Babies are a Billion Dollar Business
Billion Dollar Business Has anyone seen the movie “Business of Being Born?” Ricky Lake has been a monumental spokesperson for the money-making backdrop systems present in the United States compared to other countries. Our society has created a booming business to be part of. The healthcare system has created assembly-line maternity systems for women to deliver their babies. Midwives are here to change that! We need more midwifery-owned and operated birth center, home birth practice, women’s health clinic to support families back into the normal birth era. Babies and Birth is a business that needs to be profitable to stay open to helping families, but we don’t need to make it a high-volume, quantity practice. Insurance is paying more and more for quality. Preventing complications, lower cesarean section rates, and higher breastfeeding rates are very negotiable tactics to use when discussing the “value” of your service and fee schedule rates. Midwives can make great money taking care of families. Know the insurance codes to bill for care. Bill for more than global maternity care. Make sure you are billing for tub rentals, birth center facility use, newborn care, breastfeeding support, supplies used during birth, and primary care visits done for issues outside of pregnancy like cold symptoms. Give credit to the value of your services. We are seeing 5-7 women due each month versus 10-15 births, like typical doctors providing obstetric services in the hospital. I have seen a few doctors have 40+ women due each month in a solo practice! How does that doctor know his patients and provide individualized care? When good-quality, safe care is provided, midwifery practices become very, very busy. We need to focus more on the business aspects of midwifery to keep our lights on and compete with our major hospital systems by buying things in bulk and creating an assembly line for an efficient birth process. Quality takes more time and allows midwives to see women for longer visits. When fewer women are seen in a day, the revenue needs to come from other places. Add a boutique shop in the office. Join forces with a chiropractor to cross-refer patients and cut down on your marketing budget. Create a wellness center where multiple practices are under one roof, sharing utility costs, maintenance on the building, and growing a community of like-minded practitioners for families to drive far distances to seek out! Consider a birth center franchise. Hybrid today’s big health care system with midwifery personalized care? Have a massive assembly only on the backdrops (centralized administration support for billing, legal, staff education, obstetrician hired to be Medical Director of all facilities as a full-time job, and bulk buying of supplies), while keeping the mission at the forefront of personalized, non-rushed care during visits and birth. Find multiple business investors who share the same passion for birth center philosophy as you. Keep up with today’s healthcare trends while still preserving why each one of us became midwives: safe, high-quality pregnancy care.
Avoiding Midwifery Burnout for Midwives
Midwives Give so Much to Women I want to get rid business of midwifery burnout. Average midwife burns out around 7 years of practice. We give our skills, complete call availability, personal time, relationships, and health. Being on call all the time is focused around client satisfaction and making them top priority in life. By putting birth first, all other relationships and personal self care is put second and many times last if available. Obstetrics is full of legal pressure and stress is high to give the best care and still protect your business and yourself. Most of what we do is amazing and great, it is just very difficult to separate work and personal life with this profession. Our Care is Very Important and Needed Across the United States and World. Average midwife burns out around 7 years of practice. I want to get rid business of midwifery burnout. We can do it, but need to have a support network of midwives to give us personal breaks. Even having a solo practice an allow breaks if you put the correct relationships in place. Talk with your other home birth or birth center colleagues and cover for each other. Create a midwife community weekly meeting, group agreed upon payments for services and coverage to each other, and prenatal visits done with all the midwives potentially covering for birth calls. Take vacations, take days off each week, attend family get together, and separate life and work life the best you can. We have a very demanding job being available all the time and needing back up plans for everything we do. That makes constant levels of cortisol in our body just brew. Make blocked times for kids sporting events, music recitals, musicals, vacations, and date nights. If you didn’t get a good night’s sleep or had a traumatic birth, have midwifery back up coverage options to give yourself time to heal from sleep deprivation and emotional trauma. Good daily sleep is vital for anyone. Self care is vital for being a midwife, mother, wife, sister, and daughter. Haven’t you ever heard we can’t put the oxygen mask on someone else until we put our oxygen mask on first? We can do a better job caring for our clients and family when we put ourselves FIRST! With daily exercise, meditation, boundaries on personal life from work, gratitude journals, life couches, good support network, and vacations really protect midwives from professional burnout. Don’t become a “midwife nun” and devote your entire life purpose to midwifery. Some women choose to pick that style of midwifery, but most want a work/life balance. Miracle Morning routine has really helped me with coping with stress and managing a highly productive daily routine. It isn’t about how many things you are doing in a day. It is about how you can cope with stress and manage boundaries to protect your personal well being. Midwives are great at caring for others, but terrible about caring for ourselves. Have a friend monthly meet up retreat. Make weekly date nights with partner. Have a weekly family day trip and activity. Schedule your day, week, and month to get a midwife to cover those times for you. Have a partner see women with you and cover for each other. Truly separate from work and turn off your work phone. Change your contracts with women to break down portions of services versus global flat rate for entire maternity service. Charge for prenatal visits individually, testing, call time, birth attendance, birth assistant, supplies, postpartum home visits, and newborn care. Set expectations that at beginning of care that client is joining a team approached midwifery team versus solo practice for availability. Stress importance of midwifery self care and personal separation time needed to give better care to women. When you are feeling professional burnout, don’t take on a student at that time. Don’t recreate the wheel of burnout and showing midwifery students what work/life balance truly looks like. Midwifery students are demanding and increase stress level to practice. Wait until your practice structure is in a place to support a student. We preach self care and promote to our women and families that we are doing what we actual recommend. Action speaks louder than words. If you are healthy, attentive, empowering ourselves, eating well, passionate, personal life, and sleeping good each night, our women will model our image of healthy living. Have outside hobbies and passion from midwifery. Join art or cooking classes, pursue other passionate avenues of your life, and life to your soul’s purpose. I don’t think we were put on this Earth to just be midwives. Take care of yourself to prevent midwifery burnout. Create a good foundation of healthy living and stress reducing coping mechanism in place. Good, long term habit changes will create a strong foundation for your midwifery career and personal life dreams! “Self care is never a selfish act – it is simply good stewardship of the only gift I have, the gift I was put on this Earth to offer others. Anytime we can listen to true self and give it the care it requires, we do it not only for ourselves, but for the many others whose lives we touch.” -Parker Jay Palmer, Let Your Life Speak
Avoiding Midwife Professional Burnout
Professional Burnout Midwives are prone to professional burnout. We give to our clients, family, friends, and community. When do we have time for ourselves? Running a business might make you feel as though you cannot possibly step away. Some areas have such a high demand and not enough midwives, so time off might not even feel like an option. Being on call can really take a toll on us. You have the power to create a business plan that has networks in place and backup options to call for sick days and vacation. I became so burnt out about two years ago. I didn’t take a vacation for three years. I missed many weddings, birthday parties, baseball games, and date nights. I was so exhausted from supporting my clients that I never took the time to care for myself. I had professional burnout. I didn’t like midwifery anymore. I had regrets of the professional career choice I made. I wanted a balance. I wanted to care for women and still care for myself and family. I pushed off having another baby for three years, because I knew the practice couldn’t live without me. I stepped away from private midwife business and joined a hospital team to help heal my soul and spend more time with my family. I did a lot of soul searching, had another baby, took more business classes to learn from my past business mistakes, and found my passion for supporting midwives starting their own businesses. Women need support in all aspects of their lives and I realized that midwives are great at caring for women and weak at business ownership. LEARN TO SAY NO Simply put: midwives need to LEARN TO SAY NO! We tend to give and give even if there aren’t enough hours in the day. When your day gets busier and busier, your personal health suffers. You MUST have a profitable midwife business plan that creates a system that will run whether you are sleeping, sick, or on vacation. Go on vacation at LEAST three times a year. Even for a long weekend just to get away. Whether it is a family vacation or romantic retreat with your partner, get away and turn your phone off. Have your well trained staff run the practice for you. Plan and implement excellent staff and protocols to follow your mission and guide them while you are away. Creating a successful midwifery business is about serving your community and your life’s purpose. We don’t want to work to live, we want to live and enjoy work. Many people truly don’t retire when they have a job that doesn’t feel like a job. Create the midwife business you don’t ever want to leave and keeps you free from professional burnout! Youtube Video: Beating Midwifery Burnout
APPS THAT HELP RUN A SUCCESSFUL MIDWIFERY BUSINESS
I love doing consultation visits, because many times I am learning just as much from my clients as they are from me! I have an amazing duo in Texas that provided me with some great apps to share with others and started digging more down the rabbit hole what other apps are available to make midwifery business day to day operations easier! Here is a list of some ones I have found and would love in the comments below for other midwives to share apps they have found and how they have helped their midwifery role. 1. Call coverage for multiple midwives: OpenPhone (https://www.openphone.co/) -Great for any midwifery team that wants to share call coverage, have office & midwifery call line easily accessible by entire team, automated set up of forwarding business number to midwifery call number after clinic hours, & SO MUCH MORE! -Services included: local and toll-free calls, multiple numbers, texting, call transfer, group messaging, call recording, business hours -Price: $0-25 per line is what most midwives would need 2. Best time management tool: Atracker (https://atracker.pro/home.html) -Time tracking application which is very easy to use and requires minimal setup. On the main screen, you see the complete user defined task list, the overview of today’s time spending and goal progress. You can start/stop time recording simply by tapping a task. It only needs a name and/or icon to setup a unique task, with advanced settings as optional. So you can focus on own work instead of wasting time on mastering the app. -Price: $0-5 month 3. Best receipt scanner app for entrepreneurs: Wave (https://www.waveapps.com/receipts) -Small businesses and startups, delight. Wave’s free receipt scanner app is an ideal solution for staying on top of your receipts. It automatically and instantaneously syncs with its free, cloud-based accounting software, Wave Accounting. In addition, it enables you to flexibly export your data to your preferred accounting tool, including QuickBooks and more. This feature makes it extremely easy and convenient to work with your budgets. Note that with this receipt tracker app, there is a two-step process. First, you must upload the image of your receipt. Then, you will be asked to confirm the details to ensure that they were read correctly by the app. The double-check system prevents incorrect data from finding its way into your expense reports. -Services: also does many other financial services like payroll, invoices, collecting payments, & bookkeeping -Price: free to $35 month depending plan chosen 4. Payroll services: Gusto (https://gusto.com/) -Gusto gives employees access to self-service portals for payroll- and benefit-related information that’s accessible even after they leave a company, unlike most competitors. It also administers full-service payroll across 50 states and offers phone support. -Price: $39 month plus $6 per person for the basic package, which includes tax filings and payments. 5. Great project management system: Asana (https://asana.com/) -Asana allows you to assign and track unlimited projects on a dashboard. You can add assignees, due dates and comments to cards. There’s also unlimited file storage for files up to 100MB each, even on the free version. -Price: $0-25 per month 6. Great video conferencing resources: Zoom (https://zoom.us/) -For growing companies — especially those with remote employees or multiple locations — having access to quality videoconference software and instant messaging platforms can make the whole business run more smoothly and keep everyone in the loop. -Price: $0-19.99 per month 7. Self care app: Gaia (https://www.gaia.com/) – No matter if you are a seasoned health and wellness enthusiast or just starting to build your own self-care plan, self-care apps will make following your routine feel effortless. Self-care is anything that you intentionally do to improve your physical, mental and emotional health. -Services: With over 8,000 videos, the Gaia app helps you answer life’s deeper questions with a member-supported media network of conscious living enthusiasts -Price: $11.99 month 8. Great resource for sleep, meditation, & relaxation: Calm (https://www.calm.com/) – #1 app for Sleep, Meditation and Relaxation, with over 100 million downloads and over 1.5M+ 5-star reviews. We’re honored to be an Apple BEST OF 2018 award winner, Apple’s App of the Year 2017, Google Play Editor’s Choice 2018, and to be named by the Center for Humane Technology as “the world’s happiest app”. -Price: $0-$69.99 year 9. Virtual Personal Trainer: CoPilot (https://mycopilot.com/) -Services: 1-on-1 fitness coach to help make long-term positive changes for a healthier life -Price:$69 month 10. Great pregnancy tracker for midwives & clients: Pregnancy and Due Date Tracker (https://apps.apple.com/us/app/pregnancy-and-due-date-tracker/id1144871267) -Services: will help clients remain calm throughout your pregnancy. This guide will always keep you informed about the processes taking place in your body, the development of your baby and the things that matter the most to you now. Every time you feel puzzled and don’t know how to act in an unfamiliar situation, start this app to find answers to your questions. -Price: $0-1.99 month
Ancillary Services Boost Bottom Line for Midwife Business
Midwife business isn’t about creating income possibilities from your direct services. Your birth center could have a boutique gift shop present. Ancillary services for midwives like Massage therapy, chiropractic services, spas, pedicures, dietitian, and so much more could be part of your practice model and building services. Being able to either make revenue from renting out space to other vendors or directly collecting the funds from managing that aspect of the midwife business will only improve stability in midwifery practice. If funds are slow from insurance companies or patient payments, there are other income streams helping cushion blow another aspect of business not per forming as well as usual. As midwives, we wear a lot of hats. Our clients come to us because we provide unrivaled attention in an industry that has historically left them feeling ignored. This is why one of the best ways we can grow our practice is by providing exceptional care across a wide range of specialties. By being able to offer a variety of services, we can provide our clients with the comprehensive care they deserve! We designed our class, Birth Center Ancillary Service Opportunities, to make your practice more versatile You’ll learn from Leslie Cornwell, a certified nurse midwife with over 16 years of experience navigating the healthcare industry. Leslie has spent nearly 2 decades assisting midwives as they expand their practice and is thrilled to do the same for you! Our mission is to give you the keys to transform your birth center into a community center that will provide unparalleled care for those who need it.
All Midwives Should Have a Financial Plan
Midwives Financial Plan Midwives play an essential role in maternal healthcare, providing crucial support to expectant mothers before, during, and after childbirth. While the focus of midwifery is on delivering excellent care to patients, it’s equally important for midwives to have a financial plan in place. A financial plan is not just about making money but about ensuring financial stability and securing your future in healthcare. In this blog post, we’ll discuss why all midwives should have a financial plan and provide practical steps to help you create one. Why Midwives Need a Financial Plan Income Variation: Income as a midwife can vary, depending on factors like location, type of practice, and patient load. Having a financial plan helps you manage income fluctuations and ensure a consistent financial footing. Retirement Planning: Like everyone else, midwives need to plan for retirement. A financial plan can help you set aside funds and invest wisely to ensure a comfortable retirement. Debt Management: Many midwives graduate with student loans or may have business-related debts. A financial plan can help you manage and eventually eliminate these debts. Emergency Fund: Healthcare professionals should always have a safety net. A financial plan ensures you have an emergency fund in place to cover unexpected expenses or periods of reduced income. Investing in Your Practice: To provide the best care, midwives may need to invest in equipment, technology, or continuing education. A financial plan can help you allocate resources for these investments. Steps to Create Your Financial Plan Assess Your Current Financial Situation: Start by evaluating your current financial status. Calculate your income, expenses, assets, and liabilities. This provides a clear picture of your financial health. Set Clear Financial Goals: Determine what you want to achieve financially. This could include goals like paying off debt, saving for retirement, or investing in your practice. Make sure your goals are specific, measurable, and time-bound. Budget Wisely: Create a detailed budget that outlines your monthly income and expenses. This helps you track your spending, identify areas where you can save, and allocate funds toward your financial goals. Build an Emergency Fund: Aim to save at least three to six months’ worth of living expenses in an easily accessible account. This fund serves as a financial cushion in case of unexpected events. Pay Off Debt Strategically: Prioritize high-interest debts and work on paying them down. Once you’ve eliminated high-interest debt, focus on other debts, such as student loans or business loans. Save for Retirement: Consider setting up a retirement account, such as an Individual Retirement Account (IRA) or a Simplified Employee Pension (SEP) IRA. Contribute regularly to ensure a comfortable retirement. Invest Wisely: Learn about investment options and strategies that align with your financial goals and risk tolerance. Diversify your investments to spread risk. Review and Adjust Regularly: Your financial plan isn’t static. Review it periodically to track progress and make necessary adjustments. Life circumstances and goals can change, so your plan should evolve with them. Seek Professional Advice: If you’re unsure about financial matters, consider consulting a financial advisor or accountant. They can provide guidance tailored to your specific situation. Stay Informed: Keep yourself updated on financial news and trends. The more you know, the better equipped you’ll be to make informed financial decisions. Having a financial plan is a critical aspect of a midwife’s career It ensures financial stability, peace of mind, and the ability to provide excellent care to your patients without financial stress. By assessing your current situation, setting clear goals, and following a strategic plan, you can secure your future in healthcare and enjoy the fruits of your hard work while continuing to make a positive impact on the lives of expectant mothers and their families.
Adjusting Your Midwifery Budgets to New Normal with Covid
Midwifery Budgets Midwives are great at being cost-effective and creating midwifery budgets and protocols on what is best versus the most expensive option. During pandemics, there are ever-changing healthcare standards, and buying equipment in short supply gets expensive quickly. Birth centers and midwives all over the country are frantically trying to make their profit margins work with drastically increasing need for masks, protective equipment, hand sanitizers, and cleaning supplies to combat Covid-19 spread in their communities. We need to weather this storm and work together. I know many midwifery practices are buying supplies in bulk to help weather the high prices. Keeping a close eye on expenses and cutting spending in other aspects of the budget are essential during trying times. Marketing campaigns are usually decreased when midwives and out of hospital births are being naturally sought after with hospitals being filled with Covid sick families. It still amazes me how babies were delivered out of the hospital setting for thousands of years and it takes a pandemic for families to realize that hospital means, “sick house.” It is a place not meant for low, risk healthy mothers and babies. Midwives and birth centers are trying to keep up with the drastic demand shift and handle the additional load of patients’ safety with the ever-changing WHO and CDC recommendations. Midwives Support Midwives are survivors and do whatever they can to support healthy families and communities. As a profession, we have supported women through multiple pandemics and plaques and will continue to support them for thousands of years to come! Here are some additional suggestions from other healthcare systems on how to handle these financially trying times in our history. “For the long-term impact, there’s no question it falls into a couple of different categories. There will be a fundamental shift in how people do budgeting. Budgets are typically thrown out after a month or two anyway, so there’ll be a shift away from that. That’s as big a shift as you can possibly have – the traditional budget mindset is obsolete. It’s more of an approach where we’re trying to drive improvements month-to-month and quarter-to-quarter. We think that shift will be permanent.” Big Shift in the Area of Telehealth The most common usage for telehealth these days is for the common cough-and-cold maladies, but with the relaxation of telehealth reimbursement restrictions from the federal government, usage will likely extend beyond cough and cold – and many of those changes will be permanent. The biggest thing to focus on is adjusting your policies, standards of care, and budgets for the business support long term. Keep a close on what you are spending and other areas of the business to cut funds short term until a “new normal” is in place. Having rolling budget forecasting, following coding guidelines, and anticipating patient behavior changes will help with the coronavirus aftermath. https://www.healthcarefinancenews.com/news/weather-long-term-changes-healthcare-due-covid-19-cfos-need-action-plan Enroll to our amazing course on Covid Care Tips. This course has been created to provide crucial knowledge whether you’ve been practicing since before the pandemic or are just starting out in this career.
Additional Services to Midwife Practice: Big Financial Impact
Additional Services to Midwife Practice Have you ever thought it would be nice to serve families and not just add another birth to the monthly delivery list as the only option to bring in more revenue? There are so many wonderful services midwives can do, and many are quite profitable when looking at the time and initial costs for implementation. I have talked with so many midwives who had to stop giving birth for medical reasons or family demands. Their first thought was that their income would really be hindered by not having the birth charges included in their care. Most midwives don’t realize how much more money comes in for time in proportion to primary care and gynecological services. Most of the midwives who transitioned into well-women clinics made more money doing these services than obstetrics. Unfortunately, our midwifery services are paid based on RVU (revenue value units) that insurance companies determine our time is “worth.” Labor support, being on call 24/7, and additional time spent during prenatal visits aren’t typically paid any extra compared to a traditional medical system approach of short prenatal visits and coming to catch the baby after the nurse has done labor support in the hospital setting. Gynecological and primary services are easy to add into practice to increase the revenue potential. Add a couple extra hours of office time each week to see women for paps, pelvic exams, STD screenings, birth control counseling, menopausal therapy, or breast exams. Some midwives do newborn care, and some don’t. I strongly encourage midwives to provide care within the full scope of their practice. There are so many benefits to having the same philosophy of care for mother and baby in the first month of life. I have had so many times where a mother is given education on breastfeeding and the pediatrician gives the opposite advice. It creates anxiety, confusion, and a poorer quality of care for the family. There is an average of $500 in lost revenue purely from not servicing the baby as well as the mother. Do you have a room that can be rented out a couple of days a week when you aren’t there seeing ladies? Start offering breastfeeding support with a great local lactation consultation (LC). Do a cross-referral system in your birth center and get a commission for services rendered with LC. This isn’t adding any extra time to your schedule, and women are getting a specialist who can help with those unique breastfeeding challenges within your practice’s umbrella of care. The same cross-referral system can be used with almost any business that serves pregnancy and newborns. You could connect with chiropractors, doula support, massage therapists, childbirth educators, physical therapists specializing in pelvic floor, and family practice providers wanting another satellite office to be part of. Adding a store to your birth center is a plus You could add a store to your birth center that sells local artwork, remedies, and supportive equipment for women and their families. Anything can be bought on the internet, but think of personalized items and things that women can’t just buy online. If time is of the essence (sore bottom, cracked nipples, and lower milk supply), families are going to want an easy way to access those herbs and tinctures to help with those challenges. CNMs can expand their range of services to include various procedures such as first aid, circumcisions, ultrasounds, endometrial biopsies, colposcopies, IUD removal and insertions, Nexplanon removal and insertions, diaphragm fittings, pelvic floor therapy, urinary incontinence therapy, and menopausal therapy. These additional services can significantly enhance the profitability of their practices. As midwives, we wear a lot of hats Our clients come to us because we provide unrivaled attention in an industry that has historically left them feeling ignored. This is why one of the best ways we can grow our practice is by providing exceptional care across a wide range of specialties. By being able to offer a variety of services, we can provide our clients with the comprehensive care they deserve! We designed our class, Birth Center Ancillary Service Opportunities, to make your practice more versatile.
Benefits On Adding Water Birth To Your Midwifery Business
Many women search for a midwife, because they want a water birth and their doctor doesn’t offer that service at the local hospital. Midwives are known for water births and the peacefulness this type of birth offers. Many hospital midwives aren’t familiar with water birth and tend to find the unknown skill a bit overwhelming. I am here to tell you as a hospital midwife, home birth, and birth center midwife that did two water births with my kids, it is AMAZING!!! ACOG (organization that runs OB providers) tried scaring women away from water births with position statement that water births aren’t safe. This position statement really dropped the options in hospitals and malpractice insurance coverage that would continue to support this option of birth. Most women need to do out of hospital births to find a water birth option. Over the past decade, immersion in water for delivering the baby is becoming more popular in many countries. Benefits of water immersion include increased relaxation, mobility, and pain relief. The safety of water immersion during labor has been established by research, and does not result in reduced APGAR scores, increased neonatal or maternal infections, or increased NICU admissions (Cluett and Burns 2009). Several studies have shown that water births do not pose increased risks to mother or baby if properly planned and attended by a licensed care provider (Deckker 2014, Young 2013, Demirel 2013). If you haven’t been trained in doing water biths (common for CNM schools), find a mentor or clinical rotation that does water biths regularly. I was blessed to have a clinical rotation with Amish birth center that regularly did water births. The knowledge and skills I gained during that rotation set the framework for how I took care of msot of my out of hospital births. Water birth became second nature. There are subtle differences in assessing a women in the water and supporting birth that need to be taught. Women that choose a midwife for care are categorized as low risk and healthy based on midwifery scope of practice (varies by each state). Not all women are good candidates for water birth. Here are some examples of national guidelines to use for writing policies for your practice. Recommended Criteria for the Use of Water Immersion Mother has elected and made an informed choice regarding water birth Single gestation at or >37 weeks who is low risk and within the midwife’s scope of practice Contraindications for Birthing in the Pool Presence of thick meconium Excessive intrapartum bleeding Elevated maternal temperature greater than 100.4° F (38° C) Non-reassuring fetal heart rate patterns The midwife’s ability to manage complications Active herpes, carrier of MRSA, or untreated skin infection should not enter the pool Rupture of membranes without active labor Use of agents producing sedation It is best if the mother is in active labor, as assessed by the midwife, before the mother enters the water. If used during latent stage, pool should be disinfected and a new liner should be used for active labor. If a birth center tub is used for inflatable home tub, clean using sterilization solution in between clients. Keep a close eye on mother and baby’s vital signs. I typically did mother’s vital signs (BP, HR, and temp) within 30min of arrival at home unless she was close to delivering. I would do them again every 4-6 hours depending on how mother was doing. Baby was monitored based on AWHONN’s guidlines: 30min in active labor and 5-15min during pushing during and after contraction ended. Did around 1-2min of heart tones depending on how active mother was. As long I could determine baby’s baseline and no late decelerations were present, baby was doing well during labor. Waterproof dopplers are a must. Knowing how to angle a doppler to listen to a baby close to coming into the world while a mother is squatting is a talent. There are training programs available for water birth skills. Water Birth International has a great course to help midwives acclimate to this new skill set. https://waterbirth.org/event/online-waterbirth-course/ Since sitting in the pool can be dehydrating, the mother should be encouraged to remain hydrated, drinking water and electrolytes. The mother should be encouraged to empty her bladder regularly on the toilet. Fecal matter or other contamination should be removed from the water immediately. If the water becomes significantly contaminated, the mother should leave the pool unless birth is imminent. The midwife should prepare a safe birth environment outside the pool in case evacuation of the birth pool is necessary, such as having towels and a blanket or mattress near the pool. Special attention should be provided to prevent slipping, and towels and/or a mop should be nearby. Have plastic under the inflatable birth pool and place towels all over the floor to prevent slipping. Having partner and midwife on both sides of laboring when getting in and out of the pool helps prevent falling. I always kept lots of extra blankets around my heating pad for mother and baby when birth occurred. Birth should happen naturally without induction agents or herbs. Let the mother’s body have gaps in contractions that is normal before active pushing starts. Follow the instincts of her body for position changes and breathing techniques. If the mother is starting to breath fast or get anxious, calm her with birth affirmations and a hand to hold during peaks of contractions. Birth should be allowed to happen spontaneously with minimal stimulation of the fetal head. Having a bright, focused light on a mirror in the water is really helpful to see what descent is occurring with baby without placing fingers in the vagina. It is an art to watch the sacrum spend from mother’s back. When the rectum would bulge, I knew birth was close (many times mother would have a unique vocalization when verge of crowning was happening). Let the baby slowly crown. Mother will instinctively grunt and push a
Adding Water Birth to your Midwifery Business
Adding Water Birth to your Midwifery Business Many women search for a midwife, because they want a water birth and their doctor doesn’t offer that service at the local hospital. Midwives are known for water births and the peacefulness this type of birth offers. Many hospital midwives aren’t familiar with water birth and tend to find the unknown skill a bit overwhelming. I am here to tell you as a hospital midwife, home birth, and birth center midwife that did two water births with my kids, it is AMAZING!!! ACOG (organization that runs OB providers) tried scaring women away from water births with position statement that water births aren’t safe. This position statement really dropped the options in hospitals and malpractice insurance coverage that would continue to support this option of birth. Most women need to do out of hospital births to find a water birth option. Over the past decade, immersion in water for delivering the baby is becoming more popular in many countries. Benefits of water immersion include increased relaxation, mobility, and pain relief. The safety of water immersion during labor has been established by research, and does not result in reduced APGAR scores, increased neonatal or maternal infections, or increased NICU admissions (Cluett and Burns 2009). Several studies have shown that water births do not pose increased risks to mother or baby if properly planned and attended by a licensed care provider (Deckker 2014, Young 2013, Demirel 2013). If you haven’t been trained in doing water biths (common for CNM schools), find a mentor or clinical rotation that does water biths regularly. I was blessed to have a clinical rotation with Amish birth center that regularly did water births. The knowledge and skills I gained during that rotation set the framework for how I took care of msot of my out of hospital births. Water birth became second nature. There are subtle differences in assessing a women in the water and supporting birth that need to be taught. Women that choose a midwife for care are categorized as low risk and healthy based on midwifery scope of practice (varies by each state). Not all women are good candidates for water birth. Here are some examples of national guidelines to use for writing policies for your practice. Recommended Criteria for the Use of Water Immersion ¬ Mother has elected and made an informed choice regarding water birth ¬ Single gestation at or >37 weeks who is low risk and within the midwife’s scope of practice Contraindications for Birthing in the Pool ¬ Presence of thick meconium ¬ Excessive intrapartum bleeding ¬ Elevated maternal temperature greater than 100.4° F (38° C) ¬ Non-reassuring fetal heart rate patterns ¬ The midwife’s ability to manage complications ¬ Active herpes, carrier of MRSA, or untreated skin infection should not enter the pool ¬ Rupture of membranes without active labor ¬ Use of agents producing sedation It is best if the mother is in active labor, as assessed by the midwife, before the mother enters the water. If used during latent stage, pool should be disinfected and a new liner should be used for active labor. If a birth center tub is used for inflatable home tub, clean using sterilization solution in between clients. Keep a close eye on mother and baby’s vital signs. I typically did mother’s vital signs (BP, HR, and temp) within 30min of arrival at home unless she was close to delivering. I would do them again every 4-6 hours depending on how mother was doing. Baby was monitored based on AWHONN’s guidlines: 30min in active labor and 5-15min during pushing during and after contraction ended. Did around 1-2min of heart tones depending on how active mother was. As long I could determine baby’s baseline and no late decelerations were present, baby was doing well during labor. Waterproof dopplers are a must. Knowing how to angle a doppler to listen to a baby close to coming into the world while a mother is squatting is a talent. There are training programs available for water birth skills. Water Birth International has a great course to help midwives acclimate to this new skill set. https://waterbirth.org/event/online-waterbirth-course/ Since sitting in the pool can be dehydrating, the mother should be encouraged to remain hydrated, drinking water and electrolytes. The mother should be encouraged to empty her bladder regularly on the toilet. Fecal matter or other contamination should be removed from the water immediately. If the water becomes significantly contaminated, the mother should leave the pool unless birth is imminent. The midwife should prepare a safe birth environment outside the pool in case evacuation of the birth pool is necessary, such as having towels and a blanket or mattress near the pool. Special attention should be provided to prevent slipping, and towels and/or a mop should be nearby. Have plastic under the inflatable birth pool and place towels all over the floor to prevent slipping. Having partner and midwife on both sides of laboring when getting in and out of the pool helps prevent falling. I always kept lots of extra blankets around my heating pad for mother and baby when birth occurred. Birth should happen naturally without induction agents or herbs. Let the mother’s body have gaps in contractions that is normal before active pushing starts. Follow the instincts of her body for position changes and breathing techniques. If the mother is starting to breath fast or get anxious, calm her with birth affirmations and a hand to hold during peaks of contractions. Birth should be allowed to happen spontaneously with minimal stimulation of the fetal head. Having a bright, focused light on a mirror in the water is really helpful to see what descent is occurring with baby without placing fingers in the vagina. It is an art to watch the sacrum spend from mother’s back. When the rectum would bulge, I knew birth was close (many times mother would have a unique vocalization when verge of crowning was