The Difference Between Being a Midwife Business Owner and a Self-Employed Midwife
The journey of a midwife can take many forms, with each path offering its own set of rewards and challenges. Understanding the distinction between being a midwife business owner and being a self-employed midwife is crucial for anyone considering their career options in this field. Let’s explore the key differences between these two roles. 1. Business Structure Midwife Business Owner Entrepreneurial Model: A midwife business owner typically runs a formal business, such as a midwifery practice or birth center. This involves creating a business entity (e.g., LLC, corporation) and managing its operations. Branding and Marketing: As a business owner, you’ll focus on building a brand, marketing your services, and establishing a business identity that resonates with your target audience. Self-Employed Midwife Independent Practice: A self-employed midwife operates independently but may not have a formal business structure. They might work under their own name and may not engage in extensive branding or marketing. Flexibility: Self-employed midwives often have more flexibility in their work arrangements, such as setting their hours and choosing the number of clients they take on. 2. Operational Responsibilities Midwife Business Owner Management Duties: Business owners are responsible for overseeing the entire practice, including financial management, staffing, compliance with regulations, and ensuring quality of care. Delegation: You may need to hire staff, such as administrative personnel or additional midwives, which adds a layer of complexity to your role. Self-Employed Midwife Focus on Clinical Care: Self-employed midwives primarily concentrate on providing care to clients. They handle their own scheduling and billing but may not engage in broader management responsibilities. Limited Oversight: The operational burden is lighter, allowing more focus on direct client care, although they still need to manage their own business aspects, such as finances and record-keeping. 3. Financial Considerations Midwife Business Owner Revenue Generation: As a business owner, you’re responsible for generating revenue through services offered, which may include childbirth education, prenatal care, and postpartum support. Investment and Risk: Starting a business often requires significant upfront investment and ongoing financial management. You bear the financial risks and rewards associated with running a practice. Self-Employed Midwife Earnings Control: Self-employed midwives typically control their earnings by setting their rates and managing their client load. They may have lower overhead costs if they work independently. Tax Implications: Self-employed midwives need to manage their own taxes, including estimated tax payments, which can differ from those of a business owner. 4. Client Relationships Midwife Business Owner Brand Loyalty: Building a brand allows you to cultivate a loyal client base. Clients may choose your services based on your reputation, marketing efforts, and the overall experience offered. Team Dynamics: You may work with a team, which can enhance the client experience but also requires effective communication and collaboration among staff. Self-Employed Midwife Personal Touch: Self-employed midwives often develop very personal relationships with their clients, as they provide individualized care without a team. Direct Feedback: Clients may feel a more direct connection to the midwife, fostering strong relationships but placing all responsibility for client experience on the individual. 5. Regulatory Compliance Midwife Business Owner Business Compliance: As a business owner, you must navigate complex regulations, maintain licensing, and ensure your practice complies with healthcare laws. Insurance and Liability: Business owners often need to secure liability insurance for the practice, which can involve more extensive coverage and higher premiums. Self-Employed Midwife Personal Licensing: Self-employed midwives still need to comply with licensing requirements, but they may face fewer regulatory burdens than business owners. Insurance Considerations: They typically focus on personal liability insurance rather than broader business insurance, simplifying their coverage needs. Choosing between being a midwife business owner and a self-employed midwife depends on your career goals, preferences, and willingness to take on different responsibilities. As a business owner, you’ll navigate the complexities of running a practice, while self-employment offers flexibility and a more individualized approach to care. Both paths can be incredibly fulfilling, and understanding the differences will help you make an informed decision that aligns with your professional aspirations. Whatever path you choose, the impact you have on the families you serve will remain the heart of your midwifery practice.
The Business Side of Billing for Newborn Care as Part of Midwifery Practice
Caring for a newborn is one of the most beautiful and sacred parts of midwifery. From the first exam to ongoing well-baby visits, midwives provide essential services that support healthy transitions for both baby and family. But here’s the reality: while clinical newborn care feels natural for midwives, billing for those services can be surprisingly complex. Understanding the business side of newborn billing is crucial for running a sustainable practice—whether you’re attending home births, running a birth center, or offering outpatient women’s health care. When midwives don’t bill correctly for newborn services, they risk losing thousands of dollars each year. At Midwifery Business Consultation, we help midwives bridge the gap between compassionate care and financial sustainability. Let’s break down the essentials of billing for newborn care so you can be confident you’re capturing the full value of the work you do. Why Billing for Newborn Care Matters Many midwives underestimate the financial importance of newborn billing. Some assume it’s included in the global maternity fee, while others skip it because the process feels confusing. But here’s the truth: Newborn care is separate from maternal care and requires its own documentation and billing. Insurance companies expect claims for newborn services to be submitted under the baby’s policy, not the parent’s. Proper billing supports sustainability, helping your practice grow and expand services. By treating newborn billing as part of your business model, you not only increase revenue—you also protect your practice from compliance risks. Common Services Midwives Can Bill for Newborns Depending on your scope of practice, state regulations, and insurance contracts, newborn billing may include: Immediate Newborn Assessment after birth (APGARs, physical exam, stabilization) Well-Baby Exams during the postpartum period Routine Screenings (bilirubin checks, weight checks, feeding assessments) Procedures (if within your scope, such as tongue-tie evaluations or lab draws) Each service has its own CPT (Current Procedural Terminology) code and must be billed separately from the mother’s care. Challenges Midwives Face with Newborn Billing While the opportunities are clear, midwives often run into challenges: Credentialing Issues: Not all insurance panels credential midwives for pediatric codes. Documentation Errors: Incomplete charting can lead to denied claims. Incorrect Policy Use: Submitting claims under the mother’s insurance instead of the newborn’s. Bundling Assumptions: Believing newborn care is included in the global maternity package. These pitfalls can cost your practice significant income over time—but with training and systems, they can be avoided. Best Practices for Billing Newborn Care Verify Insurance EarlyConfirm newborn coverage and policies with families before delivery. Many babies are automatically covered under the parent’s plan for the first 30 days, but each insurance has unique rules. Use Correct CPT CodesCommon newborn codes include: 99460 (Initial hospital or birth center care, per day, for evaluation and management of a normal newborn infant) 99391 (Periodic comprehensive preventive medicine reevaluation for infants under 1 year) 99462 (Subsequent care, per day, for evaluation and management of a normal newborn) Document ThoroughlyAccurate, detailed charting is essential. Insurance companies want evidence of the exam, counseling, and any procedures performed. Bill Under the Baby, Not the ParentClaims must list the baby as the patient, with their date of birth, demographics, and insurance information. Invest in Billing SupportOutsourcing to billing professionals experienced in midwifery care can save time, prevent denials, and boost revenue. How Midwifery Business Consultation Can Help At Midwifery Business Consultation, we know that billing isn’t what drew you to midwifery—but it’s a vital part of keeping your practice sustainable. We offer: Billing & Coding Training specifically for midwives and newborn care Customized billing templates to streamline documentation Consulting services for insurance credentialing and reimbursement strategies Resources for billing staff so your team understands the unique needs of midwifery practices We’ve helped practices recover thousands in missed newborn billing opportunities simply by implementing proper systems. Empowering Your Practice Through Smart Business Caring for newborns is at the heart of midwifery—but billing for those services is what ensures you can keep showing up for families year after year. By approaching newborn billing as an essential business strategy, you strengthen your practice, protect your income, and expand your ability to serve your community. You don’t have to figure this out alone. With the right guidance, tools, and support, you can feel confident that your clinical excellence is matched by financial sustainability. Ready to Master Newborn Billing? If you’re ready to take control of the business side of newborn care, Midwifery Business Consultation is here to help. Explore our billing resources for midwives or schedule a one-on-one consultation to create a customized plan for your practice. Because when midwives thrive, communities thrive.
The Big Leap
“The Big Leap.” It is a wonderful book by Gay Hendericks. The Big Leap is about changing your overall perspective, so you can embrace philosophy that’ll help you achieve your full potential in work, relationships, finance, and all other walks of life. I truly believe that every person can reach their ultimate potential in life. We are the only ones stopping us from creating that. When excuses are being made, we are allowing external forces determine our fate. “I don’t have the money to start a midwifery practice.” There is always money if the passion and mission is present. Investors, philanthropists, and banks will invest time and money into good causes and financially profitable businesses. “I don’t have the time. Life is crazy already with my family, kids, working long hours already, and day to day tasks. How would I add one more thing into each day?” Everyone has the same amount of hours in a day: 24. Why do some people seem to accomplish more than another? Each person’s routines, goals, and way time is utilized determines how productive each day is. Doing audio books instead of radio during a drive are simple changes to improve your personal development strategies. Reading has really opened my eyes to opportunities available in today’s amazing information age. I used to just read books that I was required to for school and courses I was taking to re-certify my license. The last three years, I have read and listened to hundreds of books by using that simple habit change of no radio to audio books when driving. Take the “Big Leap!” Get out of your daily routine and push your personal limits. The glass ceiling is a real thing. We put on ourselves a subconscious limit of what we “think” we can accomplish in life. There are three key concepts I want everyone to take away from the “Big Leap” philosophy of life aimed at maximizing your potential. We don’t believe we deserve to be happy all the time, so we cap our levels of joy for no reason. Fear and self-sabotage are two common ceilings we can break through with the right attitudes and exercises. When it comes to work, we can be in four zones, but only one is worth shooting for. Every midwife can build her dream practice. We can all serve families, change communities, live personal dreams, and accomplish ANYTHING. Stop being your one subconscious barrier to success. Dream and make big things happen with this short time on Earth called life. Check out our amazing teachable course on Tips on Running a Successful Midwifery Practice “If I cling to the notion that something’s not possible, I’m arguing in favor of limitations. And if I argue in favor of my limitations, I get to keep them.” – Gay Hendericks
TeleHealth Trends Rising in Midwifery Practices
Telehealth midwifery practices have witnessed significant growth and evolution in recent years, driven by advances in technology, changes in healthcare delivery models, and the need for convenient and accessible healthcare services. Rising Trends in Telehealth Practices: Expanded Range of Services: Telehealth is no longer limited to primary care and urgent care. It has expanded to cover a wide range of specialties, including mental health counseling, dermatology, cardiology, and even specialties like midwifery and lactation consulting. Mental Health Teletherapy: The demand for mental health services delivered via telehealth has surged, especially in response to the COVID-19 pandemic. Teletherapy provides individuals with greater access to mental health professionals, reducing barriers like stigma and geographical limitations. Remote Patient Monitoring: Telehealth platforms are increasingly integrated with remote monitoring devices. Patients can use wearables and other devices to track their vital signs, chronic conditions, or postoperative recovery progress, with real-time data transmitted to healthcare providers for analysis. Telemedicine for Chronic Care: Telehealth is becoming a valuable tool for managing chronic conditions such as diabetes, hypertension, and asthma. Patients can receive ongoing support, education, and medication management through virtual visits. School-Based Telehealth Services: Telehealth is being used in schools to provide students with access to healthcare services. School nurses and other healthcare professionals can connect with off-site providers to diagnose and treat students without requiring them to leave the school premises. Telehealth for Post-Acute Care: After hospital discharge, patients often require continued medical care and monitoring. Telehealth is being used to bridge the gap between hospital care and home care, reducing readmissions and improving post-acute outcomes. Telepharmacy Services: Telepharmacy allows pharmacists to provide medication counseling, prescription reviews, and medication management remotely. This service is especially valuable for rural or underserved areas with limited access to pharmacies. Elderly Care and Aging-in-Place: Telehealth is enabling seniors to receive healthcare services in the comfort of their homes, allowing them to age in place. This includes remote monitoring, virtual doctor visits, and medication management. Telehealth in Emergency Medical Services: Emergency medical professionals are using telehealth to consult with specialists while providing care in the field. This real-time communication can improve the accuracy and speed of diagnoses and treatment. Telehealth Platforms for Providers: Healthcare providers are adopting specialized telehealth platforms that offer integrated electronic health records (EHR), secure messaging, and video consultations. These platforms streamline workflow and enhance patient care. Telehealth Policy Changes: Many governments and healthcare regulatory bodies have relaxed telehealth regulations during the COVID-19 pandemic, making it easier for providers to offer telehealth services. Some of these changes may become permanent, fostering continued telehealth growth. Telehealth Equity: There is a growing recognition of the importance of telehealth equity. Efforts are being made to ensure that underserved populations have access to telehealth services, including addressing issues like internet connectivity and digital literacy. Hybrid Care Models: Many healthcare organizations are adopting hybrid care models, combining in-person and telehealth visits to offer flexibility and convenience to patients while maintaining the quality of care. As midwifery telehealth continues to evolve, it is likely to become an integral part of healthcare delivery, offering patients greater convenience, access to care, and improved health outcomes. The trends in midwifery telehealth are driven by both technological advancements and the evolving needs and preferences of patients and healthcare providers. Join the community of satisfied practitioners who have streamlined their telehealth practices with our templates Telehealth Sample Policies and Consents.
Taxes are Due: Midwifery Business Tax Strategies
Tax Strategies How Many Midwives Fear Taxes? I used to fear taxes, money, and business complexity. Now I love learning about tax strategies, laws, deductions, and finances because that was where my hard earned money was being given extra to the government. Our most expensive bill all our lives are taxes. We give average one third of our hard earned dollars to the government. With proper education and legal application of tax strategies, I can show anyone how to change their tax bills closer to 0% versus 35%!!! By starting a business and having real estate, your owed taxes really go down drastically. Everyday used items in life like car, cell phone, home office space, internet, and supplies become tax write offs from your business. Before Taxes Versus After Taxes That key big difference can save you thousands each year in unnecessary paid taxes. How I started on this journey was feeling frustrated as a midwife already running my own private practice that health care overhead costs was dictating how many women I needed to see and deliver to pay my bills. I didn’t like feeling quality and mission was being compromised in order to pay all the rising business costs each year. I started looking at how do the rich make money. What am I not knowing or understanding to make my business successful in terms of daily completion of my mission statement. I learned some life changing facts that altered the course of my entire life: WEALTHY HAVE BUSINESSES AND REAL ESTATE! I stress in all of these tax, legal, and accounting blog posts that I am a CNM that is self taught with courses, mentors, and life application of these topics. Please seek legal advice or talk with your accountant to see what works best for you and your specific situations. My suggestions are starting points to get midwives to open their mind to different ways to look at money and business. Financial Knowledge is VITAL In Today’s Society to Have Long Term Wealth, Health, and Prosperity. The mission of Midwifery Business Consultation is to create true financial freedom so midwives can practice how they love versus what finances dictates the practice should look like. By adding real estate (birth center ownership and rental properties) as part of your future plan really taps into lots of amazing tax deductions available. Food and housing businesses have the most tax write offs out of any business in the United States. The government wants citizens to run these businesses. People need these things and keep the economy strong. If we had a housing or food shortage, our country would really be crippled economically. Take advantage of your midwifery business and look into buying the commercial building your home birth practice runs out of. Start one or many birth centers by actually owning the space versus renting. The overall costs of the building is much lower that it looks on paper. The utilities, upkeep, taxes, depreciation, loan payments, and insurance are all tax write off before taxes are due. Learning About Taxes and Business Deductions There are some great books available. I really enjoy learning from Mark Kohler. He is a lawyer and accountant. His energy and passion about small businesses being successful really makes learning about tax strategies fun if you can believe it. I have read all of his books multiple times, listen to his Podcast regularly, get his email updates, and subscribe to his YouTube Channel. Wealth of knowledge and information about decreasing taxes with business implementation tools. Please take some time today and just look into taxes and learning about finances. It isn’t knowledge is power, applied knowledge is the key. Take what you learn and start changing your business plan, personal finances, and personal goals in life. Where do you want to be in 5, 10, 20yrs from now? Do you want to be dependent on the system or have financial freedom to live life and service others how you want to do it? It is truly possible for every American to be financially free with the proper financial education and plans in place. Let’s get midwifery to be a power house in United States. In order for that to happen, midwives need financial knowledge. We need to know about insurance contracting, negotiating, taxes, accounting, business ownership, Serve women best by taking the time to learn about money and business. Check out our amazing course at https://midwiferybusinessconsultation.teachable.com
Streamline Your Midwifery Practice
Are you thinking about starting your midwifery practice? Congratulations! You’re one step ahead of that goal! As a midwife, you play an important role in assisting women and families during pregnancy, labor, and postpartum. Using templates, tools, and resources to guarantee a smooth and successful start for your firm may be quite advantageous. This blog article will examine how our templates, tools, and resources may help you simplify your midwifery practice and set yourself up for success. Save Time and Energy Your time as a midwife is precious. Our templates, tools, and resources are intended to decrease the time and effort necessary to manage your practice by simplifying administrative responsibilities. Our tools may help you develop efficient workflows and processes, allowing you to focus on providing great care to your customers. They range from customized business plan templates to detailed patient intake forms. Maintain Professionalism Professionalism is essential for developing customer confidence and establishing a respected midwifery business. Our templates and tools are intended to assist you in the creation of professional and polished documents such as contracts, permission forms, and marketing materials. These materials can help guarantee that your firm follows industry standards and laws while presenting a consistent and professional image to your clientele. Improve Legal Compliance Starting and sustaining a midwifery practice necessitates several legal concerns, such as licenses, permits, and insurance. Our templates and resources are intended to help you understand and navigate the legal requirements of establishing a midwifery practice. Our tools may help you achieve legal compliance and avoid potential hazards, from legal document templates to advice on state and federal rules. Improve Organization and Efficiency Managing a midwifery practice necessitates meticulous planning and attention to detail. Our templates and tools can assist you in developing effective systems for scheduling appointments, maintaining client data, and monitoring invoicing and payments. You may enhance your practice’s operations and streamline your administrative responsibilities by employing our services, letting you focus on providing high-quality treatment to your customers. Improve Your Professional Development Continuous professional development as a midwife is essential for staying current with the newest evidence-based techniques and advancing your career. Our resources can help you gain access to excellent educational materials such as clinical practice guidelines, research papers, and chances for professional development. Our tools and templates might help you advance professionally and stay current in your sector. Finally, templates, tools, and resources may be beneficial when starting and managing a midwifery business. Our tools are meant to assist your success as a midwife and help you give the greatest care to your customers, from saving time and effort to assuring professionalism, strengthening legal compliance, improving efficiency and organization, and promoting professional growth. Join forces with us to have access to our extensive and customized templates, tools, and resources and to position yourself for success in your midwifery business. Come check out amazing business resources available – Shop – MIDWIFERY BUSINESS CONSULTATION also visit our courses at www.midwiferybusinessconsultation.teachable.com for several courses to help you build your amazing midwifery business.
STRATEGICALLY SELLING YOUR BIRTH CENTER
So many midwives are struggling to keep up with the demands and considering early retirement. I frequently get calls about midwives wanting to sell their birth centers, but have the challenge of short timeline goals to make it happen. When we only have months to find a buyer versus years, more midwives are liquidating building and supplies at wholesale and closing down the birth center. It is really sad to see how frequent that has happened the last couple years from midwives just burning out and feeling they don’t have time on their side. I want to see successful midwifery practices sell to the next generation of midwives to help spring board our success. There is such a need for business education not just with starting and improving your midwifery business, but also how to smartly sell the practice for max profits and smooth transition to the next owner and community. Here is a list of some common things to get in order and considering when selling your birth center. It doesn’t matter whether you are selling to a midwife, physician, doula, chiropractor, or community; getting your books in order is one of the first steps midwives should take to prepare their practice for sale. It is really hard to show the financial value of your business without strong recording keeping. Midwives sometimes forget that another potential is buying this practice for the profit margin, not a self employed position and taking over your salary. Most potential buyers want to hire someone to replace your midwife role on the team and see what profits are available to manage the company. If they wanted to be self employed, they would just start their own private practice. Make sure all the policies, protocols, training manuals, and resources are updated so the new owners can easily see how well organized and strong the business foundation is to the birth center. If you are not keeping up with standards and supporting the flow of the business well, they are now purchasing a practice to fix versus is already turnkey functioning to the best operations possible. Have your staff make a list of all the supplies, equipment, and assets with the business to figure out retail value price for those items. It will help with justifying your selling price point to buyers. They want to know where you are coming up with $1 million dollar value and not just from what your emotional investment is into the birth center. As midwives, it is very difficult for us to objectively look at the value of the practice. We have put our heart, sweat, and soul into the practice to be successful. Hiring a business valuator can really help with this process (I have done this frequently for midwives and their practices). There is value in your building, supplies, client following, reputation in the community, CABC Accreditation, policies, insurance contracts, resources, and business knowledge that needs to be accounted for. Many midwives don’t even realize the untapped business selling value of slowly transitioning of 12-18 months to new owner with a business mentorship package part of the business purchase. Each birth center owner has IMMENSE knowledge about running this birth center that can be smoothly passed onto the next owner to increase chances of long term success with the birth center. In the end, we want to continue expanding midwifery access and keep these legacy birth centers in business! Please watch this FREE hour-long presentation about strategically selling your birth center: https://www.youtube.com/watch?v=1dkN6sBs88c
Stopping Midwifery Burnout in its Tracks
Midwifery burnout is a special type of work-related stress — a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity. “Burnout” isn’t a medical diagnosis. Some experts think that other conditions, such as depression, are behind burnout. Researchers point out that individual factors, such as personality traits and family life, influence who experiences job burnout. Whatever the cause, midwifery burnout can affect your physical and mental health. Consider how to know if you’ve got midwifery burnout and what you can do about it. Midwife burnout symptoms Ask yourself: Have you become cynical or critical at work? Do you drag yourself to work and have trouble getting started? Have you become irritable or impatient with co-workers, customers or clients? Do you lack the energy to be consistently productive? Do you find it hard to concentrate? Do you lack satisfaction from your achievements? Do you feel disillusioned about your job? Are you using food, drugs or alcohol to feel better or to simply not feel? Have your sleep habits changed? Are you troubled by unexplained headaches, stomach or bowel problems, or other physical complaints? If you answered yes to any of these questions, you might be experiencing job burnout. Consider talking to a doctor or a mental health provider because these symptoms can also be related to health conditions, such as depression. Possible causes of midwifery burnout Midwifery burnout can result from various factors, including: Lack of control. An inability to influence decisions that affect your profession — such as your schedule, workload, or when the babies decide to come — could lead to midwifery burnout. So could a lack of the resources you need to do your midwifery role. Unclear midwifery expectations. Sometimes not being the type of midwife you envisioned when going on this path versus what medical health care system has turned you into can make midwifery burnout more prevalent. Many of us dream of Iny May Gaskin with the Farm utopia and get stuck being mini doctors in the hospitals. Dysfunctional workplace dynamics. Maybe all of your team is burnt out by demands of birth and unpredictability of work / life balance. That negative work culture behind the scenes that clients don’t see just feeds on itself. You need to get abundance and positivity back into the team’s minds. Extremes of activity. When a job is monotonous or chaotic, you need constant energy to remain focused — which can lead to fatigue and midwifery burnout. You can be running and running from birth to birth, office and home visits to nothing for a couple days. We don’t do enough self-care during those quiet days to prepare for the crazy ones! Lack of social support. If you feel isolated at work and in your personal life, you might feel more stressed. Many midwives feel very alone in their practice and community. We don’t nearly get enough support from family, friends, midwives, and clients to make midwifery burnout unavoidable. Work-life imbalance. If your work takes up so much of your time and effort that you don’t have the energy to spend time with your family and friends, you might burn out quickly. Midwifery burnout risk factors The following factors may contribute to midwifery burnout: You have a heavy workload and work long hours You struggle with work-life balance You work in a helping profession, such as health care You feel you have little or no control over your work Consequences of midwifery burnout Too many midwives stop practicing versus finding best ways to get through midwifery burnout. The most recent data shows that professional burnout causes midwives and health care professionals to leave their professions in 7 years. Ignored or unaddressed job burnout can have significant consequences, including: Excessive stress Fatigue Insomnia Sadness, anger or irritability Alcohol or substance misuse Heart disease High blood pressure Type 2 diabetes Vulnerability to illnesses Handling midwifery burnout Try to take action. To get started: Evaluate your options. Discuss specific concerns with your supervisor. Maybe you can work together to change expectations or reach compromises or solutions. Try to set goals for what must get done and what can wait. Seek support. Whether you reach out to co-workers, friends or loved ones, support and collaboration might help you cope. If you have access to an employee assistance program, take advantage of relevant services. Try a relaxing activity. Explore programs that can help with stress such as yoga, meditation or tai chi. Get some exercise. Regular physical activity can help you to better deal with stress. It can also take your mind off work. Get some sleep. Sleep restores well-being and helps protect your health. Mindfulness. Mindfulness is the act of focusing on your breath flow and being intensely aware of what you’re sensing and feeling at every moment, without interpretation or judgment. In a job setting, this practice involves facing situations with openness and patience, and without judgment. Keep an open mind as you consider the options. Try not to let a demanding or unrewarding job undermine your health. We love helping midwives with burnout and improving their practice flow to get out of the rough patch in their lives. We can help with work / life balance, self-care, improving business operations, and realigning your midwifery dreams with your current life demands. We are here for you and know that any midwife can get out of any crisis happening in their lives with proper support, resources, and time! Enrol to our course How to Prevent and Recover from Midwifery Burnout
Stocking a Midwife Home Birth Bag
Homebirth bag Preparing a homebirth bag is an important step for expectant parents who plan to have a home birth. It’s important to have all the necessary items ready well in advance of your due date. For home birth midwives, all the resources you pack in your bags and car are what you get. You can’t go down a hallway to supply pixies and get something you are “out of in the labor room.” Your supplies are purchased, organized, and brought to a birth, are they? Deciding what to bring can be daunting. It isn’t even about the birth bags. I have a suitcase in my trunk at all times with spare clothes (birth can be messy, especially a water birth), snacks, water bottles, a blanket, a pillow, and a work outfit if I have to go right to the office visit after the birth. Homebirth Settings As time goes on, the birth bags get lighter and smaller with time (you learn what is really needed for a birth in the home setting). We joked in my practice that my main birth bag was called “Goliath.” People’s backs would be sore if we had a couple of births in a row hauling that thing around. I felt more comfortable having almost everything I could think of with me at birth “just in case.” A home birth midwife needs to be more prepared for emergencies and potential variations of normal. What you bring with you is what you have to work with. I brought emergency supplies like oxygen tanks, resuscitation equipment, bleeding medications, IV start and fluids, newborn medications, paperwork for charting, footprints, and birth certificates, educational material to go over with family postpartum, newborn assessment supplies, labor support equipment like squeeze balls, fans, and birth stools, assessment equipment like doppler and stethoscope, and so much more (see consultation services for the entire list of home birth bag supply checklists for each birth bag). Labor and Delivery I knew I wanted everything that was in the Labor and Delivery Unit cupboard of a birth room. I wanted enough lidocaine so I didn’t have to transfer for a repair. Making sure I had enough sutures to do a labial repair or significant repair was essential. You will never know when 4-0 vicryl or 2-0 chromic would be more appropriate for this patient’s repair until you are already at the birth. I wanted skills and equipment for an advanced newborn airway if needed. When my birth supplies were stocked and reviewed, it was with the mindset of safety as a top priority. I loved when medications or supplies expired in my bags; it meant I didn’t need to use them, and safe, normal birth was occurring within our practice. I had bags that EMTs used, and they were labeled in every section to clearly designate what was contained in it and how many. I would always carry a certain amount of each item and make sure after each birth restocking at the office or my home was done before going to sleep (never know when women will call and need you NOW for a baby coming. I learned that one hard way!). Resources See my YouTube channel and watch the video about home birth supply bags, where we go into detail about what is in each bag and why I carry it. We go over how to set up for birth and protect your equipment from the cold climate and banging around in a lugged-around bag. Being prepared in a limited-resource setting like a home is vital. Make sure you have what you need, not close to expiring, and equipment is working properly (always carry a couple extra doppler batteries for “just in case”). Women depend on you to prepare to care for safety issues that may arise during their labor experience. Make a list of all items you will need during labor, birth, and the postpartum period (email me if interested in my practice’s birth bag supply lists). Labor is a normal event, and usually, things just go right back in my bag after birth, never opening up, but I am grateful to have those supplies available. We’ve developed our course, How to Run a Successful Home birth practice, to give you a comprehensive rundown for your practice.
Sterilizing Your Instruments
Sterilizing Your Instruments The delivery of sterile products for use in patient care depends not only on the effectiveness of the sterilization process but also on the unit design, decontamination, disassembling and packaging of the device, loading the sterilizer, monitoring, sterilant quality, and quantity, and the appropriateness of the cycle for the load contents, and other aspects of device reprocessing. Midwives should perform most cleaning, disinfecting, and sterilizing of patient-care supplies in a central processing location (either at an office, birth center, or home) in order to more easily control quality. The aim of central processing is the orderly processing of instruments to protect patients from infections while minimizing risks to staff and preserving the value of the items being reprocessed. Consistency of Sterilization Ensuring consistency of sterilization practices requires a comprehensive program that ensures operator competence and proper methods of cleaning and wrapping instruments, loading the sterilizer, operating the sterilizer, and monitoring of the entire process. Furthermore, care must be consistent from an infection prevention standpoint in all patient-care settings. All steam, ETO, and other low-temperature sterilizers are tested with biological and chemical indicators upon installation, when the sterilizer is relocated, redesigned, after major repair, and after a sterilization failure has occurred to ensure they are functioning prior to placing them into routine use. Three consecutive empty steam cycles are run with a biological and chemical indicator in an appropriate test package or tray. Each type of steam cycle used for sterilization (e.g., vacuum-assisted, gravity) is tested separately. In a pre-vacuum steam sterilizer, three consecutive empty cycles are also run with a Bowie-Dick test. The sterilizer is not put back into use until all biological indicators are negative and chemical indicators show a correct end-point response. Biological and Chemical Indicator Biological and chemical indicator testing is also done for ongoing quality assurance testing of representative samples of actual products being sterilized and product testing when major changes are made in packaging, wraps, or load configuration. Biological and chemical indicators are placed in products, which are processed in a full load. When three consecutive cycles show negative biological indicators and chemical indicators with a correct end-point response, you can put the change made into routine use. Items processed during the three evaluation cycles should be quarantined until the test results are negative. The central processing area(s) ideally should be divided into at least three areas: decontamination, packaging, and sterilization and storage. Physical barriers should separate the decontamination area from the other sections to contain contamination on used items. In the decontamination area, reusable contaminated supplies (and possibly disposable items that are reused) are received, sorted, and decontaminated. The recommended airflow pattern should contain contaminates within the decontamination area and minimize the flow of contaminates to the clean areas. Sterilization Process Cleaning reduces the bioburden and removes foreign material (i.e., organic residue and inorganic salts) that interferes with the sterilization process by acting as a barrier to the sterilization agent. Instruments are generally presoaked or pre-rinsed to prevent the drying of blood and tissue. Precleaning in a birth room or home setting may be needed on items that are heavily soiled with feces, sputum, blood, or other materials. Items sent to central processing without removing gross soil may be difficult to clean because of dried secretions and excretions. Cleaning and decontamination should be done as soon as possible after items have been used. Several types of mechanical cleaning machines (e.g., utensil washer-sanitizer, ultrasonic cleaner, washer-sterilizer, dishwasher, and washer-disinfector) may facilitate the cleaning and decontamination of most items. This equipment often is automated and may increase productivity, improve cleaning effectiveness, and decrease worker exposure to blood and body fluids. Delicate and intricate objects and heat- or moisture-sensitive articles may require careful cleaning by hand. Contamination All used items sent to the central processing area should be considered contaminated (unless decontaminated in the area of origin), handled with gloves (forceps or tongs are sometimes needed to avoid exposure to sharps), and decontaminated by one of the aforementioned methods to render them safer to handle. Items composed of more than one removable part should be disassembled. Care should be taken to ensure that all parts are kept together so that reassembly can be accomplished efficiently. Personnel working in the decontamination area should wear household-cleaning-type rubber or plastic gloves when handling or cleaning contaminated instruments and devices. Face masks, eye protection such as goggles or full-length face shields, and appropriate gowns should be worn when exposure to blood and contaminated fluids may occur (e.g. when manually cleaning contaminated devices). Organization Contaminated instruments are a source of microorganisms that could inoculate personnel through non-intact skin on the hands or through contact with the mucous membranes of the eyes, nose, or mouth. Reusable sharps that have been in contact with blood present a special hazard. Employees must not reach with their gloved hands into trays or containers that hold these sharps to retrieve them. Rather, employees should use engineering controls (e.g., forceps) to retrieve these devices. Once items are cleaned, dried, and inspected, those requiring sterilization must be wrapped or placed in rigid containers and should be arranged in instrument trays/baskets according to the guidelines provided by the AAMI and other professional organizations. Guidelines These guidelines state that hinged instruments should be opened; items with removable parts should be disassembled unless the device manufacturer or researchers provide specific instructions or test data to the contrary; complex instruments should be prepared and sterilized according to device manufacturer’s instructions and test data; devices with concave surfaces should be positioned to facilitate drainage of water; heavy items should be positioned not to damage delicate items; and the weight of the instrument set should be based on the design and density of the instruments and the distribution of metal mass. While there is no longer a specified sterilization weight limit for surgical sets, heavy metal mass is a cause of wet packs (i.e., moisture inside the case and tray after completion of the sterilization cycle). Other parameters that may influence drying