Tuesday, December 04, 2007

The Value of Worth

I had dinner with a midwife last night. We chewed the fat about how things were going and I reflected on the first time we met... I had invited her to my office for a meet and greet. This was around 2002 or 2003. She accepted my invitation and we sat and chatted a couple of hours. (I often meet people this way. If I want to get to know someone, I simply call them up and invite them out to coffee or lunch or something.) During our conversation I asked how her collaborating physician was compensated, and she confided that he got what seemed like more than his fair share of what she made. "What !?!" I yelled without stopping to censure myself, "that's more like pimp and prostitute than doctor and midwife!" I pictured some middle-aged guy in a lab coat but sporting a purple feathered fedora and two-toned wingtips... I chuckle about it now, but that was really a defining moment for me. I wanted to help women have better births and more options, but the work of the midwife seemed so unfairly compensated. I also saw midwives getting little respect from their OB colleagues while doing twice the work for half the pay. I dropped in on a local meeting of CPMs last week and found them discussing compensation for their work. They laughed about how clients would say they could not afford their fees and yet would miss appointments because their pedicures were still wet, or their massage appointment ran late. If we want to be valued for what we do, we must first value ourselves and the work we do. I want to help women, help themselves. I want to help careproviders provide better care AND I want to be well compensated for it. Do those values seem at odds? They are not. They are both essential to a quality life.


Anonymous said...

Insurance, I'm seeing that insurance should pay for midwife care. If evidence shows the outcomes are the same or better for low risk births, then insurance should pay. Of course, it might make more pain for the midwives, I mean, more regulations than there already are. Of course, if we went to a different form of insurance like savings accounts, that might work. If families (mine included, I'm guilty) saw health as an investment to save money for, maybe we'd have more freedom to shop around and use a lower priced service that's better for us in the long run. I still say midwives should be the baby catchers at the hospital, save the OB's for things midwives don't do, like c-sections or instrumental deliveries. Can you imagine how great it would be to have OB's and midwives work together and collaborate? If they really could work together, women might get the best of both worlds. Why can only "low risk" women be mentioned really for midwives? If there was a model where midwives caught babies and were there for women in labor, and OB's were saved for surgery and medical interventions...then even high risk women would benefit. Oh, in a perfect world...


Laborpayne said...

This 'perfect world' exists. Many countries use the model of maternity care you've just described. You are right on the nose about the medical saving accounts. I'm researching them now for my book and how they would work for a homebirth.

kris said...

i agree with what you said. the problem w/ the savings is that there are too many families that live hand to mouth. they have to choose between feeding the family and health care, or feeding the family and paying the house payment. many families end up putting their kids in the state funded insurance plans just to get by and they themselves go w/o any insurance. it's really rediculous how one of the wealthiest countries in the world can't help their people w/ health care more.

on a totally different topic, tho not really. if you remember awhile
back we talked a little about how socio-economics affected the help lower income women get w/ breast feeding? well i got in touch w/ a nurse w/ the WIC program and it turns out that they provide 2 programs for lactation help that are completely free. too little too late for me, but now i am armed w/ more info to give out:)

mm said...

Coming from a Province with 'legislated midwifery'... which means that it is part of the Provincial Health. If you chose to have a homebirth, you get together some supplies on your own. Shower curtain, extra sheets, towels, big bowl, ziplock for the placenta... I have the list somewhere... but I'm not emotionally in the mood to go find it.
With legislation (paid for by the Province) comes a lot of other problems.
Rules and regulations to be followed.
1. no more than one previous c/s.
2. consult with an OB for vbac.
2a. now required to have at least one, I've heard it was changed to two! ultrasounds for placental placement, size scare tactics (okay that was me being snarly with the size comment =( bad me!)
3. CRAPPILY written and researched hbac concent forms.... if you were a 'normal pregnant woman' you'd get the 'place of birth concent forms. I FREAKED on this one. Still trying to get them re-written.... but being on the college as a volunteer... I have to keep my nose somewhat clean sigh!
4. IF you get a midwife, for every one client accepted. There can be anywhere from 3 to 5 turned away.
5. Not available in all Regional Health Authorities... so women are moving to one where they hope to get a midwife and changing addresses (die hard mamas!)
6. Starting to get other restrictions... like weight. Overweight mama now has to fight to have a homebirth. =(
7. Having to call the paramedics for any homebirth 'issues'... which happened with my daughter. And watching the paramedics treat them like 'insert nasty explitive'.
*okay, okay that last one was me, still bitter two years and 38 days later... yeah. I hold that ball of rage next to my ball of stress =)
It isn't all sunshine and roses when you have someone else picking up the tab.
With my first child. I had insurance in that horrific Province (had to pay out of pocket for regular healthcare (exactly like you do!) went with the cash in hand so that they wouldn't have to do the paperwork either!
And yet, no one would take me. Ended in a c/s. I keep that particular ball of rage next to the comment of 'oh you aren't healed enough from that experience, my fees are____________.'
I like balls, must take up juggling! =)

It USED to be in Holland (father in laws homeland) that if you chose to have a doctor, you had to pay for it out of pocket. Other than that you have your babe at home with the midwife. His mother was also visited for four weeks afterwards. Three hours a day. He remembers being bundled up by this 'after baby nurse' to go to school every morning. I'll ask more about it again soon.
I think they were spot on with that! Granted it was over 55 years ago!

So yes. Value your Worth! Because goodness knows, some of know the difference it can make!

Apologies on the lengthy comment. Feeling rather at odds right now. Birth in 2007 has not been pretty in my world. Cheers to the 2008 season! Here is hoping for better!
steps of soapbox and slinks in to the corner.

Laborpayne said...

I've said many times that legalization comes with its own set of problems. The Netherlands offer up a wonderful model but even they aren't what they used to be. Homebirth rates have dropped there from around 70% to 30% due to the type of 'regulation' you're talking about- still better than here though. The sad irony is that many Missouri midwives practicing illegally today are much better off now than they would be under a legalized (read scrutinized) system.

harmony said...

I found the same attitude in child care. In an effort to stay home with my children I ran a daycare and found many providers not willing to provide quality childcare AND be compensated well for it. I chose to be firm with my clients and they always rose to the occasion. I never once had family default on payment or skip out not in five years of daycare...but it is a matter of priorities, the provider as well as the client.

Mid-life Midwife said...

As a midwife, I believe we should be able to practice midwifery NOT just as a hobby (i.e., leaning on my husband's income to float me), but that we should be fairly compensated for what we do. I've read so many negative things on the Mothering forums about women complaining about homebirth fees. It's hard, because I want to go as low as I can. Yet many midwives live hand to mouth!!
If people want midwifery care bad enough, they should really evaluate what they pay for month to month. Every channel cable? High speed internet? Netflix? Massage? Eating out? How much did they pay for their engagement ring? How much are they willing to pay to have their baby at home with an experienced midwife?
The last Midwifery Today issue had a great article by an American CPM who really wanted to practice in Australia. She did and was very disappointed. It seemed she felt that since midwifery care was paid for by the government, many women didn't value it. They didn't value the freedom of choice they were offered. Very interesting and along these lines.
I'm babbling, sorry. Up all night at a birth and have yet to sleep!

Judit said...

Our first was born while my dh and I were both students and we paid our mw fee with student loans. By our second, we had one income and one scholarship to live on. Again, we found a way to pay, in 12 monthly installments.

I am not convinced that moms are trying to shortchange their midwives. Most home birthers are committed to their birth plan seriously enough to finance it to the best of their ability.

If a client is not paying within her means, it may be a symptom of either a tentative commitment to home birth, or a less than ideal personal relationship with her midwife. Both need to be explored by the midwife.

By the way, prenatal massage is not necessarily a luxury for a preggo lady! Please!!! My chiro charged me $40 for an adjustment plus short massage. I must say, for less than a few hundred bucks total, that type of care contributed more to my basic day-to-day well being than tests and charts ever can.

But. At the end of each of our evening long prenatal-potluck dinner-kids' playdate, I was more than happy to hand her my monthly installment, even if I had to fudge our family budget to make sure the check wouldn't bounce. I was paying her for her time spent on us creating an intimate relationship. And the more intimate the relationship became, the more I understood our mutual interdependence. My responsibility is for contributing to her family's livelihood while hers is for our baby's safety. I would ask the midwives you met: what do they do to make this clear to their clients?