Episode 121 How to become a private midwife in Australia
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. In each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:22] Hello Rebels, welcome to this bonus episode of the Great Birth Rebellion podcast and this one is specifically for Australian midwives. The reason I'm doing this bonus episode is that all week this week, and it started yesterday, we've been doing what I call free week and every October I spend one whole week talking to midwives about how they can transition from working in a hospital system or as an employed midwife into private practice being a self-employed midwife. One of the benefits of being self-employed is that you can offer women services that wouldn't necessarily be available to them inside the system. You can work more autonomously and provide services like home birth. There's some real barriers to entering into private practice mostly because there's a lot of confusion about how to do it and what the rules are and so I spend all week one week of October and this is it giving as much information as I possibly can it's completely free to any midwife who's keen to discover what the logistics would be of moving into private practice all week I'm sending out free resources they come via email so if you want to keep getting them all week this week then go to my website melaniethemidwife.com and there's a button at the top of the website there where you can click it get on the mailing list and all the resources come straight to you and you can just watch it in your own time through the week.
[1:52] My email inbox is open and I'm ready to answer questions for people so that you can get a full understanding of the logistics and practicalities of working as a private midwife.
[2:04] This opportunity doesn't really come up anywhere else, so this is pretty unique. So if it's something you've been thinking of, this is your opportunity. Head to melaniethemidwife.com. The details will be in the show notes, and you can get the rest of the week's free information. But today, I'm going to offer a little bit of what we're going to be doing this week to help get you started. Let's get into it. And welcome to this series about becoming a privately practising midwife in Australia. This week, we are going to hear a lot of information and it's all designed to help you understand and if you're ready to start your journey into private practice midwifery. And some of you have just come to learn and observe and explore. Just a bit curious, completely fine. Welcome to you. That's great. This is the perfect opportunity for that. But if you are here and you're keen to actually start working in private practice, then I can promise you that you're on the right path by being here. This is the beginning of that journey and so I want to welcome you and congratulate you on that. It's really exciting and thank you for using this opportunity to get started.
[3:14] Now, this learning opportunity only comes up once a year. Every year around October, I offer this. For midwives to break out of the shift work, the day-to-day mentality of showing up for rostered work day after day after day. And I have to say, over the last five years, I've really noticed an increased number of midwives who are contacting me and asking for options about what they can do if they no longer want to work in a hospital. And that's what I'm here to talk about. That's what this week is about, opening you up to the possibilities that await you in your midwifery career. We do not have to keep working this way day-to-day, shift-to-shift in jobs that don't satisfy us. So I come to you from a place of having made this change myself, positioning myself where I am today. I'm passionate about helping other midwives do the same. And I've been practicing, privately practicing midwife for 15 years and in that time I've been providing women with care to give birth at home and just chipping away and building up my business to make it what it is today.
[4:24] Of course in all journeys in all new journeys there's confusion and failures and mistakes but they are very quickly followed by small wins and then bigger and bigger wins and the further along I get in business the fewer mistakes I make, the less clunky it becomes and the bigger the wins get. And that's what I'm here to share with you today. So maybe you don't have to make the same little clunky mistakes that I made.
[4:50] When I first started in private practice, it was relatively easy to become a privately practicing midwife. But over the years, I've just watched it become more and more complex and more confusing. And it feels out of reach for a lot of midwives. And it's a real deterrent. And some midwives just don't start or try because it seems like it's too hard. And so I'm going to demystify all of this for you this week. You can skip over the hard stuff, the problems about making mistakes and just have a really clear path and understanding of what you need to do next if you want to move on to private practice in your career.
[5:30] Now, I've been helping private midwives move, well, helping midwives move into private practice for years now, formally and informally. And over the last four years, I've mentored 120 midwives. And I've watched many of them build these beautiful, successful businesses and start offering private practice midwifery services in parts of Australia that have not had access to home birth in the past. Before we talk about what the beginning of your journey might look like into private practice, I want to just give you a little bit of background on how I got here, a little bit about myself. I feel like it's important for you to know who you're dealing with, why I should be the one giving you this information.
[6:14] So just like where you are, I started midwifery knowing absolutely nothing about what it would take to be a privately practicing midwife. I mean, that's pretty much how we all start until we start learning and looking and exploring. But over the last 15 years, business has become so successful for me that I turn away more clients than I could ever take on. And I'm not saying that to brag. I don't want to sort of toot my own horn, but I just want you to know what's happening for me and that it's also possible for you because many people have concerns that maybe there aren't enough women wanting home birth to make private practice midwifery successful. Career opportunity but there is such demand out there for private midwives women are asking for more there are women who want to find midwives and there aren't enough so we can squash those concerns if that's one of your concerns that you maybe can't make enough money being a private midwife because there aren't enough women out there I'm here to tell you that with the current level of interest I do believe you can take that concern off the table.
[7:18] So the other big fear that I hear from midwives is that they're feeling frightened to step away from a job that pays them, but it's conflicting because they know that that job is not serving them and it's not serving women. And so it's frightening to explore a business opportunity that they don't know will even work. Now, this type of thinking will immediately stop you from going on the journey to change things in your life and you'll get stuck if you're sort of paralyzed by fear you won't move forward you'll get stuck there so don't let the fear paralyze your dreams just let it spur you on to keep learning and motivate you to succeed in business so turn that fear into a motivation to just keep learning don't be deterred from it I'm here to help you with that. You aren't alone in doing this and other midwives have gone before you. You're not the first person who felt frightened. But if you don't continue, you will never get into private practice.
[8:21] So back to the story. How did I start? When I graduated from midwifery, I was 24 years old. I didn't have any children and I just stubbornly and naively committed to working as a private midwife. I knew that it was either for me was going to be private practice midwifery or nothing. I knew I just, I couldn't bring myself to work my entire career in the system.
[8:44] And I take my hat off to you midwives who were doing that. I don't know how you found the strength to do that. It's amazing. I knew I couldn't. I knew it would make me emotionally, morally, mentally, physically just unwell and ill over the long term. It might be sustainable for the short term but can you see yourself doing this for the rest of your career? I couldn't. So I knew that private practice midwifery is where I would have to go if I was going to stay in midwifery and I needed a career that would be sustainable. I was 24. I was going to work as a midwife for the rest of my life. I needed to pick something that was sustainable and that wouldn't drain me and also leave room for my future plans that I had for my life and my family I didn't want work to dictate what else I could do in my life where I could go to when I could have time off so working for myself ticked a lot of the broader goals that I had for my life and that I had for myself so I was just so committed to fleeing the system I didn't even need to do a new grad year I just trained as a midwife I got registered and went straight out into private practice. I had zero hospital-based experience as a registered midwife. I was just as a student was my only experience in the hospital.
[9:59] But it's given me a really unique skill set when I'm attending births. You know, I've basically just learned to be with physiological birth. And so that has become a really unique point of sort of that's a massive part of my skill set, something I'd really, really love to share with you all. So, I mean, unfortunately, you can't do this now. The path into private practice midwifery has become a lot more arduous and just lengthy than it used to be. But that's what I want to talk to you about today. So although things are different, I'm going to explain how things work. There are a few things to get you started and a few critical things that you need to know if you're planning to work towards private practice. So as I said, when I started, it was super easy. I got registered. I gathered up a kit. I made a very basic website. and along with my mentor who was sort of helping me out, I made some new connections in the home birth industry and just started taking on clients. At this time, there was no insurance product at all. We were all working uninsured. There were very few requirements that we had to adhere to, none of the guidelines that we have today. So fast forward to now, it's a lot more complex. The political culture around birth in this country doesn't make it any easier and it actually feels as though everything is working against us and resisting against us on our path into private practice.
[11:23] And, you know, it makes sense. We've been groomed by the system to train people, in order to enter in hospitals to work. The pathway into hospital-based work is easy. They tell us exactly how to do it. There's interviews. We're just groomed to move into shift work at a hospital so that we can support and uphold a maternity system that's been built around us. We're trained with the expectation that we will toe the line. And because of that, if you want to do something different to that, there is no clear pathway on how to start and do what to do what's next. They don't teach us that at university. They don't encourage us to think broadly about our career options. We're encouraged by the whole education process and the system to fall into line, work shifts at the hospital. Midwives don't even know the basics of what else we could possibly do if we didn't work in a hospital. And that is a strategic design to keep us there.
[12:21] Now it doesn't have to be this way. There are other options. You just need someone to show you how to achieve this. So today I'm going to show you the starting point, the absolute ground level essentials of what needs to be in place for you to start planning your business. If you don't do, don't do anything else until you've done what we talk about today. And I'm going to show you how to break out of that conditioning and the expectation that we're just all going to work in hospitals. So this opens up an opportunity to have clarity about how to start in private practice and break out of the small versions that we've been conditioned to be. We've been conditioned not to expect more from our careers, but there is more. You don't have to keep going down the path that you're on. And this is your opportunity to explore another option. And that's what we'll be doing all week. So this is really exciting. We're going to have paradigm shift.
[13:14] Okay, these are the things that you need to do in order to become a private midwife today. So grab a pen. This is a kind of tick list opportunity of things that you need to be moving towards. You may well have already done them, which is really good information. Even if you've already done all these things, this is good information to have because then you know that you are on the right path to private practice. So firstly, number one on your page, you have to be a registered midwife. And this might be obvious, but you have to have a university degree, be registered as a midwife through the Nursing and Midwifery Board if you want to work as a private midwife. So if you're already trained and registered, then tick, first thing is done on your list. If not, you know what to do next. Finish your training, get registered. That will be your main goal. You need to do nothing else except finish your qualification. Many of you watching, tick, easy, you've done that. So secondly, you need 5,000 clinical midwifery hours, which is the equivalent of three years full-time clinical experience. And at the moment, that has to occur over a maximum of six years. It doesn't all have to be in the hospital. And we'll talk about creative ways of banking up these hours as we go.
[14:29] But I know 5,000 hours sounds daunting, but there are whispers on the grapevine that are indicating that this 5,000 hour rule is being reviewed, it will likely be changed and significantly reduced. And there's a really big push to reduce these hours. And it's been acknowledged that, yep, they're a real barrier for midwives getting to private practice. So you can, even if you're working on accruing these hours, just know it might not stay at 5,000. So that's really good news. Now, thirdly, private midwives are also required to get a postgraduate degree in pharmacology and diagnostics. And there are three courses designed for midwives that satisfy this requirement. The Nursing and Midwifery Board of Australia does have all three listed on their website and there's a little link below this video. If you just click on there, that will come up with a document that shows you which three courses you can do that are approved. So, And I know some of you are going, oh, my gosh, not back to university. The thought of going back to uni feels like a real big deal breaker. But don't let it frighten you. You can do that. You've already done that. You've done a degree. You're a midwife. I did this degree while I was pregnant and I was working. You can do it too. It doesn't last long. It's six months to a year depending on what you choose.
[15:52] And when we're making big changes, doing new things and in business, We have to do hard things sometimes to get to the place where you want to go. So don't put a lid on this opportunity because it requires extra time and effort. You can do this. Just hard yards at the beginning and you'll reap all the rewards. And that's the same with the 5,000 hours. Many midwives just can't get through those 5,000 hours and they give up. But the giver-upperers will never be privately practicing midwives. So we've got to keep showing up day after day, do these hard things if we want the rewards. So now your path is clear. If you are registered, tick. If you're working at accruing your hours, tick. If you are currently on maternity leave, you can actually also be accruing hours at that time. That's a little perk, tick. Now, last thing to do is knock over that university course and tick. After you've finished all those things, apply to become an endorsed midwife through the Nursing and Midwifery Board of Australia, which means that you are eligible for the insurance product that privately practicing midwives need to purchase in order to be insured from our work. So there's one person, one organization that insures us, MIGA, M-I-G-A.
[17:03] You know, we do all of those things, the 5,000 hours, the university degree, all in order to get endorsed because MAGA will only ensure endorsed midwives. And so for that reason, only endorsed midwives can work as privately practicing midwives. You know, and as part of our endorsement, we get a Medicare provider number and a prescriber number. And all of that means that we can get Medicare rebates for a portion of our care. We can write scripts for medications if women need them and referrals for blood tests and ultrasounds. So there's a lot that we can do once we get our endorsement. So it's a worthwhile venture and a requirement if you're going to be in private practice.
[17:46] So those are those initial three steps. Some of you are thinking, whoa, hang on a second, I've done all of that. And if you are already there, that is super exciting. You've already moved through what I think is the most challenging part of becoming a privately practicing midwife is those initial steps. So if you've already completed those, the good news is, is that, I mean, you're centimeters away from being able to launch yourself into private practice midwifery. It's really exciting. There is not much standing between you and private practice midwifery. So if that's you, I think, pat on the back, bit of an excited dance. This is a great day. So for those of you who are still on that initial journey. You might already be feeling overwhelmed and if you're at the beginning of the journey I know this first bit sounds like a bit maybe a bit much for you now but everything that is hard can be achieved by breaking it down into small achievable steps and sometimes big things you know like working towards a private practice can be like being confronted by this huge elephant but.
[18:50] How do you eat an elephant? This is what my mom taught me. How do you eat an elephant? It's one bite at a time. And that's how we do hard things. One little micro bite at a time. Before you know it, you'll have eaten the elephant. So that's what I'm here for this week, to help you eat the metaphorical elephant. And that's why I'm offering this opportunity to help you make a map and a plan for how to get from where you are now in your career into private practice and how we're going to progress. So there is nothing like this opportunity in Australia. No one else is sharing this information freely like what you're going to get this week. So lap it up. I've taken the road myself. In fact, I've taken other midwives along this road over the last three or four years and formally mentored 120 other midwives. This is the place to be if you are ready to enter into private practice.
[19:42] Okay, now there are three things we have to get our head around when we are starting a private practice. Again, this is a pen and paper opportunity, a moment to drop down some things. So three parts to private practice, come up, the three pillars. One is being clinically prepared for your work as a private midwife. Two is becoming a business person so that you can operate your own private practice because you are also running a business. In fact, I encourage private midwives to see themselves as business owners whose service is midwifery care. So many midwives tell me that they don't want to be in business. They don't want to do the business side of things. They just want to be private midwives and attend women who give birth at home and give midwifery care. I'm telling you now, it's a recipe for failure to neglect to manage your business in order to focus completely on providing midwifery care. Don't let that stop you though. Don't let your concern about running a business stop you from exploring private practice. We can do this. We do hard things. So in the coming videos this week, I'm going to run you through a few things that you can do to get your business started right away. All the business basics that you need to lay down before you do anything else. We're going to take it step by step, one bite of the elephant at a time.
[21:00] Okay, thirdly, the third pillar, the last thing you need to consider is the legal and legislative framework around your work as a privately practicing midwife. So those are the three pillars that you've got in your head. Drop them down. You know you've got to get your head around those things. Now those last two things, the business and the legal stuff, that's what I really want to focus on in the coming videos through the week.
[21:23] And those videos are going to be available to anybody who's joined the mailing list for this free week. And so if that's something that you're interested in, if you've gotten just a taste of information now and you think, I definitely am going to need the rest of the information, please do go to MelanieTheMidwife.com and sign up to the mailing list. You'll see the button at the top of the website. It's on the homepage. And everything will get emailed to you all this week. So you'll have the rest of the story about how to become a privately practicing midwife. Now, what I'm going to do next is answer some of the most frequently asked questions that I get about private practice. So these might be something that you're thinking about. So let's answer those now. 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. 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 done in the hospital.
[22:40] So the question is, what advice do you have to help me through the 5,000 hours. It is 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.
[22:56] Here's how to get through that time.
[22:59] 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. 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.
[23:20] Adopt what I call or what is called, I don't call it, it's not my terminology, but the craftsman's mindset. 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 there's 5,000 hours in the system, although it's really difficult, is an opportunity to hone some of your craft. 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 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 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.
[24:33] 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? That would be amazing to keep practicing that. So think of the skills that you might need for journal exams, resus, cannulation.
[24:49] You know, obviously there's a lot that you'll be learning when you leave and there's a lot that you'll be unlearning when you leave the hospital system, but there's certain core skills that will take you through to your private practice midwifery career. 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 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, antenatally, postnatally or during birth, that that hospital will willingly accept and welcome your clients and you in a situation that's not hostile. And so work at 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 is like-minded midwives who are really keen to also enter into private practice and you guys can just work at that together.
[26:09] 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.
[26:34] Okay, next question is about the role of the second midwife. So 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 the role of a second midwife in regards to sort of what the woman needs and what every single sort of different midwife uses.
[27:07] 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 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.
[27:41] 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. 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 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 offer the opportunity for women to have their second midwife take over.
[28:39] 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. 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 be the 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. 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.
[29:57] 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? All right, so the backstory on this is that as privately practising 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 through the Australian College of Midwives or you can buy yourself a copy.
[30:29] But basically, the Australian College of Midwives guidelines for consultation referral, or we just simply call it the guidelines, have divided lots, a big, big list of pre-existing 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.
[31:08] Now there are some women who fall outside of the guidelines so what we would say probably a category B or C who decline the recommendation to be referred to or consult with another health care 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 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. So they still want their midwife to be caring for them and they've declined the opportunity to escalate care to another healthcare provider if required.
[32:04] 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 cesarean. And although 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 midwife's guidelines. And as a result of that, I'm required to recommend that we have a consultation with an obstetrician, somebody else, the health service. 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, 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, offer her the opportunity for a consultation and or referral.
[33:24] 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-bias, 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 requirements, and you complete the record of understanding. That's how you keep yourself safe. Give really good thorough care and education.
[34:02] 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 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. 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 thorough 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 in private practice and this is where some of the issues come up where 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 we're.
[35:06] 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.
[35:22] 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 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. I mean, there are statistics that suggest that up to 50% 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'd make every effort to keep everybody on side. 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.
[36:39] I was very, very 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, I would take low-risk, multiparous women only. So I would not take on women who were 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.
[37:10] But at first, it's absolutely fine to just select women, collect 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. So this is a way that you can help support women to have 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 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 good, I think it's good, way of calculating how many women you can look after in your year. And so this is something that you can apply to your particular work circumstance and your life circumstance.
[38:17] So over the years, I've had a look at the documentation that I keep for every single client, and I've tallied up roughly an average of how many hours each client will take over the duration of their camp.
[38:33] 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 when you 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. 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 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 that's a choice that you can make can I just recommend that you don't make the choice to provide less care.
[39:54] 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. 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 to acquire it next month or, you know, however it works out.
[40:24] So then you've got to consider, well, how many hours do I have to give to private practice? 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. 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 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 six and a half 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 and that client might pay you $6,500 to $8,500.
[41:33] How does that feel for you in terms of the amount of money that you'll need that month versus how much time you've got? And so that's how you can kind of 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 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 six and a half and eight and a half thousand dollars, then you can work out how much you need to work.
[42:26] In order to earn an income that's required for your lifestyle and how much time you have to commit to each client. And this next question kind of flows on in from that. And this is people asking, how do you balance having kids 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 at all their children and have other things going on in life that mean that being on call could be a bit challenging 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. 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.
[43:49] Whereas if, you know, you can control antenatal, postnatal visits and when you're going going to do those you can have allocated booking times so how do you balance being on call with your other lifestyle commitments well life the kids aren't really a lifestyle are they but they're a life commitment all right so again work out how many hours a week you have to allocate to your work as a midwife 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 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 started to stretch yourself and try to fit things in in hours that you don't have so you've got to be disciplined really do the maths how many hours do I have per month to dedicate to private practice midwifery.
[44:58] 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 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? And so that's questions that I've always asked that I, well, that, you know, when I started.
[45:24] 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 there might be times where I'm called away at the last minute.
[45:41] 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 7am to make sure the goats are milk 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 having an on-call plan 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, 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, no, 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. They're aware of what my work requires. The other thing that I do is I have some non-negotiables.
[46:50] So one thing that I always remind my children, and right from there with 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, 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 mummy's work and this is important and they know that they are loved and cared for and that mummy always comes home I we always have a holiday together in December 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 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. The other thing that we do is that Christmas, they don't really know what day it is. And we just will drop Christmas on them sometime.
[47:59] You know, obviously not just any time 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 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.
[48:23] So that's some ways of how I've balanced and managed being on call with kids.
[48:29] All right, next question is that, okay, once you've satisfied all the requirements and that requirements of being a private midwife and getting endorsed and you're ready to start practice, how much does the insurance package cost? Okay, so the insurance is based on how much you earn providing antenatal, postnatal care. So it's tiered. So you basically, MIGA, 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. Consider allocating $3,000 to $4,000 a year for your insurance product. Then that will be enough, particularly as you're getting started. You can pay it monthly. It's less if you're working less. So it is based on income.
[49:24] And what is the last question that I'm going to do today is what is the earning capacity of a private midwife? So we spoke about 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. 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. So calculate how many women you think you can take on by what you think you might charge 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 10 clients a year.
[50:21] Then that's $65,000. If you can double that, then it's $130,000. That's only 20 women a year. And then also factoring your holidays and time that you want to have off. So I always calculate income on a 10-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 some people are lactation consultants also they'll do additional things like center 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.
[51:22] Okay, that is it for today. If you want to hear the rest of the information that I'm giving out through free week and you're interested in understanding what the steps are to move from working where you are now into private practice midwifery in Australia, then And I'm doing a full week of free information, very similar to what you just heard. It all gets delivered to your email. And so register for that mailing list at melaniethemidwife.com. There's a little link in the show notes. And the rest will come to your inbox. Now, I'm doing this this week through October. It started on the 20th of October, and it'll go all the way through to the 25th of October. It's your opportunity to learn you won't hear it anywhere else that's been this week's episode of the great birth rebellion to get access to the resources for each podcast episode join the mailing list at melanie the midwife, And to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
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