HOW DO WE EXPAND ACCESS TO MIDWIFERY?

When I look at the landscape of maternity care in the US, it’s clear to me that more midwives are needed. Report after report confirms that increased access to midwives – and to community-based midwifery in particular – results in better outcomes for mothers and babies. On the other hand, national marketing campaigns for midwifery can cause demand shortages when there are not enough practices to fill those needs. I work every day with midwives who can’t keep up with their current practice volumes, who constantly stretch beyond their limits, who risk making safety errors after working too many hours, and ultimately risk burning out.

How do we stop this vicious cycle of too much demand for too few midwives? How do we train more midwives when hospital practices are competing with residents for clinical experiences? So many people want to increase access to midwifery training by opening more schools, but current schools are already having trouble finding clinical sites. Lots of students want to be placed into private practices to learn about homebirth and birth center birth – but the midwives in these practices are often too busy or too exhausted to take on the responsibilities of being a preceptor. The few that do can be poor role models, showing the next generation of midwives that they need to give everything to midwifery at the expense of self and family.

We need to get to the heart of this problem. I am a person who likes to find challenges and then look for solutions on a large, visionary scale. I love midwifery to the core of my being. I want the midwifery profession to thrive, not just survive, for the future generations. We have come so far, but I worry that the massive influx of demand as a result of the pandemic is changing the profession. From where I sit, this could take midwifery in one of two very different directions. In one scenario independent midwives burn out from pure exhaustion, take hospital jobs, and risk becoming cogs in the bigger healthcare assembly line, thereby losing the core of what makes midwives, well, midwives. The other path is that this moment forces the profession to find answers which help it grow, addressing the root causes underlying its Achilles heel.

One innovative solution is to incorporate business and professional development for midwives into every educational program. Teaching student midwives those skills at the heart of a successful midwifery practice, as well as showing them the financial value midwifery brings to the health care system as a whole, is imperative. We need to give them the tools they need if they choose to work independently, plus knowledge that help them be a voice for midwifery if they choose to work within facilities.

As a whole our society doesn’t teach professional development and business skills to health care providers. Most learn through perseverance, usually devoting extra time they may not have, and taking their hard knocks. It is well beyond time to add these courses to midwifery program curriculums. Even if this happens, where does that leave midwives who are already in practice? Education isn’t limited to universities. I truly believe midwifery could head in a very different direction if we can get more midwives to start listening to business and personal development audiobooks and podcasts while driving to work or winding down from a busy day. As we listen, our mindset changes, our knowledge expands, and our creativity sparked, opening doors we didn’t even know were available.

Instead of midwives saving their own hard cash to build small and slow midwifery practices that can’t keep up with the influx of clients calling, my goal is to assist midwives in having the business tools they need. I want all midwives to understand how to create a strong foundation for their businesses using risk reduction strategies, to have the negotiation skills to increase insurance contract payments, and to create strong business plans they can present to investors and then make their dreams a reality. As for those midwives employed by a hospital, understanding business and personal development skills will make them more valued members of the team. If you can see an area where the financial backdrop system is losing revenue because of EHR errors or see commonly missed procedure codes after taking a billing course, you will not only increase the knowledge of your co-workers, but you can also get them the recognition for the services they are providing and increase the financial and quality value of the bigger system. Businesses big and small are looking at financial reports all the time to determine which services make them money and which ones don’t. You can help them see all that midwives contribute.

The more we can improve income streams for both our own businesses and the ones we work for, the easier it becomes to ask for raises, more vacation time, and additional perks that allow for improved lifestyle opportunities. In turn, when more midwives have a team to support their growth and have self-care in place, the more they will want to take students and give additional inspiration to the next generation of midwives. Instead of teaching that being a clinical midwife is always exhausted and over-stretched, let’s pass on our love for midwifery and show them how to run a successful midwifery career as well.