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Life has been throwing us a few curve balls lately, and I would really appreciate both prayers and, if you feel so inspired, guidance/inspiration/advice. The email link works pretty well, and comments are also emailed to me as they are posted.
I can't go into a lot of detail, but my employer is a federally qualified health center. That means that our funding is unpredictable and the needs for our services increase exponentially as the economy tanks. Of course, our funding usually decreases just as the need for us increases - that's the way things tend to work. There are non profits and there are non-profits. Some are pretty flush financially - the Ford Foundation, the Kaiser Family Foundation, Planned Parenthood, etc. And some get pretty desperate for funds - your local community health center, your local public radio station, EWTN, etc.
Now, it seems logical to me that midwives are a cost effective and generally good way to provide prenatal care and birth services. But OB residents can not only provide a lot of that care, they can also provide funding to a clinical site (to pay for the providers that supervise them, for one thing). We have OB residents, but there are not enough of them, nor do they have enough time, to take care of all our patients. So we schedule them to see the high risk moms and invite them to meet the low-risk moms and allow them to do labor and birth care under the supervision of OBs for the high risk and midwives for the low risk patients. It is clunky, but it has been creaking along for the last 6 years or so.

Things seem to be poised for a change. Some of the recent changes in funding for health care are having a negative effect. We are already being pressured to see patients every 15 or 20 minutes, and to do not only their care but their teaching and the documentation of that care within this short timeframe. If the financial constraints continue, we may be forced to provide the same care for the same # of patients at 75% of the time and at 75% of the reimbursement level.

I'm not sure where this is going to send me, in particular. I love working with the population that I serve, especially the immigrant moms. I have some patients that have been seeing my since I arrived at this practice more than 5 years ago. I am on second or third babies for some of these moms, and I have whole families for whom I am their partera, their 'doctora'. But I know that I am not indispensible.

Pray that I will be able to discern what, if any, message God has for me as I adjust to some of these changes. Pray that I will be able to be humble and obedient to His will. Pray that I will continue to be able to discuss this openly with my beloved husband. Especially pray that I will be able to get my self out of the way.


Alicia, I can offer you absolutely no advice, but I can definitely pray and I will. Thanks for the option!


So sorry to learn of the situation that you may have to participate in and co-operate with.

I was never fortunate enough to have benefitted from having the same midwife for my pregnancies or my childrens subsequent births. In fact I think I probably saw every single midwife in the whole of the hospital during those 18 months of pregnancy and labour. (and it's a big city hospital)

There was no consistancy. This meant repeating every detail of pregnancy over and over, hearing differing opinions from practically everyone and crucially this left me feeling as though I had no 'concrete' support or advice. I had a number to phone in an emergency or when worried - not a name of a staff member, not a midwife allocated to my care. Ironically the clinic I attended was completely 'clinical'.

I didn't know any of the midwives by first name, but of course, they knew mine...they saw places on my body I didn't even get to see, but I felt like a 'job' for them to get 'done'. It was as though I was on a conveyor belt...'pop the goods out and adios!'

I remember feeling bereft when I came home with my first child. Elated but bereft. Having little idea what to do with 'it' and feeling terribly insecure.

The personal touch means everything. It may sound trite, but that's the way of it. We don't want to be ticked off, like tasks 'to do' on a worksheet.

I will be praying for you.

God Bless.

Hi Alicia,

I work for a stand-alone non-profit hospital that has a very heavy load of Medicaid and medically indigent patients - most of whom are, of course, immigrants.

Early last year our perinatal department started providing education to new moms in groups. It's worked very well and has actually improved our customer satisfaction ratings dramatically. It may be a difficult schedule adjustment in some ways, but perhaps there may be a way to provide group education and preserve a larger amount of time for individual clinical and charting.

Regardless, you're in my prayers.


THe best thing about midwife care, I found, was having the extra time to talk to someone who really cared and was knowleadgeable. In contrast, the docter's office seemed very cold and business-like. Many things I discussed with my midwives would not have come up if we hadn't had that 45 minute window for discussion.

I agree with Gregg that perhaps some fo the education could be done in groups - which would perhaps giev the moms some community and new friends too. But I think you need to ask yourself why you became a midwife in the first place, and what things are non-negotiable necessities for you to do a job you can be proud of.

Praying hard.

My only suggestion -- I'm a health reporter up here in Canada -- maybe a bit of publicity for your clinic, its wonderful work and financial plight could help. If the institution accepts donations, publicity could lead to donations. It can also give you leverage with the bureaucrats. The squeky wheel gets the grease.


No advice other than every time I have been forced to make a change, God has blessed me with something better.

Our health care system is so broken, and I know those on the front lines such as yourself see it every day.

Prayers, Alicia. I like the above comment about getting some publicity.

No advice, but sending prayers. Change can be difficult but in my own life, I've found that God has used it to lead me places I would have never chosen on my own.

I had my last four kids with a single-practice midwife (although she had various apprentices over the years), and all the education was done in required-to-birth-with-her group evening classes. Of course this was a very different population -- pretty much all middle-class Caucasian home-birth advocates -- but it worked well for us.
Prayers going up for wisdom for you and the decision makers!

Will be praying...

I will pray for you, but as to advice, I am baffled by the whole health care system: consumers pay more, providers receive less, levels of coverage decrease, and the insurance companies keep citing "rising costs." The money is going somewhere (my guess would be insurance companies and lawyers).

These are a lot of hard things to wrap your brain around. I will pray for you and your patients, as well. You will find the answer you're looking for, it might just take a little time. Rest your mind and be well!

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This page contains a single entry by alicia published on January 10, 2006 9:58 PM.

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