Yes, the life of a homebirth midwife is very different than the life most of my peers are headed for!
What comes to mind when reading the comments of this post... which I am so grateful for, it feels good to try blogging consistently again... is, these are like two very different careers. A CNM working full time in a private office asking for her own office space is not over the top. Nor is requiring a substantial salary. She's seeing the same number of patients a day as her peers... she's providing the same basic care... she requires the same equipment... she deserves a place to hang her degrees, consult her patients, and eat her lunch in peace just like the other providers... and she deserves to be compensated equally for equal work. I am not a midwifery martyr. Working for years without payment is unacceptable to me. But good luck to those who can afford it. It reminds me of a conversation we had one day about how midwifery is a" rich white woman's hobby." I bucked at that comment because, as always, I was thinking about the granny midwives, and I never seem to meet any wealthy midwives. But now I can see how people came up with that, and after being in this environment for a while I have learned that many wealthy people do whatever they can to look otherwise. That doesn't mean that I buy into this definition of midwifery, but I get it. It gets at a subgroup of women who might be able to afford to work for free for several years and still pay bills and have partners who are home 24-7 raising babies and supporting them in their life journey. But I think the more likely scenario is struggle. I'm done strugglin. Spend most of my life strugglin. Don't intend to spend the rest of it doing the same.
There's such a huge difference between a provider who sees maybe 10 patients a month and one who sees 20 a day. It's one thing to have a rough patch of 24-48hrs of active call time for one or two patients at various times during the month, but it's another thing entirely to be at the hospital for 24hours and then in clinic for 10hours directly following that, twice a week, continuously, every week. I think that's unsafe.
I believe in homebirth. But I don't want a homebirth practice. (not to mention it's illegal for CNMs in Nebraska anyway) I'd have my babies with a homebirth midwife in a minute (if I weren't risked out for this pesky, fluffy adipose ;o) and I wanna catch a baby or two in my lifetime, but otherwise, homebirth catchin is not in my future!
If I know one thing for sure, it is that midwifery does not come before me and my family. And I'm ok with that. I hope I can find a good balance though.
Thursday, October 9, 2008
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1 comment:
First - I'm glad you're back - I missed you, and kept checking on the off chance you reappeared!
The discussion of lifestyle is fascinating to me, and something I think about a fair amount. As a family doc, I practice probably more as you will in the future than my homebirth-practice friends, excluding the research factor for you. I see clients in an office setting, and attend births in a hospital setting. A major difference is that my practice consists of clients other than maternity and women's health, and perhaps that makes it a bit easier to manage (or perhaps it makes it harder?)
At present, I practice in a small group practice - 3 family docs and 2 nurse practioners. 2 of us do maternity care (an older male family doc, and myself) At this point, I attend all my own clients in labor unless I am on vacation, which means probably 49-50 weeks of the year I am on call for my own clients. I attend 60-70 births a year, and have for the last 7 years. I have been thinking recently about doing something like Pamela is looking into, with being off call one weekend a month, and already am having my partner cover for me when I need to for family events.
I don't honestly find it that hard to function with the call - I practice in the small town I live in, and I rarely want to be somewhere else, so being on call doesn't restrict my activities as much as it would if I lived farther away from where I worked. My kids are very busy, and I try to attend all their games and concerts and what have you - and it is in fact, fairly rare that I miss something. I immensely enjoy attending my own clients, and would hate to completely give that up, and my current clientele frequently chooses me because they know I cover my own call, so at present I can't fathon giving up that continuity completely.
It is draining, though, just to be on call, even if you are never called. It is getting harder as I get older to stay up all night and try to see patients the next day. There is also the feeling sometimes that the client you are working with may well have done just fine without you, but the child who is missing you at home may remember your absence forever.
I think it's important to work out ways to provide high quality care without sacrificing the care provider to do so. In my lower volume maternity practice, it is reasonably practical to continue to attend my own clients and at present the sacrifice is not too onerous, but in other settings it would not be practical to practice as I do. I have been making it a point more often to turn over my call to my partner when something important is going in my family life, and I tell my clients that as much as I want to be their for them, my own kids and husband have to be my priority. Clients are amazingly understanding about that type of thing it turns out. After all, my children do not care that I'm missing them to do something noble - they only understand that I'm not there for them and that is not the type of mother I want to be.
Good for you for thinking about these kinds of things before you are even out there looking for a job - I suspect that many folks do more as I did, which was not give much thought to how I'd handle being on call and such until I was having to do it all the time!
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