Do I still have to pay you if I transfer?

I get this question pretty often at consultations. The short answer is: yes. The why of that is the content of this blog post.

Most people hire a homebirh midwife to provide prenatal, antenatal, and postpartum care. That care includes all of the really fun and crunchy stuff like preparing sitz baths and herbal teas but it also covers the midwife assessing if her client's pregnancy requires medical intervention. If a midwife transfers a client to physician care or refers for physician assessment because of a physical or emotional condition she is doing her job. She should get paid for doing her job.

I won't speak for all midwives, but I will speak for most when I say that we struggle over demanding payment for our services. We develop a relationship with our clients and usually don't have a big staff who can do all the sticky stuff for us. We know that young families struggle to pay us. We know that when birth doesn't go as expected it is an emotional blow as well as a financial blow.

Yet, midwives leave our own families to take care of our clients. We incur expenses in order to care for our clients. Most of us can't work for free. In my midwifery 'practice' I ask for full payment for care that goes past 36 weeks. Most folks don't realize that if I break down the costs I am only making about $500 for each birth, the bulk of what I do is done prenatally. So yes, even if you transfer out of my care at 36.5 weeks you will owe the whole fee. Sometimes, I will extend a courtesy discount, but I am still planning to attend your birth (if I am not leaving another laboring woman without a midwife) and give you postpartum care as long as it is appropriate to do so. I am still your midwife.

I appreciated the perspective of a family I cared for. They had to transfer out of my care late in pregnancy when complications developed. They were devastated. For awhile, our relationship took on a tense nature. I was able to stay with them through the labor, birth, and postpartum experience. While they were still somewhat disappointed about not having the birth they had prepared for in time they found peace with it and let me know later that they are grateful for the care that they had during their pregnancy and we have remained in contact. In fact, I count them as friends. It was a huge relief for me that the relationship that we had did not disintegrate over a tough decision.

Money is a difficult issue for midwives. We work from our hearts not in respect to our wallets. Yet, we live in the real world and can't provide care to women if we are expected to devote ourselves to them without compensation. I have made the mistake of being too flexible with payments. Because of this, I have yet to pay myself a wage for the work I do. I still have to pay for my rent, my assistants, my supplies..etc...so even if I work for free the work I do is not free. I have learned this lesson the hard way to the extent that my future clients will not be extended the same graces that some of my former ones benefited from. Most of my families have not taken advantage of my leniency...but some have and it only takes a few to put you in the red.

It breaks my heart to transfer clients and the few times I have had to I had to steel myself in order to do the right thing. I sought advice, researched, and searched my heart to come to the inevitable answer if it was a prenatal transfer and if it was a transfer during labor or the early postpartum hours I was doing a LOT of praying for a resolution before I called it. This is not an area to be flippant with. It is also not an area to be meek about. As a midwife, you have to make tough decisions. You have to think of the safest scenario. I am not God, I don't even work for him...but I do work for the families and I respect the position they put me in when they ask me to care for them. I also realize that I can be wrong; that is the nature of hiring a human. I realize that I may transfer someone who ends up having an uneventful experience...it may mean that I was wrong or it may mean that what could have happened didn't. Great!

All of this when the short answer should suffice. :-) Yes, pay your midwife!