A MIDWEST MIDWIFERY MODEL

A MIDWEST MIDWIFERY MODEL

Twenty or so years ago, I began a midwifery practice. Working first slowly with only a few clients. I did prenatal care out of the home where the midwife who trained me lived. She too had an office there. It was an ideal situation. If I had questions, she could help me. We had a camaraderie and friendship that was personal and professional. As my practice grew and hers was already a large practice it was clear that the neighbors did not appreciate all the coming and going and the parking wasn’t doable. I had a student midwife at that time with a big vision for professional midwifery. Together we found a small office and established a new business in a suburb just outside Wichita, KS. We had very similar desires. To offer personalized and professional midwifery care while still having time with our husbands and families.  To be frank we wanted to stay married and not have our kids neglected. We valued relationships and wanted to flourish at home and in our God given calling to service.
To this endeavor, I began to brainstorm and search out a model that gave us each some independence but also created a business relationship that was cohesive and interdependent. A framework began to emerge based on a model I saw working in other fields. I set out on a plan to create a team practice that would help midwives to share expenses and help one another in serving women in our community. Reviewing the costs and getting the details worked out was sometimes by trial and error.  As time went on the details got worked out and we began to add midwives to our twosome. Each time, of course, there were things to work through, bridges built and miscellaneous details that needed tweaked.   When we added a nurse midwife with a huge insurance practice, we had a lot of new challenges to work out. It was a big change and a lot of work at first. Costs went up and we had to make changes not only in procedures, but our practice guidelines changed and our relationships with one another experienced growing pains. Much like a family we work on communication, growth, and love.  It’s not always perfect but it works very well.
When I had the chance to sit down with Leslie Cornwell for a consultation to get some advice on a few issues she coined the term “co-op” to describe our business model.  It’s a term I use now to describe the kind of business we have.  Each midwife is technically an independent contractor. This provides a level of ownership to each midwife. My position is the director and owner. I facilitate the barrage of tasks that come with owning and running a multi person business. I work for and with the midwives in my group. Ultimately there is a cost of doing business and my job is to make sure that “business” is done, so they (and I) can be midwives. Our office structure helps to minimize menial tasks for the midwife so she can do what she really does best. This position requires financial stability along with leadership skills.
Each midwife in the practice is awarded the blessing of having many services and supplies provided and available for their work.  For example, a fully furnished office, utilities, office line, janitorial, EHR, stocking of extensive supplies for the office and medical practice supplies just to name a few. We also have an office coordinator who provides office support. This entails a variety of things like sending invoices, birth certificates, uploading documents and faxes etc. Where the rubber meets the road so to speak is when things like Covid happen. Beyond the business side the benefits of having other midwives are a comfort personally.  Our team had incident after incident of quarantines, illness, family illness and stressful situations on many levels. We are all familiar with each other’s clients and the clients are familiar with all of the midwives. For myself, it’s great to go to bed at night and wake up knowing there is a camaraderie of other midwives available if needed. A perfect example happened last fall. One of my midwife partners had her father get very sick. She was needed tremendously to help and wanted to share in his final weeks of life. When this happened her midwife life stopped on a dime. The rest of us picked up where she left off. She didn’t need to worry about a thing. Priceless.      
The co-op model makes sense on many levels it addresses the business cost components, it improves the quality of care, and it minimizes burnout. I will say there is tremendous give and take and we give and get a lot of grace from each other.  This form of collective cooperation is an effective and cohesive way for midwives to experience some independence and at the same time have the support of a team. We are beyond blessed with this business model because we can wholeheartedly serve our community because of the shared responsibility of shouldering the midwife’s life with one another.
-Deidre DeGrado, CPM