationary or taxes. So, at least for us, 20 births/month did not generate an income that could support a single mother and her family. There is also annual licensing fees and insurance which were significant outlays and increasing. We also had 2 midwives or 1 midwife and a second attendant trained in maternal and neonatal resucc etc. at each birth, so unless she was your partner or student then you would be paying your second attendant $200-$300 per birth. When you actually do the accounting you don't do private practice for the money, it truly is a labor of love. And, unfortunately it is with great heartache that many (not all) independent midwives cease practice, it is a hard profession to stay married in and raise kids in. Some of you appear to have amazing and incredibly supportive partners and from my observation this is what is necessary to survive for a longish independent career. Only one practice that I worked in had this small number of births and they struggled financially both midwives having other part-time jobs. of course when you're older (as I am) and the children have grown and are no longer at home (or you aren't) and you are single, then there are no such restrants on your practice.   The other practices I worked in had an average of 40births/month/midwife (incidently in BC, Canada the maximum number of births is 40 and the minimum is 10 per year, continuity of care, there was no maximum in the USA). With this number of births we did not do homevisits for all of the prenatals but had the mums come to our clinic, which were all very homey and actually a great place for the mums to meet. WE made appointments at times when the mums, dads, and kids could come, they seemed to like the outing. Our home visits were more to make sure we knew how to get there. However, being this busy is exhausting and especially if you have a cluster of long labours not necessarily best practice ( example if your 4 ladies for October and 2 from November all birth the last weekend in October you can be quite stretched. Constantly being on call should not be underestimated in its affect on your life health and well being.   I am not saying this to put down independent practice, NMAP both of which I totally and wholeheartedly support, I am just saying it to make the point that those who are apprehensive of their ability or even willingness to commit to being on call should not be put down, but rather encouraged by searching for systems that will be supportive of the midwives and the mothers. There are practices around the world, primarily it seems in Britain where the groups of midwives have worked out a sharing of duties, time on call, etc. that have been beneficial to all and liveable for the midwives. We should acknowledge that being on call can be very tough for the practitioners.   I think what may put a lot off too is the mess that they see being on call makes of the doctors lives that they observe. I think we must remember that GP's get called out for outpatients and other non-obstetric emergencies too, so in a rural practice this must be really demanding. The obstetricians I know have worked in group practices and so have rotated the on call time. I do think it is fair to say that most people don't relish being on call though we love going to births.   I really do hope you don't all take this the wrong way. much love   marilyn From: Sally Westbury To: [EMAIL PROTECTED] Sent: Thursday, October 31, 2002 6:39 AM Subject: RE: [ozmidwifery] Obstetric Perception - Your thoughts? I have been attending women at births for many years now. I love the flexibility of my work. I am fully supported by my partner and my extended family and friends.   For me being with a woman birthing is an intense experience and I choose not to have many women each month. Two women birthing each month is enough for me so that I feel that I am able to really be with my family. I am able to do most of my antenatal and postnatal work within school hours and then it is only 2 times each month that I am with a woman birthing. So at worst 2 nights each month I am away from my family overnight.. at best none. Not too bad realy.   Financially if we look at 2000 dollars per birth. There is an income of 2000 per fortnight. This is very roughly speaking.   I would be interested to see what people see as a full time case load?   There are great benefits to being with a known women. I love my work. I grow real relationship with women. I’m still longing for and missing the women in Victoria that I have left behind even as I see mothers born and babies birthed here and know that I am growing those connections here. I still think about women in Tasmania and remember the important lessons they taught me as a new midwife and wonder how those children are as the approach their teenage years. This is amazing work and my family is only enriched by my work as we have links and are loved by many in the community.   Oh gush gush gush… sorry but honest I so much adore the women I am with and am honored by being invited to journey with them. I am sure there are so many other midwives who would be so much happier and more enriched by working with known women.   Just imagine… instead of going home from work mostly frustrated… you went home feeling mostly elated… how would your family benefit from that??   My family support me entirely because they see how happy the work makes me and that spills over to our whole family life.   Gush.. gush.. gush….   In peace and joy   Sally Westbury