Starting a Midwifery service is a complex endeavor. Grow Midwives offers consulting services that help navigate this process, provide support to the client as the process is underway, and assist in finding and creating a supportive professional community. Reach out to us using the form on the contact us page or call (913) 717-7896.
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How do I Start a Midwifery Practice or Service?
The first thing you need to do when starting a Midwifery practice or service is investigate the licensure and regulations process in the state where you want to practice. If you are planning to practice on a state line or in more than one state, you will need to look into each state’s regulatory requirements.
You need to understand how the design of a practice is legally regulated. What are your states regulation requirements for consultation, collaboration, and referral to a higher level of care for clients who need care outside the Midwife scope of practice? Do you license yourself with the State Board of Nursing? The Board of Healing Arts? The Health Department or Public Health Board?
If you’re operating a midwife-owned practice, other essential elements include finding a location. It’s probably going to be based on insurers who are going to reimburse you and assurance you can be credentialed from the hospital at which you want to attend births.
What’s your staffing model going to look like? Solo or with a couple partners? How are you going to run the office and non-medical side of the practice? There are a variety of things to consider just in terms of legal and financial questions.
If you are attending women in a hospital, does that hospital have bylaws that allow non-physician providers to maximize hospital privileges. If they do, what do those bylaws indicate in terms of scope of practice, admission, and discharge: things that are elemental to hospital providers, and delineated in bylaws of that hospital.
Then, is there an understanding of how to create a list of privileges that allows the Midwife to practice the scope that they are trained to do and beyond. Can they first assist? Can they repair a third or fourth degree? Can they use a vacuum extractor? I’ve mentioned things that are all not taught in Midwifery education, but are skills Midwives do beyond their educational training through additional certification programs. How do you credential somebody who wants to first assist in surgery with your patient needing a c-section? How do you know they have the necessary skills and training? There are mechanisms that can be put in place to assure competency.
How do I Start a Hospital Based Midwifery Service?
When starting a hospital-based midwifery service, the assumption is that you will be an employee of the hospital. Has the hospital ever employed midwives before? A hospital may be starting a service for the first time, having never employed midwives on their staff before, which, again, means looking at hospital bylaws and assisting in designing the credentialing process.
What kind of privileges can you ask for to render care in that hospital environment? Such as, can you admit and discharge in your own name? Or do you have to admit and discharge under a physician’s name? Again, staffing questions need to be answered. Is it just a maternity care service or is it full scope? Are you providing care through the lifespan from young girls through aging women?
Who are the collaborating physicians going to be? It’s unlikely that collaborating physician is going to be a family care doctor, because what if the patient needs a cesarean section and they don’t have privileges to do surgery. However, some family physicians have additional training and perform c-sections. If midwives are working in rural health in a hospital team that is primarily family physicians, internists and surgeons’ how can a midwife bring additional assistance to this team?
You need to think about where the hospital is located in terms of resources they have and levels of care that they provide. What does the target market population look like? What is the case mix of the potential caseload? What will insurers cover as a licensed provider?
How do I Open an Accredited Birth Center?
Alongside the AABC, is an accrediting body that is not affiliated with, but works in tandem to promote accreditation of freestanding birth centers, the Commission for Accreditation of Birth Centers (CABC).
Birth Centers can be owned and operated by midwives or physicians or hospitals. When you think about accrediting a birth center, again you need to go back to state regulations. About half the states in our country have state licensure regulations that are additional to an accreditation process. Some insurance companies are likely to mandate both state licensure and accreditation before reimbursing for a facility fee. Additionally, some states do not require accreditation of your birth center or have regulatory requirements. Optimal safe practice is best provided by meeting minimum requirements of CABC accreditation. There is a cost associated with accreditation as with any oversight organization that provides recommendation of quality review.. However, Grow Midwives believes this is the most rigorous process demonstrating public safety and accountability. We believe this is a requirement for safe care.
How can Midwives Design a Sustainable and Successful Physician/Midwife Practice Model in all Settings?
How do you figure out your income and expenses in a collaboration? How do you ensure that all parties make some profit margin that’s respective to the body of work that each has done and to their degree of training? How do you measure the level of acuity of services each provides?
Midwives aren’t surgeons. Midwives primary scope of care is in working with normal, healthy people. One of the important things few midwives have thought about, or accounted for in any kind of data collection, is “How much money are they generating based on the services they provide in a given period of time?” Creating this kind of pro forma is incredibly important for Midwives, yet almost never happens today.
How do Midwives Address Burnout and Attrition in the Workplace?
Grow Midwives has learned over the last few years that there is an exhaustion factor that comes with working really long shifts. Sometimes for 24, 48 or even 72 hour shifts Midwives are literally on the entire time.
They may have short, little breaks that are built in, but early in 2017 ACNM released a Position Statement suggesting Midwives should not work longer than 16 continuous hours without 4-hours of uninterrupted rest, as well as additional recommendations.
The question then becomes, “Are we not staffing the units properly?” Are we so committed to continuity of care that we don’t realize that a specific Midwife doesn’t have to be the one attending the birth. It could just as easily be one of the other partners. It could be another person in the hospital who doesn’t know the patient at all. What is an appropriate level of personal sacrifice and safety in care delivery versus patient expectation?
Hiring raises its own needs and questions. Are you hiring people with similar philosophies? In that case, does it really matter which of us is there if we are all going to provide the same style and quality of care?
Burnout and attrition in midwifery is high. People are leaving the profession every year or considering leaving. Some feel that they aren’t being paid enough, some don’t feel like they are being acknowledged for the importance of the job they do, some can not take earned vacation time, so simply are exhausted from poor staffing.
Taking care to structure a balanced and supportive collaborative practice will keep both Midwives and Physicians from feeling overworked, underpaid and underappreciated.
How does a Midwife Facilitate Difficult Conversations in the Workplace?
Try to come up with some ideas, so that you have some kind of empathy. Try to start a dialogue in an open question environment. You will then begin to discover things you might not have found if you stayed mired in the original position.
Facilitating difficult conversations requires the ability to look at things with an empathy to the other side, with some preparation in regards to what you really want, how you want it, and alternatives to how you want to get there.
Good negotiators are civil, well informed, will challenge tresspasses, but be quick to forgive those tresspasses. To train people to deal with difficult conversations is a matter of both an empathetic review of how to deal with conflict, but also raising the bar on what truly is difficult.
In many environments, when you are dealing with one that is in collapse, every issue is so impacted and so layered with “this is what it really means” kind of statements, that almost anything from the whether the birthday cake for the last employee birthday was vanilla or chocolate becomes an issue. If you can figure out how to raise that bar back up, past an adult level and into a professional level of what an insult really is, you can then have conversations that ease those tensions and open up dialogue.
A difficult conversation tries to drill down to a more granular level on both sides of what really are the needs, concerns and points on both sides.
How does a Midwife Introduce Evidence Based Practice (EBP) Clinical Options to a Maternity Care Product Line?
Take Nitrous Oxide, it’s slowly emerging across the country as a pain management tool in labor.
It is widely used in Europe and contributes to positive outcomes while providing safe care for mothers without risk to the baby.
There are also a number of practices that are nonpharmacologic that hospitals may just not know how to effectively implement, train, orient or evaluate yet. Some of these may be best practices that lead to reducing the number of cesarean sections in a hospital, incorporating doulas into a hospital, providing the option of water in labor in birth, and a variety of other practices that are evidence based .
How does a Midwife Negotiate Mutually Beneficial Employment Agreements?
For the most part, a normal employment agreement for a Midwife deals with salary versus how many hours they work on call and in the office, as well as other perks. The way a compensation package is structured in terms of rate and style can help alleviate overwork, feelings of underappreciation, and burnout.
The most common issue that normally happens is that after an employment agreement is entered into, the number of working hours increases substantially. There are also questions related to the realities regarding malpractice coverage, non-compete agreements, and a host of other legalities.
How Does a Midwife Negotiate and Maximize Reimbursement for Services?
Medicaid negotiates reimbursement rates on a state by state basis. Midwives often have to partner with physicians who speak on their behalf to payer panels trying to convince them that Midwives deserve the same reimbursement as Physicians for a normal, healthy birth.
Common questions to answer in a hospital setting include: Is a midwife going to bill under their name or under a physician’s name? Who is going to be reimbursed and how much? Whose name is on the birth certificate? There are many strategies that can be employed to navigate all of these questions and more.
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