Research to Remember
In a retrospective study to learn about success rates and risks of vaginal birth after cesarean delivery (VBAC), researchers found low risk for maternal and neonatal complications where women had had one or more prior VBACs after a low transverse c-section. There also was no increase in the rate of uterine rupture after at least one successful VBAC. The same was found for the risk of uterine dehiscence and other peripartum complications.
— Obstet Gynecol 111: 285–91, 2008
(But note that just getting that first VBAC can be a real problem. The International Cesarean Awareness Network [www.ican-online.org] now has a map that allows you to check on whether your local hospital has banned VBACs. See "50 Ways to Protest a VBAC Denial," by Barbara Stratton at www.midwiferytoday.com/articles/50ways_vbac.asp for ways to overturn such a ban.)
Professional Education in Breastfeeding and Lactation
April 14–18, 2008
Train to provide accurate and consistent breastfeeding/lactation information to support new families in feeding their babies from birth through the weaning process. Learn to work with other healthcare providers, ensuring continuity of care for breastfeeding mothers and infants. Sign up at www.signup4.com/lactationeducationtraining or (510) 625-5873.
Who should attend: MDs, LLLI leaders, RNs, midwives, LCs, childbirth educators, and doulas. CEUs available.
Independent Midwives and Employment
So, you've decided to start a midwifery practice. Congratulations! Whether you are considering a completely independent practice or just part-time consultation, you need to identify your goals. Examine your motives. Are you seeking financial or professional independence? What budget and income do you foresee for the first year? These are all important business questions that you need to ask yourself. The tax implications of starting a practice may seem daunting at first, but careful planning and budgeting can help your new practice succeed.
You can choose to be a sole-proprietor or partner with other practitioners in a joint practice. Many midwives and doulas choose to supplement their regular income with a part-time practice. You also may choose to work exclusively for a hospital or combine that work with a private practice. The desire for compassionate care and continuous labor support is on the rise, and midwives can capitalize on the increased demand for their services.
The Internal Revenue Service (IRS) considers a midwife to be self-employed if she is hired directly by clients for private services. If you are employed by a hospital and work for a salary, then you are strictly an employee. If you do both, then the IRS considers your income from your private practice to be separate from the income earned from your job, and your deductions are treated differently. Wages that you earn from an employer are taxed automatically, and the deductions come out of your check. If you are an independent practitioner, then you must figure your own taxes and pay them accordingly.
Independent part-time practitioners can [also] earn extra income as postpartum doulas, lactation consultants or general postpartum counselors. They can offer nutritional and general psychological support. In many communities, the demand is great for licensed midwives. Alternative health services are highly marketable, and midwives should try to capitalize on their resurgence.
Don't be afraid to promote your services. Holistic approaches to pregnancy and childbirth are always in demand. Web sites are an inexpensive way to market your practice and services. Many online Web site providers offer e-mail, Web design software and customer support for less than $50 a month. Use your Web site to feature your services. People love case histories, and your Web site can describe childbirth "success stories" for new clients to read and enjoy.
Be proactive! Develop a business plan, set your fees and create a budget so you can track your profits. Midwives are educated professionals, just like accountants, lawyers and doctors. Women are willing to pay a premium for pregnancy services, and you should be proud to offer those services at a fair price and still make a profit. After all, the key to building a successful practice starts with being profitable and still satisfying your client base.
— Christine Silva
Excerpted from "Tax Tips for Independent Midwives," Midwifery Today, Issue 79
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American College of Nurse-Midwives 53rd Annual Meeting
Boston, May 23–29, 2008
Join your colleagues for the number one continuing education, networking, and business meeting for midwives nationwide featuring inspiring and informative education sessions lead by top women's health care experts. Discounts are available for ACNM members and Friends of the College. Register today at http://www.midwife.org/AM.
Web Site Update
"When we speak of technology, we are talking about its dangers in normal birth. I think everyone can agree with the necessity of using technology to save lives of mothers and babies when needed. However, while conceding that some great strides have been made in medical care, we know birth is not a medical event and that when medical care is applied to a social/spiritual event without good reason, horrendous things can happen." Read this editorial, "Technology: Stemming the Tide," by Jan Tritten from the Spring 2008 issue of Midwifery Today here.
You may check out the table of contents for the newest issue of Midwifery Today (Spring 2008) here.
Read this article from the Winter 2007 issue of Midwifery Today:
A Midwife's Touch—by Elaine Stillerman
Philadelphia Conference Advertising
Time is quickly running out to promote your product or service at “The Healing Touch of Midwifery and Birth,” conference in Philadelphia, Pennsylvania, March 26–30, 2008. If you are unable to attend with an exhibit booth, we can place your flyer/sample directly in the hands of all conference attendees. This is a great conference for healing touch products such as lotions, essential oils, massage tools and accessories. [ Learn More ]
Hope and Healing Conference Advertising
Ann Arbor, Michigan, hosts the "Hope and Healing" conference May 7–10, 2008. This is a great place to highlight products and services for counselors, social workers, therapists and mental health providers. Watch your business benefit from an exhibit booth, conference program ad or literature distribution. [ Learn More ]
Midwifery Today E-News
Do you have a Web site? Does reaching more than 14,000 potential customers sound appealing? An ad in Midwifery Today E-News, our free biweekly electronic e-mail newsletter, gets your message out and sends customers directly to your Web site. Each issue is archived and continues sending more customers in the future. [ Learn More ]
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Question of the Week
Q: How long can a baby be on breast milk only, with the addition of no solid food or liquids? I don't want to feed my baby anything but breast milk until I have to, but am not clear whether there is a maximum after which it becomes less healthy to do so.
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
Question of the Week Responses
Q: If you are a midwife, how do you feel when your clients refuse services like ultrasound?
A: I support my clients' right to make informed choices about the use of technology such as ultrasound. We discuss the possible risks, possible benefits and alternatives—including the option of refusing. I am comfortable with clients refusing ultrasound. Ultimately the client makes the choice and takes responsibility for the consequences of her decision, if any.
— Anita Jaynes, CNM
A: I have no issues with clients refusing screening or any other services, as long as I have provided full information on the risks, benefits, false positive/false negative rates and complete details on what the screening test entails and feels like. I also ensure that the woman and her partner know what the test is for, and what the consequences might be of having it (e.g., further testing and/or decision-making).
I believe that my role as a midwife is to provide women with the information and support to make their own choices; this does not include judgment on my part, or applying any coercion to facilitate a certain decision. I have only just recently completed my training, and spent time as a student with a wonderful group of midwives who applied this philosophy to all their clients—no woman was coerced in any way to undertake any form of screening (or any other type of care) that she did not want. Trusting women to make choices that fit within their unique terms of reference is what I feel I should be doing when I support them. I feel very strongly about this aspect of midwifery!
— Neroli Moore, Registered Midwife
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Learn about midwifery education!
Are you an aspiring midwife who's looking for the right school? Are you a practicing midwife who would like learn more? Visit our Education Opportunities page to discover ways to start or continue your education.
Think about It
Our Bodies Ourselves (OBOS)*, in addition to having a new book out on Pregnancy and Birth, has posted an article that describes the midwifery model of care and how it relates to and differs from the medical management model for the care of pregnant women. You can read it at www.ourbodiesourselves.org/book/companion.asp?id=21&compID=121.
*OBOS is also known as the Boston Women's Health Book Collective (BWHBC), and is a nonprofit, public interest women's health education, advocacy and consulting organization. They are best known for the women's health book Our Bodies, Ourselves, which was first published in 1970.
Trendy Birth: An Odd Dichotomy
Recently the American College of Obstetricians and Gynecologists (ACOG) released a statement against homebirth, calling it, among other things, a dangerous popular trend in modern times. Oddly enough the latest trend in birth truly isn't homebirth (an occurrence that has existed since the beginning of time) but elective cesareans, or "Too Posh to Push," as the media has dubbed it. A few years ago ACOG released a statement about elective cesareans, acknowledging the serious risks to choosing major abdominal surgery for birth, but stated that it was a choice that should be left up to the doctor and his patient.
When I started looking into existing research on both issues I was quite fascinated to note that, contrary to ACOG's opinion, quite a bit of good research shows the safety of homebirth. In fact the one study used as the reason to restrict homebirth was actually flawed to the point of uselessness, due to, among other things, poor controls. Other than that one flawed study, used as the basis for ACOG's opinion, I could find no other studies that showed homebirth to be riskier than hospital birth for low-risk women. In addition to the latest large study on homebirth published in the British Medical Journal in 2005, I also found over ten years worth previous studies that showed the safety of homebirth for low risk women attended by midwives.
Conversely, one of the sad benefits of the latest trend toward elective cesareans is that we now have enough of a population to determine the pros and cons of an extreme choice like elective cesarean. The results show some very extreme negative risks that are punctuated by increases in maternal and infant mortality.
So why, if there is this laundry list of serious risks to elective cesarean, but no real studies showing serious risks for low risk moms having homebirth, is ACOG coming out full force against homebirth, but not against elective cesarean? Very strange, and very scary.
— Amy V. Haas, BA, BCCE
Community Resource Coordinator, Rochester Birth Network
Certified Childbirth Educator
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Living Tree College of Midwifery: June 2008 and 2009 sessions offer apprentice model academics, clinical and homebirth studies. Upcoming Doula workshops: January, April, July, and October 2008. Visit www.school.birthandwellness.com or call (505) 541-6177 for application.
CONFERENCE: California Association of Midwives Annual Conference is May 16–18. Pam England, Robbie Davis-Floyd, Mary Jackson and Ray Castellino, Karen Strange and many more! www.californiamidwives.org or Fawn (707) 251-8747.
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