Creating a routine office flow for the week is vital for successful time management and preventing burnout. I encourage making a vacation scheduled every three months to help separate personal and work schedules. For smaller midwifery practices, being able to block time versus 24/7 in a scatter function which tends to happen with home births is a must. The most successful home birth practices I have seen do two office days (usually Monday and Thursdays) 10-6pm. This rotation gives the luxury of moving office schedule to next day of week if birth is occurring (Monday would move to Tuesday and Thursday would move to Friday). By starting at 10am versus 8am, midwife can either get some extra sleep from doing a birth that night or having time available in morning to see postpartum home visits prior to office hours starting.
Births are unpredictable and if your office structured time can have some consistency with simple flexibility during birth time, will only help your personal work and life balance. I have seen some midwives do Saturday office days (especially with just opening the ,midwife business to be flexible with working mother’s schedule challenges). My main challenge with that is midwives get enough weekend family time interrupted with unpredictable birth. Try to structure as much family time on weekends as possible.
I would see my first prenatal visits and visits that needed more education like 36wk gestation and postpartum home visit as one hour blocked slots. I would make sure driving to and from home visit was placed on my schedule so receptionist didn’t accidentally schedule me an office visit right after leaving patient’s home (has happened a few times). Rest of my visits during pregnancy, annual exams, and gynecological services were 30min visits unless client requested longer time slot. I always gave families autonomy to add more time to their visit (just call office to make sure we could slot them longer and not have next visit be waiting).
Some midwife business budgets allow that time flexibility and some don’t. When your practice is basing its overhead funding and budget on insurance reimbursement, it is ALWAYS a balancing act of quantity versus quality. Insurance company will pay for prenatal visit, birth, and maternity care amount whether midwife is doing prenatal visit for 5min or 1hr. One of main reasons why doctor’s office and even busy hospital based midwifery practices have 5-15min prenatal visit. Insurance plans do dictating of time spent due to flat reimbursement scales for care.
Larger midwifery practices typically create an office and call schedule rotating evenly among team. Midwife groups with 2-4 midwives tend to have office and call on same days. Their volume is usually low enough that birth doesn’t affect office schedule as much. I have seen where there is always two midwives in the office each day so even if one has to leave for a birth, other midwife will see some of patient’s that other midwife was seeing.
Once there are 5 or more midwives within a practice, it is much harder to have office and call on same day. Many large midwifery practices have midwife stay on Labor and Delivery Unit when on call, because birth volume is so high. They would get off day from post call (typically 24hr call coverage) and then office 2-3 days week. It is rare that a midwife will do office post call at a busy midwifery practice. There is only so many hours in a row anyone can safely be up and not make a mistake.
Budgets and local norms of midwife expectation dictate what is defined as a full time midwife status. It isn’t so much based on how many average hours she will work, but volume of care numbers in office and births that determines salary and number of midwives present with team. When creating your personal office schedule or coordinating a team of midwive’s schedules, always have in mind structure, budget, and full time expectation of a midwifery schedule.