Frequently Asked Questions

Transcript

Please note this transcript was generated using AI software and may contain errors.

[00:00:00] Mel: Hello everyone, Melanie Jackson here with you again. And today, second day of our Becoming a Privately Practicing Midwife series. And on this second day, I always like to do the frequently asked questions section because usually people are coming to this workshop or this week of information, whatever we're going to call it, with some longstanding questions about private practice midwifery.

[00:00:23] Mel: And then they always flood in on day one. I've been getting so many emails from yesterday's Lesson and also the call out to just offer information about what's blocking you from entering into private practice midwifery. So today I want to answer some of those questions and you'll feel free through the week to email me with more of your questions because I'll be doing this through the week is offering answers to some of the more commonly asked questions.

[00:00:50] Mel: So I'm just going to get straight into those today because I want to give you as much information as possible. That's what this week is about answering your questions. To see if maybe entering into private practice midwifery is not the scary step that you thought it was. So, first question that always comes up is about being a new grad or a midwife who's still getting through those 5, 000 hours that we talked about yesterday.

[00:01:15] Mel: And it's really hard to work in the system if you want to be a private midwife and you're stuck in this system that just is railroading you down into managing birth only in the way that's So, the question is, what advice do you have to help me through the 5, 000 hours? And this, I'm really passionate about this 5, 000 hour thing.

[00:01:37] Mel: And as I said yesterday, in the first video, is that this 5, 000 hours, they're likely to be reviewing it. But let's just work towards the possibility that you might need to still get 5, 000 hours. Here's how to get through that time. With actually, I think this is actually an opportunity and a lot of people look at the 5, 000 hours really disappointed that they're going to have to do it.

[00:02:01] Mel: But if we can see this as an opportunity to gather the skills that you are going to need for private practice midwifery, all of a sudden, your complete mindset on the 5, 000 hours changes. So that's my first tip. Adopt what I call, or what is called, I don't call it, it's not my terminology, but the craftsman's mindset.

[00:02:20] Mel: And a craftsman always looks at his or her work and asks, how can I get better? What do I need to do to gather the skills to keep building and honing my craft? So your craft is midwifery and you want to get really, really good at it. And this 5, 000 hours in the system, although it's really difficult, is an opportunity to hone some of your craft.

[00:02:43] Mel: And there are some things that you don't get a lot of practice on when you're actually in private practice midwifery. So, for example, I don't get to suture very often because actually not many perineums need suturing at a home birth, even if there's been a tear. That's a whole other thing, but...

[00:03:00] Mel: Practicing suturing. The other thing is we don't do a lot of vaginal exams at home but when we do we need to be really really good at it. So take your opportunity while you're in the hospital to practice things that are done repetitively over and over and over again. Things like cannulation, you know, getting used to some policies about what do you do for women who've got preeclampsia or high blood pressure or whatever it is.

[00:03:25] Mel: Things that, anything that you can learn that you know that you're going to be able to transfer into private practice midwifery, take the opportunity to hone that craft. And so this is about, the 5, 000 hours is about gathering the skills that you're going to need for private practice midwifery. Yeah, can you cannulate?

[00:03:43] Mel: That would be amazing to keep practicing that. So think of the skills that you might need for general exams, recess, cannulation, you know, obviously there's a lot that you'll be learning. And there's a lot that you'll be UNlearning when you leave the hospital system. But there's certain core skills that you, that will take you through to your private practice midwifery career.

[00:04:04] Mel: And so, focus on gathering those. The craftsman's mindset says, What can I learn and how can I get better? Instead of... How do I just get through these hours and get out of here? So take this opportunity to learn. The other thing that's really important is that you build strong relationships with your local health care services.

[00:04:26] Mel: Because when you're in private practice, you're still going to be using them. You still need to have a good reputation with your local hospital, so that when you transfer your clients in or when you need to escalate care antennally, postnatally or during birth, that that hospital will willingly accept and welcome your clients and you in, in a situation that's not hostile.

[00:04:47] Mel: And so work at finding work, finding buddies in the system, work out who might be somebody who you can tap into when you're in private practice as a contact point. But basically you want to maintain a good reputation in your service. The other thing that you might find. It's like minded midwives who are really keen to also enter into private practice and you guys can just work at that together.

[00:05:12] Mel: So, building strong relationships where you can uphold a good reputation will put you in good steed for your career as a privately practicing midwife once you leave the system. So that's always my answer for people who are asking what can they do in those 5, 000 hours, even though it's hard. I think take advantage of the opportunity that you have to repetitively practice skills and to build strong relationships.

[00:05:37] Mel: Okay. Next question is about the role of the second midwife. If you're new to private practice and the idea of working as a privately practicing midwife, the rules are here in Australia that you have to have a second midwife at the woman's birth. So that can work a number of different ways. And, you know, we can talk much later about how, or what the role of a second midwife in, in regards to sort of what the Woman needs and what every single sort of different midwife uses.

[00:06:11] Mel: I personally, I've always used other private midwives as the second midwife for lots of different reasons, and we'll talk about that. Some midwives have midwives who just work in, who work in a hospital, and they will access them just for the birth. So they'll call on whoever's available that day. But the role.

[00:06:31] Mel: If at the very base level, the role of a second midwife is to be present for the birth. And I guess it's just in case there's an emergency, but the rule is, is that we have to have a second midwife. So it depends on you and the midwife that you're working with as to what role she or he might have as your second midwife.

[00:06:52] Mel: I can speak to my personal experience, but I have always hired. Second midwives who are already private midwives. So they already have their own caseload as well. The reason for that is that that way I know that they have all the equipment that they need. in case I'm not available. And so, for me, part of the role of a second midwife is to step in as the first midwife, as the primary midwife, if for any reason I can't be there.

[00:07:18] Mel: For either an antenatal visit, the birth, or a postnatal visit. So I know that all the midwives I work with could completely replace me, if that was necessary. And this is really nice for things like sick days, important events that you don't want to miss, if you need to take holidays, you know that you can.

[00:07:38] Mel: offer the opportunity for women to have their second midwife take over, knowing that they are fully qualified to do that and have all the equipment and experience. But a lot of midwives don't have that luxury of having a spare private midwife available. And so you can use any registered midwife as a second midwife.

[00:07:59] Mel: And at the actual birth, how we do it is the primary midwife goes, the woman's Midwife who she's hired goes when it comes closer to the woman actually giving birth. We call our second midwife They come usually do paperwork help with passing equipment if we need it Reheating the pool emptying the pool after the birth stepping in if there's an emergency to beat a second pair of hands you know, they might be the one making the phone call to an ambulance if we need to and they're there also for Just to bounce ideas off and strategies But essentially, the way I explain the second midwife to my clients is that they could replace me if needed, but they are there to do all the other background work while I'm working clinically with the woman.

[00:08:45] Mel: So the second midwife is there for me and then occasionally for the woman in an emergency. And it's true that the second midwife doesn't have to be endorsed. So any midwife can step in as a second midwife, whether you're working in hospital or not. And, yeah. So that can happen. So next question that's come through is how do you support women who want care outside the guidelines so that you can protect yourself and avoid being reported?

[00:09:15] Mel: Alright, so the backstory on this is that as privately practicing midwives we work under certain legislative documents. And one of those documents is the Australian College of Midwives Guidelines for Consultation and Referral. And you can get access to this as a PDF. It's completely free, uh, through the Australian College of Midwives, or you can buy yourself a copy.

[00:09:37] Mel: But basically, the Australian College of Midwives Guidelines for Consultation and Referral, or we just simply call it the guidelines, have divided lots of, a big, big list of pre existing You know, uh, conditions, things that come up through pregnancy or afterwards as a Category A, B, or C. And then that dictates, if a woman's a Category A, B, or C for her certain health conditions, that will dictate whether or not you as a midwife are required to refer that woman on, or whether you could just consult with someone, or if they're a Category A, they're completely within your scope and you don't have to activate the guidelines.

[00:10:17] Mel: Now, there are some women who fall outside of the guidelines. So what we would say probably a Category B or C. who declined the recommendation to be referred to or consult with another healthcare provider. So as midwives, we're required to offer women the opportunity for consultation and referral if they are in a category B or C.

[00:10:39] Mel: In the guidelines. If they decline that opportunity, then there is a document that we can use called a record of understanding that is in the guidelines and basically this record of understanding is designed to be used as a record keeping tool for women who decline the recommendation. So these are the women who you might be thinking are outside of the guidelines.

[00:11:01] Mel: So they still want their midwife to be caring for them and they've declined the opportunity to escalate care to another health care provider if required. So the, the way that we protect ourselves in these situations is educating the woman thoroughly about her circumstance. So one of the things that would be considered outside the guidelines would be something like VBAC, Vaginal Birth After Caesarean.

[00:11:30] Mel: And although it's, it does feel within my scope to care for women who are planning a VBAC. I still will always tell them that they're a Category B in the Australian College of Midwives Guidelines. And as a result of that, I'm required to recommend that we have a consultation with an obstetrician, somebody else at the health service.

[00:11:49] Mel: Most of the time, women decline this opportunity. And so we complete the record of understanding. I list out all of the education that I've given to the woman and it needs to be broad and thorough. Not just your perspective. It needs to be all the options that are available to this woman. What would be offered to her in hospital.

[00:12:08] Mel: What, you know, what the research says, what the guidelines say. What you've got to offer so that the woman can decide for herself what she wants to do next. Does she want consultation referral? Does she want a home birth? Hospital birth? What kind of level of monitoring does she want? So basically, your job is to give her all the education.

[00:12:29] Mel: Offer her the opportunity for a consultation and or referral. And if she declines that, then you complete the record of understanding which details everything that you've gone through with the woman. So if you've been really thorough with your education, It's non biased, it's broad, the woman's been receptive to that, you've documented all the care that you've given, your recommendations are evidence based, and you've been very clear about your scope of practice and the ACM guidelines.

[00:13:02] Mel: requirements. Then, and you complete the record of understanding. That's how you keep yourself safe. Give really good thorough care and education. Inform the woman of absolutely every little bit of information that you have. Inform them of your scope of practice. If you don't feel capable of caring, of caring for a woman who's planning a VBAC, then you need to let the woman know that this is out of your scope and that you recommend that she seeks different care, for example, or does something else to make sure that she's kept safe.

[00:13:36] Mel: And so, this is how we keep ourselves safe. Either follow the ACM guidelines, or follow the documentation process and education process that would be required to complete a THARA record of understanding. If you're giving evidence based care and non biased approach to educating women, the other thing you can do to keep yourself really safe.

[00:13:58] Mel: In private practice, and this is where some of the issues come up when midwives get reported for doing things that are considered outside our scope. Even if we've been through this beautifully thorough process of thorough documentation, thorough education, evidence based care, following the ACM guidelines.

[00:14:16] Mel: But when you're engaging with other people in the healthcare service, because this is where usually your complaints are going to come from, not from your clients, usually other healthcare providers are going to be the source of What we like to call vexatious reporting against private midwives. But if you have worked really hard to build your reputation, and you are really polite and kind to people when you engage, you're much less likely to be reported to the HCCC based on an emotional response to your care.

[00:14:49] Mel: or your presence. So some people who feel threatened by you might do vexatious reporting, not at all based on the type of care that you're providing, just because of their hostility. So make every effort to just be kind and polite to people and you may find yourself able to avoid complaints. This doesn't happen to everybody.

[00:15:08] Mel: I mean, there are statistics that suggest that up to 50 percent of private midwives get reported, but that is not as scary as you think. I've had three reports in the past. All of them have gone nowhere because I really vigilantly give thorough care, complete the documentation thoroughly, follow the guidelines, it's evidence based, I'm as non biased as possible and I make every effort to keep everybody on site.

[00:15:37] Mel: So complaints are not the big scary thing that you think they might be. They are not career ending. You can keep yourself safe by doing a really good job. But also early on in my career, I was very, very selective about, selective about the clients that I would agree to care for. So in the first few years of my midwifery career where I was just a brand new midwife and you know feeling, Not very skilled.

[00:16:03] Mel: I would take low risk, multi pressed women only. So I would not take on women who are planning a VBAC or who had gestational diabetes or thyroid conditions or anything like that. My scope and your scope will gradually grow and grow and grow the more times you care for a woman. But at first, it's absolutely fine to just select Women, so let clients who are within your comfortable scope of practice, don't stretch yourself at first, only do what you're comfortable with and let women know that from the beginning.

[00:16:36] Mel: So this is a way that you can help support women to make care that are outside the guidelines, but also avoid being reported, protecting yourself, but educating the women as well. So you want to just give thorough care, really good care, focus on high quality. And very good documentation. And that's what's going to keep you safe.

[00:16:58] Mel: All right, next question. How many women do private midwives normally look after and how do they manage their workload? Such a good question. It always comes up every single year. So fortunately, I've worked out a pretty, uh, good, I think it's good, way of calculating how many women you can look after in your year.

[00:17:21] Mel: And so this is something that you can apply to your particular work circumstance and your life circumstance. So, Uh, over the years, I've, I've had a look at the documentation that I keep for every single client and I've tallied up roughly how, an average of how many hours each client will take over the, the duration of their care.

[00:17:44] Mel: So the average care that a woman requires from you as a midwife is about 40 hours over her care. If she's had a really long labor, obviously that blows out. If she has a short one, that's different. Sometimes we can go to 42 weeks and you're giving way more antenatal care than usual. Sometimes they've got some extra postnatal issues and you'll be seeing them more frequently, but you can average it out to approximately 40 hours per client.

[00:18:09] Mel: So that would kind of be, I imagine 40 hours to be a standard work week. And so if you want to work full time as a privately practicing midwife, you can look at that and go, if I have... to allocate 40 hours per client and I have roughly four weeks a month, then a full time load would be approximately four women a month.

[00:18:33] Mel: There are midwives who take on more than this and they may compensate by either doing. Much longer hours each day or providing less hours of care somehow. So it depends on what you want to do. If you want to work really hard and heaps of hours and that's all you're doing with your week, if you don't have a family to cater to or you know, you're sort of free to do that.

[00:18:56] Mel: That's a choice that you can make. Can I just recommend that you don't make the choice to provide less care? Uh, I just, one of the real hallmarks of private practice midwifery is that we have time for our clients and that we provide Adequate care. The time pressure is what you get in a system. It shouldn't be what women are going to get from their private midwives.

[00:19:19] Mel: That's just a personal opinion of mine. There are midwives who take on heaps and heaps of clients. That's their choice. I personally believe that the cap is at about four women a month. Sometimes you can take on more if you've got a quieter next month or, you know, however it works out. So, then you've got to consider, well, how many hours do I have to give to private practice?

[00:19:41] Mel: If you are a woman with small children, or if you don't have a lot of support, or if you only work part time anyway and you're thinking, I only actually want to work part time as a privately practicing midwife as well. Think about how many hours you've got. Do you have 40 hours a month to commit? And if you do, then you could take on one client.

[00:20:01] Mel: Or if you have 80 hours a month to commit, then you could take on two clients. And then also think about the money that you need to make. Think about how much money do I need, per week or per month, as an income. What are you currently making and how would that compare to how many clients you might need to take on.

[00:20:19] Mel: And we're going to talk about in the, in this video as well, the earning capacity of a private midwife. But midwives can charge anywhere from 6, 500. I've seen midwives charging up to 8, 500. So it depends on your service structure. But if you think to yourself, right, I can only take one client a month because I only have 40 spare hours a month.

[00:20:39] Mel: And that client might pay you six and a half to eight and a half thousand dollars. How does that feel for you in terms of the amount of money that you'll need that month?

[00:20:52] Mel: How do You can determine how many women you can take on. It just depends on your circumstance and how much time you have. On busier months, for example, this week, where I'm here with you answering questions and really engaging with this learning process. I take a lot fewer clients in October because I know that I'm busy with other things.

[00:21:14] Mel: Whereas there's some months that I have nothing else on, there's no other business things going on and I know that I can take on more women who are due that month. So that's how I manage my workload, but if you, in your mind, just imagine that one client equals 40 hours and somewhere between 6, 500 and 8, 500, then you can work out how much you need to work in order to earn an income that's required for your lifestyle and how much time you have to commit to each client.

[00:21:44] Mel: And this next question kind of flows on in from that. And this is people asking, how do you balance having kids? Uh, with being on call, or this could be really any other responsibility. Some people are looking after their parents or their carers for other people, or their children, and have other things going on in life that mean that being on call could be a bit challenging.

[00:22:09] Mel: So, here's my tips on how you can balance this way of working with being on call. And can I just add here, you know, when you're working shift work in a hospital, you actually have very little control over When you're going to be working. We're always shuffling something around and looking for support. If you're on a morning shift and you're supposed to be taking your children to school, you've got to be making alternative plans frequently.

[00:22:35] Mel: So, I find that working as a privately practicing midwife, Actually gives you more control over your day and how you allocate your time than what you'd be doing in a hospital setting. So I just want to start with that because there's always this myth of like, oh wow, but you're on call. Yeah, but if, you know, at most you're going to be out four times a month where you can't control the time.

[00:23:00] Mel: Whereas if, you know, you can control antenatal, postnatal visits and when you're going to do those. You can have allocated booking time. So, how do you balance being on call with your other lifestyle commitments? Kids aren't really lifestyle, are they? But they're a life commitment. Alright, so, again, work out how many hours a week you have to allocate to your work as a midwife.

[00:23:23] Mel: And then you can manage, you can manage your workload. So you've got to be disciplined with that. If you've nominated that you only have 40 or 80 hours, available per month to be a privately practicing midwife, don't take on more than one or two clients a month. And so you've got to be disciplined to not exceed the hours that you've allocated to your work as a privately practicing midwife.

[00:23:47] Mel: The problem comes is where you mentally know that you've got only room for one or two clients and you take on three or four. And all of a sudden, that you've, uh, started to stretch yourself. And trying to fit things in in hours that you don't have. So you gotta be disciplined. Really do the maths. How many hours do I have per month to dedicate to private practice midwifery?

[00:24:09] Mel: The next thing is to take stock of your support network and childcare arrangements. So, this is something that I've always done, is checked in with my husband and with my, with my children's grandparents and friends. Is, you know, if at the last minute, if I needed to call on you for something, how would you feel about that?

[00:24:29] Mel: And so that's questions that I've always asked that I've pulled that, you know, when I started, uh, midwifery and throughout my career, asked what people's availabilities are and their willingness to help with this, you know, and it can be as simple as, Hey, I'd like to become a privately practicing midwife in order to do that.

[00:24:48] Mel: There might be times where I'm called away at the last minute and cannot, and need some Help with this this or this I also have goats that need milking so in my mind I need to make sure that I'm here at 7 a. m.. To make sure the goats are milked But what happens if I'm not and so that's part of what I factor in as well when I think about what I need to Have support for so checking in with them Um, having an on call plan.

[00:25:15] Mel: So, early in my career, my husband also worked. And so, every night we would sit down and go, Right, if I was called away tonight, what would we do? How can we manage this? And so, we knew the capacity of our support network. He knew where he was going to be the next day. I knew what might possibly happen. So, we'd always just make a little plan.

[00:25:34] Mel: And the other thing that you can do is talk to your kids, or the people who are under your care, or your commitments. Talk to your goats about your decision making around your work plans. So, for example, my kids know I'm a private midwife. I might be gone at any time. They're not surprised by that if they wake up and I'm not in the house.

[00:25:55] Mel: They're aware of what my work requires. The other thing that I do is I have some non negotiables. So, one thing that I always remind my children, and right from they were very little, is that mummy always comes home. So, mum's going out to a birth, but mummy always comes back. And so that was a really nice way, particularly speaking to small children, that mummy always comes home, once the baby's born.

[00:26:20] Mel: And this is mum's work, and that's okay. And so we're not. I mean, I've let go of guilt about leaving my children for this work. This is mommy's work and this is important and they know that they are loved and cared for and that mommy always comes home. Uh, I, we always have a holiday together in December.

[00:26:39] Mel: We take them camping and they look forward to that December holiday. I always take my kids birthdays off and we have a great big party for both of them. And it's a really special time for our family. Uh, we also have a plan to go to There's a festival that our kids really, really enjoy and that's something that I always make time for.

[00:26:59] Mel: The other thing that we do is that, uh, Christmas. They don't really know what day it is and we just will drop Christmas on them. Sometime, you know, obviously not just... Anytime in December, but around Christmas time, we will have a surprise Christmas morning where we go, It's time to open presents! And we have Christmas breakfast, and that means I'm always there for Christmas.

[00:27:24] Mel: Even if I'm actually away on the 25th of December, we will do Christmas with the kids, whether it's on the 25th, or the 23rd, or the 24th. They don't care. So that's some ways of how I've balanced and managed being on call with kids. Alright, next question is that, uh, okay, once you've satisfied all the requirements in that first video that we talked about, the requirements of being a private midwife and getting endorsed, and you're ready to start practice, how much does the insurance package cost?

[00:27:57] Mel: Okay, so the insurance is based on how much you earn providing antenatal postnatal care, so it's tiered. So, you, you basically, MIGA, M I G A. Our insurer will ask you what your earning is approximately, and again that would change every year, and then they will calculate a cost for you. It's not as expensive as you think.

[00:28:21] Mel: Consider allocating three to four thousand dollars a year for your insurance. product and that will be enough, particularly as you're getting started. You can pay it monthly, um, it's less if you're working less. So it is based on income. And what is the last question that I'm going to do today is what is the earning capacity of a private midwife?

[00:28:42] Mel: So we spoke about, uh, just earlier, roughly six and a half to eight and a half thousand dollars that you'll get per client. There are expenses that come out of that. So consider things like tax, and the second midwife, and insurance, and equipment, and any of your you know, paying for training and education, and things like that.

[00:29:02] Mel: But the earning capacity of a private midwife is far higher than any position in a hospital. Any midwifery position in a hospital, you will always earn more per hour as a privately practicing midwife. There's just no doubt about that. So calculate How many women you think you can take on by what you think you might charge.

[00:29:26] Mel: If you start that at six and a half thousand dollars, that's kind of the bare minimum. Do that calculation. If you can see just ten clients a year, then that's sixty five thousand dollars. If you can double that. Then it's a hundred and thirty thousand dollars. That's only twenty women a year. And so, and then also factor in your holidays and time that you want to have off.

[00:29:50] Mel: So I always calculate income on a ten month basis, knowing that you could have two months of the year completely off if you want to. Now private midwives can earn money in lots of different ways. It doesn't just have to be a full package of care. It doesn't have to be home birth. Some midwives only do antenatal postnatal care.

[00:30:11] Mel: Some people are lactation consultants, also. They'll do additional things like placenta encapsulation, and childbirth education classes, and they'll run blessing ways, and all kinds of add on services that you could add to your work as a private midwife. It doesn't have to be on call. You can have everything scheduled in and doing that within your life, within your other life commitments.

[00:30:38] Mel: That's been today's session on Frequently Asked Questions. There will be more of these. Keep sending your questions through. And tomorrow, we're going to be working on the three pillars that we spoke about in the last video. So clinical midwifery working as in a business, as a business person, and the legal and legislative framework that governs us as privately practicing midwives.

[00:31:05] Mel: So stay tuned for that video tomorrow and please kept sending through your questions and I'll keep answering them as best I can. Bye for now.