What Every Midwife Needs to Know Before Hiring Her First Employee
There is a major difference between being a midwife who works in a practice and being the person who owns the practice and employs other midwives.
When you’re an employee, your primary responsibility is generally to provide excellent clinical care within the expectations of your employer.
When you become the employer, your responsibilities expand dramatically.
Now you’re responsible for:
Your patients.
Your employees.
Your payroll.
Your policies.
Your business finances.
Your compliance.
Your workplace culture.
And ultimately, the sustainability of the practice.
For many midwives, hiring the first employee is both an exciting milestone and a major transition in professional identity.
You’re no longer simply asking:
“How do I provide excellent midwifery care?”
You’re also asking:
“How do I build an organization where other midwives can provide excellent care?”
That requires an entirely different set of skills.
1. Understand That Being an Employer Is a New Job
One of the biggest mistakes a growing practice can make is treating employment as simply:
“I’m hiring another midwife to help me.”
You’re not just adding another clinician.
You’re creating an employment relationship.
That means you now need systems for:
- Hiring
- Compensation
- Scheduling
- Payroll
- Benefits
- Orientation
- Training
- Performance management
- Communication
- Documentation
- Compliance
- Termination
- Workplace safety
The transition from clinician to employer requires a shift from doing the work to building the system that supports the work.
2. Determine Whether You Actually Need an Employee
Before hiring, ask:
Do I need an employee, or do I need additional capacity?
Those aren’t necessarily the same thing.
You might need:
- An employee
- An independent contractor
- A part-time midwife
- A per-diem provider
- Administrative staff
- A virtual assistant
- A billing specialist
- A practice manager
Don’t automatically hire another midwife simply because you’re busy.
Identify the actual problem first.
3. Understand Employee vs. Independent Contractor
This is an area where you should obtain professional advice.
You generally cannot simply choose “contractor” because it is easier or less expensive.
Worker classification depends on applicable federal and state rules and the actual nature of the working relationship.
Consider factors involving:
- Control
- Independence
- Economic dependence
- How the work is performed
- Who provides equipment
- How the worker is paid
- Whether the relationship is ongoing
- Whether the worker operates an independent business
Misclassification can result in significant financial and legal consequences.
Don’t guess.
Have your employment structure reviewed by a qualified attorney or HR professional familiar with healthcare practices.
4. Know What an Employee Actually Costs
One of the biggest mistakes new employers make is thinking:
“I can afford to pay this midwife $60 per hour.”
That isn’t the same as being able to afford the employee.
Your actual cost may include:
- Wages
- Payroll taxes
- Workers’ compensation
- Unemployment insurance
- Benefits
- Paid time off
- Continuing education
- Licensing
- Professional liability coverage
- Administrative time
- Recruiting
- Orientation
- Training
- Equipment
- Technology
- EHR access
- Office space
Your employee’s compensation is only one component of the employment cost.
5. Calculate the Employee’s Revenue Contribution
Before hiring, ask:
How much revenue will this employee generate?
Then calculate:
How much will it cost to support that revenue?
For example, if an additional midwife generates significant additional patient revenue but requires substantial staffing, administrative, insurance, and overhead costs, the business needs to understand the resulting margin.
Don’t hire based solely on:
“We’re busy.”
Hire based on a business case.
6. Know Your Break-Even Point
Before adding an employee, calculate how much additional revenue the practice needs to cover the new position.
Include:
Compensation
Payroll taxes
Benefits
Insurance
Administrative costs
Additional supplies
Technology
Training
Other overhead
Then determine:
How many additional clients, visits, or births are needed to support this position?
This number should be part of your hiring decision.
7. Create a Written Job Description
Don’t hire someone with:
“You’ll help me with the practice.”
That is not a job description.
Clearly define:
- Job title
- Clinical responsibilities
- Administrative responsibilities
- Patient population
- Schedule
- Call expectations
- Documentation requirements
- Meetings
- Education requirements
- Reporting structure
- Performance expectations
The clearer the job description, the easier it is to hire and manage the right person.
8. Define the Role Before Hiring the Person
This is critical.
Don’t hire someone and then figure out what you want them to do.
Determine:
What will they own?
What will they assist with?
What decisions can they make independently?
What decisions require your approval?
Who do they report to?
Who manages their schedule?
Who handles clinical questions?
Who handles performance issues?
Ambiguity creates conflict.
9. Create an Organizational Chart
Even a two-person practice benefits from an organizational structure.
For example:
Practice Owner
↓
Midwife
↓
Administrative/Clinical Support
As the business grows, this may evolve into:
Owner/Clinical Director
↓
Practice Manager
↓
Midwives / Clinical Staff
↓
Administrative / Support Staff
Your organizational chart should clarify who is responsible for what.
10. Write an Employee Handbook
A handbook can establish expectations regarding:
- Attendance
- Scheduling
- Communication
- Dress
- Professional conduct
- Documentation
- Confidentiality
- Technology
- Social media
- Workplace behavior
- Leave
- Safety
- Complaints
- Performance management
Have employment policies reviewed for compliance with applicable federal, state, and local requirements.
11. Create an Employment Agreement
Your employment agreement should clearly address applicable terms such as:
- Position
- Compensation
- Schedule
- Call responsibilities
- Benefits
- PTO
- Professional liability
- Continuing education
- Licensing
- Confidentiality
- Documentation
- Termination
- Ownership of work product
- Applicable restrictive provisions, if any
Employment agreements are legal documents.
Have them reviewed by an attorney.
12. Don’t Copy Another Practice’s Employment Contract
A contract you find online may not fit:
- Your state
- Your profession
- Your practice structure
- Your employment model
- Your compensation arrangement
And provisions that are appropriate in one jurisdiction may be restricted or unenforceable in another.
Use professional legal guidance.
13. Establish a Fair Compensation Model
Midwives may be compensated through combinations of:
- Salary
- Hourly wages
- Per-visit compensation
- Call pay
- Birth fees
- Bonuses
- Productivity incentives
Whatever structure you use, it should be:
Clear.
Consistent.
Legally compliant.
Financially sustainable.
And understandable to the employee.
14. Don’t Pay Only for Births
This is especially important in midwifery.
A midwife’s work isn’t limited to the moment of birth.
There may be:
- Prenatal visits
- Postpartum visits
- Charting
- Phone calls
- Lab review
- Referrals
- Consultations
- Team meetings
- Education
- Administrative responsibilities
Your compensation model should reflect the actual work required by the role.
15. Establish Call Expectations Up Front
Call can become one of the most complicated parts of midwifery employment.
Define:
- How call is assigned
- How call is compensated
- Backup expectations
- Response time
- Vacation coverage
- Sick coverage
- What happens when multiple clients labor
- How schedule changes occur
Don’t assume everyone has the same understanding of “call.”
Put it in writing.
16. Create a Strong Orientation Process
Your new midwife shouldn’t have to learn your practice by trial and error.
Create an onboarding program that covers:
Clinical
- Protocols
- Documentation
- Emergency procedures
- Transfer procedures
- Equipment
- Medications
- Referral processes
Administrative
- Scheduling
- Billing
- Communication
- EHR
- Forms
- Supply management
Culture
- Mission
- Values
- Communication expectations
- Team structure
- Professional standards
A strong onboarding process protects both the new employee and the practice.
17. Create a Competency Checklist
Don’t assume that because someone is an experienced midwife, they automatically know how your practice operates.
Establish competency expectations for your specific practice.
Depending on the role, this could include:
- EHR
- Documentation
- Emergency equipment
- Medications
- Birth procedures
- Newborn care
- Transfer protocols
- Communication
- Practice policies
Document orientation and competency appropriately.
18. Standardize Your Clinical Practice
When you become an employer, consistency becomes increasingly important.
You don’t want:
Midwife A does it one way.
Midwife B does it another way.
The owner does it a third way.
Develop appropriate:
- Protocols
- Procedures
- Documentation standards
- Communication standards
- Emergency processes
Clinical independence can exist within a strong practice framework.
19. Don’t Confuse Standardization With Micromanagement
A strong employer doesn’t need to control every clinical decision.
Instead, establish:
Clear standards
Clear scope
Clear expectations
Professional autonomy
Your midwives should know where they have independent clinical judgment and where practice protocols apply.
20. Create a Feedback Culture
Don’t wait until the annual review to tell an employee something isn’t working.
Provide regular feedback.
Ask:
What’s going well?
What’s difficult?
What resources do you need?
What could the practice do better?
What could you do differently?
Feedback should work in both directions.
21. Learn How to Have Difficult Conversations
This may be one of the hardest transitions for a first-time employer.
You may eventually have to address:
- Poor documentation
- Attendance problems
- Communication issues
- Boundary problems
- Patient complaints
- Clinical concerns
- Team conflict
- Performance problems
Avoiding difficult conversations doesn’t make the problem disappear.
It usually makes it bigger.
Address problems:
Early.
Directly.
Professionally.
Consistently.
Document appropriately.
22. Don’t Manage Employees Based on Friendship
This can be especially difficult in midwifery because professional relationships can become very close.
You can care about your employees.
You can support them.
You can have genuine friendships.
But when you are the employer, you also have responsibilities to the practice and the entire team.
Policies should apply consistently.
23. Build a Culture You Actually Want
As the owner, you set the tone.
Employees watch:
- How you communicate
- How you handle stress
- How you treat patients
- How you respond to mistakes
- How you treat other employees
- Whether you respect boundaries
- Whether you follow your own policies
Your culture is created by what you do, not what your handbook says.
24. Don’t Become the Bottleneck
A common problem with growing practices is:
Everything still has to go through the owner.
The owner approves:
- Every schedule
- Every supply order
- Every referral
- Every administrative question
- Every patient issue
- Every staffing decision
Eventually, the owner becomes the bottleneck.
Create appropriate decision-making authority.
25. Hire for More Than Clinical Competence
A great midwife isn’t automatically a great employee.
Look for:
- Clinical competence
- Communication
- Reliability
- Judgment
- Teamwork
- Emotional maturity
- Documentation skills
- Adaptability
- Respect for patients
- Respect for colleagues
Skills can sometimes be taught.
Character and professionalism are much harder to change.
26. Don’t Ignore the Business Side of Clinical Productivity
Track appropriate business metrics such as:
- Number of clients
- Visits
- Births
- Revenue
- Documentation completion
- Billing performance
- Patient retention
- No-show rates
But don’t reduce a midwife’s performance to:
“How many births did you attend?”
Quality matters.
Patient experience matters.
Clinical judgment matters.
Team contribution matters.
27. Invest in Your Employees
Good employees are expensive to replace.
Consider investing in:
- Continuing education
- Mentorship
- Professional development
- Training
- Leadership opportunities
- Appropriate compensation
- Reasonable schedules
- Recognition
Retention is a business strategy.
28. Protect Your Employees From Burnout
A midwife practice can unintentionally recreate the same burnout conditions that cause clinicians to leave traditional employment.
Watch for:
- Excessive call
- Too many births
- Inadequate recovery time
- Constant messaging
- Poor backup
- Unrealistic productivity expectations
A sustainable practice needs sustainable clinicians.
29. Create a Succession Plan
This may sound premature when you’re hiring your first employee.
It isn’t.
Ask:
What happens if I want to retire?
What happens if I become disabled?
What happens if I want to sell the practice?
What happens if I want to step away from clinical care?
Building a business that can function beyond the founder creates options.
30. Make the Mental Shift From Provider to Leader
This is perhaps the most important step.
As an employee, you may have measured your success by:
How well I cared for my patients.
As an employer, success becomes:
How well have I created an environment in which patients receive excellent care and clinicians can do their best work?
Your role changes from:
Doing everything
to
Building something.
Employee-to-Employer Checklist
Before Hiring
☐ Determine why you need an employee
☐ Calculate the financial impact
☐ Determine employee vs. contractor classification
☐ Create job description
☐ Establish compensation
☐ Determine benefits
☐ Create employment agreement
☐ Review insurance
☐ Establish payroll
☐ Review applicable employment laws
Before Their First Day
☐ Employee handbook
☐ Orientation plan
☐ EHR access
☐ Email/communication access
☐ Clinical protocols
☐ Emergency procedures
☐ Equipment training
☐ Documentation standards
☐ Competency checklist
After Hiring
☐ Regular check-ins
☐ Performance feedback
☐ Continuing education
☐ Compensation review
☐ Workload review
☐ Culture assessment
☐ Employee retention strategy
Final Thoughts
Hiring your first midwife is a major milestone.
It means your practice has reached a point where you can’t—or shouldn’t—do everything yourself anymore.
That is exciting.
But it also requires you to develop a new professional identity.
You are no longer only responsible for being a good midwife.
You are responsible for becoming a good employer and leader.
That means learning about:
Employment law.
Payroll.
Compensation.
Human resources.
Leadership.
Performance management.
Team culture.
Financial management.
Risk management.
And perhaps most importantly:
Delegation.
You don’t have to know everything before you hire your first employee.
But you do need to recognize that employing people is a professional responsibility that deserves the same intentionality you bring to clinical care.
Your first employee should not simply make your practice bigger. Your first employee should help make your practice stronger.
