How To Build A Successful Midwifery Practice

What I Didn't Learn In Midwifery School

As midwives, we go through years of college and post graduate education and clinical training. We learn a lot about women’s bodies and supporting the natural processes of puberty through menopause, of everything childbearing and breastfeeding. We learn to provide excellent midwifery care - the science and the art of it. We learn prevention and management of complications and emergencies, and to collaborate or refer to a physician, when we are presented with situations beyond our broad scope of practice.

Doulas take a short course to learn how to provide labor and postpartum support, what is needed to mother the mother during this special journey. These things are obviously necessary to a successful midwifery or doula practice. But how to run a thriving midwifery or doula business is not really included in our training. Unless you’re going to be working in a setting where you’re purely an employee with no administrative or marketing role, there are some key elements missing to our education.

For those of us who are called to accompany families through the incredible journey of nurturing and birthing new life into this world, there is no greater honor than when a momma tells us, “I choose you.”

Even after helping moms to give birth to over 1,000 babies, every time I am hired to provide holistic maternity care I am so grateful and so delighted. I know that I will be a part of a powerful experience for that family. Returning power to women, encouraging them to feel their vitality, live in joy and love their birth are some of the hallmarks of my successful midwifery practice, as are my holistic approaches to health and healing.

However, I didn’t earn the opportunity to support the successful births of so many beautiful babies or empower so many inspiring mommas by education alone.

Having a successful midwifery practice of 21 plus years has provided me with many resources and a lot of lessons that I wish I would have known when I first started.

After my education and training, I felt skilled as a doula, childbirth educator, and a midwife. I could help people heal and transform psychic pain with Clarity Breathwork; I could teach yoga for pregnancy, labor and postpartum, and for life. With much experience and ongoing deeper work, I knew I had what it takes to help mommas love their birth experience and I created an online course to share my local practice with the global community. Professionals around the world also take it, to help them help the mommas they serve. Eventually I could write #1 international best selling books on natural holistic birthing and healing emotional pain, trauma and stress so prevalent in the modern world!

On the other hand, I had no clue how to build a successful, thriving practice. I spent a lot of money and time taking many workshops and continuing education. I embarked on my own self-study to master and refine my skills as not only a midwife, but also as an owner of a private practice and its administrator. And I made A LOT of mistakes along the way.

Below are the key things I wish I knew before I embarked on my doula, and my midwifery journey.

10 skills you need to learn (even if you outsource) for a successful midwifery practice

1) Bookkeeping. Billing, collections, taxes, accounts payable. If you don’t have financial systems in place from the start, things can get pretty messy.

2) Dealing with insurance. If you plan to accept medical insurance, there’s a whole world of claims, codes, and coverage that you need to understand.

3) Online Marketing. Between the ever-changing social media platforms, chat rooms and websites, online marketing can feel overwhelming. It’s important to learn how to stand out on the over-crowded internet.

4) Client paperwork. Making needed practice forms, legal documents, and informative handouts for clients is a must in every practice.

5) Charting. The most efficient chart forms vary from practice to practice. And charting challenging cases can be well...challenging.

6) Professional communications. As you grow your practice, there will be a variety of situations that call for written communications to other health care professionals. These include networking and forming collaborative relationships, thank you notes for excellent supportive care, and summarizing cases for consultations or referrals.

7) External Communications. These are letters written to individuals outside the health care team on behalf of expectant mothers as their obstetric care provider. For example, disability claims, approval for gym membership, dental work, or travel, insurance exemptions, as well as payments and appeals.

8) Team Management. As my practice grew, it became increasingly necessary to have clarity about the roles of other members in my practice. Birth assistants and administrative team members need clear protocols for things like handling emergencies and maintaining certain skill sets.

9) Supply Management. This may seem simple, but not having the right supplies for a care visit or a birth can be a real nuisance. Not to mention embarrassing!

10) Self-care. Setting boundaries in your practice for your own personal health and self-care is key to being the best you can be for everyone in your life - family, clients, and self.

Want to learn how I did all this and more (like how I consistently earn six figures)?

Whether you’re considering a career as a midwife or doula, getting your practice started, or an experienced birth professional looking to take your practice to the next level, my programs will get you where you need to be.

You can have a successful midwifery or doula practice, and I’m here to help.

The Homebirth Midwifery Model of Care

           As a certified nurse-midwife with a full-scope group homebirth midwifery practice,  I am often asked what the homebirth midwifery model of care actually is.  I can speak for my philosophies, which are shared in general by many of my colleagues. We provide prenatal, labor, delivery, postpartum and newborn care, as well as breastfeeding support for healthy low risk families planning to give birth at home; we also provide gynecological and some primary care services to well women. We offer a unique, comprehensive model of maternity care that provides an exceptional level of holistic support and services to achieve optimum health. We believe there are several ingredients that contribute to a deeply positive and healthful pregnancy, homebirth and postpartum experience, in addition to our midwifery care. These include wholesome nutrition, whole food supplements and healthy joyful living, relevant health education with books, movies and childbirth classes, connection with a supportive community, regular exercise as well as an ongoing practice of yoga and meditation and other such methods to reduce inner stress and increase inner calm; we often draw on the expertise of additional professionals, such as doulas, childbirth educators, lactation consultants, acupuncturists, massage therapists, chiropractors or osteopaths, and mind/body medicine practitioners to name just a few. We also encourage each woman and partner to take advantage of the many classes and support groups we recommend  – from prenatal yoga, yoga for labor workshop, and postpartum mommy and me yoga classes, positive birth story pregnancy circles, community new mother blessing ceremonies, annual family reunion, postpartum mom circles, pregnancy retreats and a variety of other educational, supportive, and fun events, classes, and ways to connect with other likeminded people and build community – in an effort to bring back the needed village it takes to raise a new baby, and new parents.

           While we continue to expand in our academic, clinical and intuitive knowledge and wisdom, we are also growing in understanding, appreciation and awe of the sanctity of life and its many facets, transitions and phases. Most women are candidates for midwifery care and homebirth; over 92% of pregnant women in our practice will have a homebirth, and we maintain a cesarean section birth rate of less than 5%.  Ongoing individualized care determines the needs of each childbearing family. We have developed practice guidelines in conjunction with other homebirth midwives, evidence based research and the current midwifery literature; they reflect our philosophies and professional standards for practice, and they are reviewed and evaluated periodically as needed. We follow these practice guidelines to protect the health and safety of each individual in our care; and we try our absolute best, within our human capacity, to give our utmost attention and care with integrity, honesty, and heartfelt commitment and dedication.

Photo by Niki Torres

            We firmly believe that pregnancy and childbirth are normal natural bodily functions, profoundly spiritual, truly inspiring and an empowering rite of passage for women and their families. We also believe that childbearing families are best served by caregivers who promote and encourage a loving, respectful, supportive, family-centered environment, and maintain trust and calm confidence in the normalcy of the process, until proven otherwise. We have taken and will continue to take every reasonable precaution to ensure safety, comfort, and deep satisfaction, which are our top priorities. A safe and wonderfully positive birth experience requires the joint cooperative efforts of both the expectant family and health care providers, with a relationship based upon good open communication, mutual respect, and shared responsibility. Education of women and their families is an integral part of our services, so that women are able to assume this responsibility for health maintenance and effective utilization of health care. Opportunity is offered to our clients to participate in the planning and implementation of their care, as emphasis is placed on an outcome that satisfies emotional, educational, family and spiritual concerns beyond the obvious physical needs. 

           We feel that every individual has the right to safe and satisfying health care by the provider of their choice, given with respect for personal preferences and cultural variations. We believe that normal, healthy women have the right to birth at home if they choose to do so, and as licensed practitioners, feel an obligation to make birth as safe and satisfying as possible for them. For the overwhelming majority of families, the childbearing experience is one of health rather than illness, and there is a need for preventative and loving supportive care that is not only safe, but also sensitive, compassionate and empowering. We believe in enhancing the normal processes of the female reproductive cycle, pregnancy and birth through education, physical and emotional support, and involvement of significant others according to the choices of each expectant mom and those she chooses and wants to be involved.

            Our responsibilities include review of each woman’s complete health history, physical examination findings, and lab results to determine her eligibility for continued midwifery care and homebirth, as well as ongoing evaluation and guidance throughout pregnancy, labor, birth and postpartum with attention to signs of normalcy and/or signs of complications.  All findings are discussed openly; and there will be no routine procedures or interventions unless medically necessary and mutually agreed upon. While childbearing is a healthy, normal and natural process for the vast majority of women and babies, problems can infrequently occur, and need to be recognized and attended to. Although many complications can be prevented or handled simply within our practice, some do require consultation with a collaborative physician or transfer to medical and hospital care to increase the likelihood of a safe outcome.  It is our philosophy that decisions regarding each woman’s care are informed and collaborative, and ultimately hers to make; however, rare emergent situations may arise in which the professional judgment of the midwife and/ or consulting physician must be relied on exclusively for the safety of mother and baby. We are grateful for life saving hospital medical and surgical care when there are serious complications and illness; and it is my hope that the homebirth midwifery model of care can be applied as much as possible in all birth settings, including the operating room, if surgical birth is needed.            

           There is an overwhelming cultural belief in the United States that hospitals are the safest place to give birth, regardless of the extensive scientific data that planned homebirths with skilled midwives suggest otherwise. Numerous studies around the world have documented the safety of planned homebirth by trained professional midwives, with outcomes at least as good, if not better than those occurring in a hospital.  This is especially true of women who have delivered vaginally before. The total slight increase newborn mortality risk of home birth is estimated to be 10 per 10,000 babies born at home, and that 1 in 1000 babies born at home may be adversely effected by the extra transport time in reaching advanced care in the hospital; the absolute risk is small however. Despite spending the most money on obstetric care, the United States ranks among the lowest of industrialized countries around the world in neonatal mortality and morbidity, and ranks quite low in maternal mortality and morbidity as well. Countries that consistently demonstrate the best maternal and newborn outcomes have a large percentage of midwife led maternity care for healthy women experiencing normal pregnancies - which constitutes the vast majority - a higher percentage of homebirth midwifery care with supportive hospital/medical transfer arrangements when needed, while the obstetricians attend to the women with high risk complications and serious illnesses, which is how they are educated as surgeons and medical doctors.  When midwives and obstetricians work together as a team, both using their unique skills, knowledge, expertise and training, the outcomes for moms and babies are far superior. Midwives are trained in guarding the normalcy of pregnancy, birth and postpartum, not disturbing it when all is well, knowing when to compassionately observe with loving support, and when and how to use holistic remedies, or medical intervention only when necessary as a last resort; they are also educated in prevention, assessment and treatment of complications, which most times can be managed simply and naturally, but sometimes involves consultation or referral to an obstetrician. Although unforeseen events and emergencies can occur in any birth setting, some of which can be best handled in a high risk hospital, a low risk healthy woman entering the typical U.S. hospital expecting a normal vaginal birth is subjected to a routine barrage of procedures and interventions that dramatically increase the risk of complications and problems, with potentially longstanding physical and emotional ramifications for both mother and baby. 

            There are many other benefits of homebirth midwifery care, in addition to safety, which provides an alternative to the impersonal, fear based, law suit prevention oriented medical and hospital care that has become prevalent in our society. These benefits include but are not limited to the power of the human touch and presence, of being surrounded by supportive people of a family’s own choosing, security in birthing in a familiar and comfortable environment of home, feeling less inhibited in expressing unique responses to labor (such as making sounds, moving freely, adopting positions of comfort, being intimate with her partner, nursing a toddler, eating and drinking as needed and desired, expressing or practicing individual cultural, value and faith based rituals that enhance coping) -- all of which can lead to easier labors and births, not having to make a decision about when to go to the hospital during labor (going too early can slow progress and increase use of the cascade of risky interventions, while going too late can be intensely uncomfortable or even lead to a risky unplanned birth en route), being able to choose how and when to include children (who are making their own adjustments and are less challenged by a lengthy absence of their parents and excessive interruptions of family routines), enabling uninterrupted family boding and breastfeeding, huge cost savings for insurance companies and those without insurance, and increasing the likelihood of having a deeply empowering and profoundly positive, life changing pregnancy and birth experience. Getting holistic prenatal through postpartum care and birthing in one’s own home attended by a skilled midwife, is a refuge for those who want to protect the normalcy and sanctity of pregnancy and birth. But focusing on the normal does not mean that problems go unrecognized or unattended; rather they are viewed as imbalances that need to be righted, not expected or feared. 

           That being said, certain hazards do exist however, in all settings, whether childbirth occurs in or out of the hospital; and there are risks unique to each setting.  Some of these risks will never be eradicated no matter what our state of technology or medical advancement. The safety of home birth is well documented, but childbirth by its nature is a threshold passage for the mom, and the baby.  Some babies are born with defects and injuries despite all the technology, tests, and skills of the attendants.  In spite of the fact that that hospitalization of birth has failed to eliminate fetal or neonatal death, there is a cultural expectation that doctors and hospitals can guarantee a “perfect baby” every time. This is a pervasive myth. It is impossible for any provider to guarantee much of anything. Birth defects may or may not be detectable by prenatal testing. The practice of midwifery, nursing and medicine are not exact sciences and no assurances can be made regarding the results of examinations, diagnostic tests, treatments, procedures, or interventions. It is impossible for any provider to guarantee a normal healthy birth, mother or baby. Part of the wonder of the miracle of birth is the inherent lack of guarantees in life and birth, and the surrender to a power far bigger than ourselves. Part of life is death, and we often do not know why a person lives or dies. We do have a spiritual perspective, and believe that while we can do our best to do what is humanly possible, most of life, birth and death are ultimately not in our control; we do believe that everything that happens is meant to happen, because it did, and that it happened for our benefit, even if beyond our understanding, as we are souls temporarily residing in bodies, and know that G-d/Spirit of our own understanding is only good. Conception is the beginning of life, yet every life must end sometime.  Part of pregnancy is the excitement of new life and the fear of its loss. This is normal human reality and is in part why pregnancy deepens and matures a woman and man spiritually and emotionally.

Art by Spirit Y Sol

Photo by Megan Hancock Photography

           We try our hardest to give the best care that we possibly can, pray we make the right decisions and that our hands are blessed. But we are all only human.  Midwifery and obstetrics are such humbling professions. And I would choose no other. 

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma,

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are planning a birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams.

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom andcommunicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

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