Grow Midwives Webinar Follow-Up: Conducting a Meaningful Community Assessment When Opening a Birth Center or Midwifery Service

December 27, 2017

grow midwives performing a community needs assessment

In case you missed it, here is the video and transcription of the Webinar “Conducting a Meaningful Community Assessment” with Ginger Breedlove and Lesley Rathbun on Wednesday, December 20, 2018. If you haven’t signed up already, make sure to join our newsletter to keep up to date with all future news and webinar announcements from Grow Midwives.

Remember that if you would like to speak with Ginger and Lesley about starting a midwife business or birth center, you can reach us on the Contact Page.

Ginger: [00:00:00] So my name is Ginger Breedlove. We’re all absolutely thrilled you’re here with us. And this is our third webinar. It’s the first time that we have, sort of, enabled the video and the audio capacity, so Lesley and I feel much more connected to you. And we hope you feel the same about being able to have the conversation tonight about community needs assessments that Lesley will be leading. What we would love to do if you’re willing. And I appreciate the fact that your microphones are on mute. It will make it much easier. We have over 30 people registered, so we may have a lot of people popping on as we get started, but we also would love to hear from you at the end of Lesley’s presentation if you have questions. So to start out, now my old academic hat is coming back on if you would be willing just to un-mute and tell us who you are: if you’re a midwife, a student another invested person, and where you live, that would be awesome. If you’re a student we would love to know what program you’re in, but we would just like to do a round robin here, so whoever wants to start, go for it.

Agatha: [00:01:25] Okay, I’ll start. Can you guys hear me?

Ginger: [00:01:27] Yes.

Agatha: [00:01:28] OK, I’m sorry. I’m trying to find the spot where the lighting is a little bit more effective.

Ginger: [00:01:33] That’s ok

Agatha: [00:01:34] I have to lock myself in my room because my kids are outside watching TV, so this will have to do for now but, hi my name is Agatha. I live in Florida, South Florida, close to Miami, Fort Lauderdale. I’m a student midwife with Jefferson University, formerly Philadelphia University, hoping to graduate this summer and pass my boards with flying colors. And one of my aspirations for the future is to open a community clinic, so when I saw this online I was immediately interested, so it’s certainly great to hear everything you have to say.

Ginger: [00:02:25] Thanks, Agatha. We appreciate that.

Spring: [00:02:34] I’m Spring and I am a student at Georgetown University and planned to graduate in May and I live in California.

Ginger: [00:02:43] OK, great. Welcomes, Spring.

Chelsea: [00:02:51] I guess I’ll just go. My name is Chelsea and I live in Rapid City, South Dakota. I’m a midwife here. I’ve been practicing for about a year and a half now and I went to school at Frontier.

Ginger: [00:03:05] Ok, others?

Shannon: [00:03:13] I’ll go my name is Shannon and I’m off up from Rapid City South Dakota. I’m actually a certified doula with possible aspirations of being a midwife. And yeah, that’s it.

Ginger: [00:03:26] Great, thanks.

Cassie: [00:03:32] Excuse me. My name is Cassie in Rapid City South Dakota. And we have hopes of opening up a birth center here, so we are wanting to learn as much as we can about our community.

Ginger: [00:03:48] Thanks, Cassie. Katie?

Katie: [00:03:54] I’m Katie. I am from Minnesota and I am a student at Georgetown University.

Ginger: [00:04:02] Great, welcome.

Tanya: [00:04:11] Hi, I’m Tanya. I’m a midwife in New York City and I work in home birth right now, but we have some new legislation that’s been going through New York and I just want to hear more about assessing and birth centers and things like that, because hopefully, that’s going to be changing in New York soon.

Ginger: [00:04:30] Yeah we hope so too, Tanya.

Lesley: [00:04:33] Yes.

Ginger: [00:04:35] Wonderful. Have we missed anybody? If not, let’s just jump right in. And, you know, if you can hold your questions or write your questions down, it might help Lesley get through the whole presentation and then we’re going to have plenty of time to, sort of, open this up and have a larger dialogue. So, Lesley, I’m going to go on mute myself and you can take it away.

Lesley: [00:05:02] Ok. So, thank you, everyone, for taking time out on an evening right before Christmas during the holiday’s everybody has usually more to do than they need, so I appreciate it. I am in Charleston, South Carolina, so this photo is not a photo of my community. Where I live is called the Low Country, so it definitely looks nothing like this, but what we’re going to talk about tonight is a community needs assessment, which is a very valuable tool for starting a business, specifically a healthcare business, such as a midwife business.

So what is a community needs assessment? A community needs assessment identifies needs and resources available in your community and a successful business provides a need that’s not currently being met and that complements resources that are already available.

And so, my story is I was working in a large practice, collaborative practice, of nurse midwives and physicians. There were six nurse midwives, seven physicians, and four PAs in his practice. We did hospital births and the midwives pretty much did all the vaginal births and just called the physicians in when it was time to do a cesarean section, but we were very much treated more like obstetrician extenders and it was a lot of push and pull between the midwives and some of the physicians on how to manage patients and I just basically became unhappy and we talked about opening a birth center with the practice and they weren’t sure whether they wanted to do one or not.

And so, finally, I just said, “Well forget it, I’ll just go do it myself.” So one of the first things I did was attend the how to start a birth center workshop, so those of you who are Frontier grads are well aware of that and part of that training does tell you to do a community needs assessment. So that was my first step. And this was in in 2007 and our birth center will be open coming on 10 years. And we’ve had around 25 hundred births.

I started it by myself, just myself and a business manager and we now have five full-time CNMs and we’re still expanding. We hope to very soon expand into a new space. So in 2007, I just printed out a questionnaire on paper and took some clipboards and pencils and went to areas that I wanted to get into contact with women of childbearing ages in different demographics in my community, so I basically stood outside of mainly grocery stores and just would say, “Hey, excuse me, would you mind answering a few questions about childbirth?”

And I gave them the clipboard and it was very short and only took a minute or two for them to finish. Over a few weeks, it was myself and two of my friends, we were able to get 500 responses which I thought was a good number to be able to have a good example of our community. So, a need is what’s missing in your community.

This is a picture of our birth center on a particularly pretty sunset, so it could be a birth center, a freestanding birth center. It could be a home birth midwife practice. It could be a midwife practice that offers something that either there are no midwife practices in the hospital systems or there are more physician extender type practices and you want to have a more midwife model practice maybe offering water birth, whatever it is that your goal is or what your thought is what the community is missing in that it needs and what interest is there in that need.

So one of the things that you will need to do as research, and what you want to do is find out what’s already available, and a lot of this you can do online. This little picture is a picture of a website here with the health department in South Carolina where you can go in and you just check some boxes of what you want and the vital statistics birth certificate information will give you that.

There are also online resources Truven is a good resource to look at cost and what it costs to have a baby in your area. Leapfrog is a voluntary hospital website that looks at quality indicators and they have several maternity ones and cesarean section is one of the big things that they’re looking at now. It has to be voluntary, so sometimes you won’t see all the hospitals in your area. The Listening to Mothers survey, which there’s three of them now. The most recent was in 2014. That has a lot of good information about mothers experience in childbirth on a national level. And then, of course, ACNM the American College Nurse MidwivesAABC the American Association of Birth Centers, and ACOG the American Congress of OB-GYNs also has resources available and some are open to the public. Others will be closed for members only, but those are places that you would want to gather information. Things like the number of births in your community, what the birth rate is.

Other things you want to know is just some basic demographic information like the average household income, how many hospitals there are in the area. You also want to know how many out of hospital providers are in the area and then through the vital statistics is where you will find things like mortality rates and those types of things. Cesarean section rates are going to be much harder to find. Hospitals sometimes don’t want to share that information. It’s like asking a woman for her weight. They get very uncomfortable talking about it and they might not tell you the exact truth.

And one thing I have found is that most providers, nurses doctors, midwives that work in hospitals in the maternity services, they don’t even know what their hospital c-section rate is and many of them don’t even know what their own cesarean section rate is, so it can be a little bit more difficult to get that information. And one of the things when you’re looking at c-section rates too, the rate that you want to ask for is what’s called the NTSB, which is Nulliparous Term Singleton Vertex. In other words that’s the woman that should be having a good chance of having a vaginal birth. And that rules out the things like the twins and the breeches and the stuff like that.

So in your community your going to want to know what your birth options are, whether that’s in-hospital or out-of-hospital. Out of hospital would be birth centers and/or home birth. Try to find out how many births are in each area, so which hospital is doing the majority of the births, which is the smaller, what level they are, if they are in the perinatal network. Home births providers, depending on the area you’re in, in some areas the medical community is pretty hostile toward home births and in some areas it’s not legal, so it can be a little harder to find these folks. They kind of practice a little quieter.

So one good way to be sure that when you’re opening a practice, you don’t want to be a threat to anybody. You don’t want to be a threat to the hospital. You won’t be a threat to home birth practices either, so you want to build these relationships right from the get-go. And part of that is by going to them and asking them and checking them out and telling them what’s going on and asking them to maybe even help participate in some of the survey information.

So, when you’re doing the survey, this is just a clipboard that I found online I thought was hysterical. I wish I had it when I was standing around doing my surveys. You can do what’s called a windshield survey, which is what I did, which is just a pen and paper and clipboard and going to places where people gather, specifically people in the demographic that you’re wanting to talk to.

And then there are online surveys, which are getting much much easier to do and online surveys can be done with, you can go to Facebook groups like, here we have one called Natural Moms the Low Country and ask if you can ask those members to participate in your survey and then you can use a tool like Survey Monkey. There are others out there. Survey Monkey I think is the one most people are familiar with and, as long as it’s a smaller survey, there’s no cost associated with those and they’re pretty easy to do.

So the main thing that you are going to want is to make sure that you’re going to get enough responses. You can’t really get too many as long as you stay within you know your demographic, so your timeline for getting all this stuff done would be first you’re going to develop your idea. What is it that you are thinking. You’re thinking of starting a birth center and then research these demographics, conduct your survey, and then the last step is to evaluate the results of your survey.

So when you’re going to try to find this group of people, whether you’re doing it online, like I said, through social media like Facebook groups or if you physically go to places that specifically women of childbearing age hanging out: grocery stores, coffee shops, I also went to some of the universities so you can very easily take a Google map and ask to see where these places are.

Another thing, when I was doing my surveys, I wanted to have the surveys match the socioeconomic demographics of the community. So, of course, I thought that people who shopped at Whole Foods and Trader Joe’s might be interested in waterbirths, so I definitely went to those places. But I also went to places that were lower resource areas that had high Medicaid populations and so you are going to get a better picture of your community if you make sure that your results match the demographics of the community that you live in.

Then you want to evaluate your results and the best thing that you can do with these results is to make some graphs out of them graphs are very helpful especially when you’re talking to people who don’t know much about the topic of childbirth, which, I can tell you, especially if you’re going to talk about midwives and birth centers, most of the business people, banks, and those type folks, are going to know very little about this type of business, so seeing these pictures makes it a lot easier for them to understand.

So once you have this evaluation, you’ve got your graphics, and you’ve got your tool. Then when you go to develop your business plan it will make that much easier for you. But the most important thing that this tool is, is a way for you to show a community need. When you go to a banker or if you apply for a grant, they want to not just hear what a great idea you have, they want to know that there’s a need and that it’s a fairly safe investment, that you’ve done your homework, the community seems very interested in this and it looks like something that will be successful. And by doing this tool you also show that you’re very serious about what you’re planning to do. So now we have plenty of time for questions. I’m going to go back to the screen so that I can see people.

Ginger: [00:18:09] So Lesley, this sounds like a big project. Is this something people should have in a portfolio or just have in their head.

Lesley: [00:18:20] Oh definitely in a portfolio. You want to make it as shiny and glossy and pretty and professional looking as you can.

Ginger: [00:18:29] So what’s an estimated length would you say? You know, I’ve written a lot of grants in my lifetime on the academic side and 30 pages now is like a maximum now for federal grants. What do you think is an anticipated average proposal for this kind of community assessment integrated into a business plan.

Ginger: [00:18:52] Well, just as a tool, it shouldn’t probably be more than five or ten pages, because you’re condensing all of that information that you’ve got. But, as part of your business plan, your business plan is going to be probably around 50 to 100 pages depending on what type of business you’re looking at. Nonprofits with boards are a little bit more complicated.

Ginger: [00:19:20] So, what I think you’re saying is, the weight and importance of this particular action, this the first step, is is critical. And I would absolutely agree. It’s probably the most critical piece of gathering data that drives a lot of where you go next.

Lesley: [00:19:40] Right. Hopefully, it’s going to uncover things. You know, you don’t know what you don’t know and you don’t want a lot of surprises as you’re developing this business. And this is to help uncover what you don’t know.

Ginger: [00:19:55] So you guys feel free to un-mute your mike. We’d love to sort of seeing what may be resonating with you and what you’re thinking.

Tanya: [00:20:11] Hi, this is Tanya, I have a question. Can you hear me?

Lesley: [00:20:16] Yep.

Tanya: [00:20:16] Oh, great. Hi. Thank you, Lesley. I’m just wondering if you could talk a little bit about your own personal experience. I mean I loved hearing how you said that clearly you just had to do it yourself and I think a lot of midwives, you know, that’s how these things are born. So I would just love to hear about like any mistakes that you made along the way or if there were any re-dos that you had to have or maybe any pathways that opened for you that you knew this is exactly the way that you should be going.

Lesley: [00:20:47] Good question. So from the very beginning I contacted the Women’s Business Center here and most communities do have something like that and then they also set me up with an organization called SCORES, which is some retired businessmen that help entrepreneurs, because the business end of it, I knew how to create a practice that I thought midwives would enjoy working in and that families would want to come have their babies at, but the business side of it certainly was super intimidating.

So I went to the how to start a birth center workshop, followed their manual, did my community assessment, wrote my business plan, and then when I took it to the consultants of these business places, you know, the one old guy who is probably 80, he had a string of gas stations and convenience stores was his business. And he was very, very impressed and he said, “You know, some people come to me and they have their business plan written on a cocktail napkin from when they were sitting in a bar with their buddy.” So, you know, handing him this big portfolio, that was impressive.

And our second meeting after he had a chance to get through everything, he said, “If you are standing on the edge of the diving board waiting for somebody to tell you to jump, consider yourself pushed.” And so, I think getting people to help you and advise you in the areas that you’re not comfortable with is very important. To answer your question about what I would have done differently. I was a little naive about real estate and whether to buy or rent. I would have done something different in that aspect.

And I was warned to be prepared for fast growth. But it’s kind of like warning people what it’s like to have a newborn baby. Until you experience it you can’t really be prepared. And, if done appropriately, and the people who are on this phone call are obviously very thoughtful. But most birth centers do do very well and many of them grow very fast, so you also have to plan for the growth right before you even open. Any other questions?

Cassie: [00:23:14] Hi, it’s Cassie we did do a community assessment survey, but I’m just wondering what kind of questions do you feel like are the most important to ask?

Lesley: [00:23:28] So, what I did, the way I did mine is I didn’t want to ask people if they wanted a birth center because I wasn’t sure that people A: knew what one was and B: I kind of didn’t want to let the cat out the bag yet, so I asked questions like, “Have you had a baby?” “If you had a baby, did you have an epidural? Did you have a natural childbirth? Did you use I.V. pain medicine? Of the following options which were available to you and which do you wish were available. Like being able to move around and labor being able to eat and drink in labor. Intermittent monitoring.” Questions like, “Who would you like to care for you during your pregnancy and birth? A obstetrician a family medicine doctor a midwife. Would you consider giving birth outside of a hospital setting?” You know, questions like that.

By the end, most people handed me back the clipboard said, “Are you starting a birth center?” And I’d say, “Well, I’m thinking about it.” And, so, you know, just kind of getting a feel for the community’s interest and the one question I got the most response that surprised me was a question about who would you want as your first choice to care for you. And I had it broken down like I said before but it was primarily a midwife with an obstetrician available for consultation and referral and almost 90 percent said that’s what they wanted. Which really surprised me. And the number that were willing to have an in-hospital birth was 80 percent, which I’m sure contributed to our fast growth. I didn’t realize there was such a want or need in our community.

Ginger: [00:25:43] I think Cassie, to add to what Lesley is saying is to be strategic with your personal knowledge of the community you live in about what are you anecdotal or perceived challenges surrounding childbearing families. And part of what you want to do in this is validate and verify for yourself whether that is true and to be able to go to the other stakeholders who could be important players like the payers, like the hospital, like physicians who you very much want to have some kind of collaborative relationship with. You’re not making this up. This isn’t this isn’t the way Cassie feels. Although I may agree, this is what the community you live in is saying and there is no rebuttal for that.

Lesley: [00:26:43] Right, Your consumer is who is going to open all the doors for you. So this is basically your consumer’s voice. And there’s nothing wrong with having some open like comments and you know any special key things. One of them, when I was doing this, one of the women that were filling it out, her husband came out, they were actually visiting from another area of the state they were on vacation going to the beach. And she came up to her husband and showed him the clipboard. He was an OB-GYN in another part of the state. And he you know smiled after he read it and he said, “Oh you’re opening a birth enter are you?” He said, “Would you ever consider moving up my way? I’d love to open a birth center.” So you just never know who you’re going to be talking to. But yeah.

Ginger: [00:27:41] Lesley did your community assessment play a role in how you pitched this to the bank.

Lesley: [00:27:48] Oh definitely. Because we did have such high interest as soon as I showed it to them, it was pretty much they were like, “Wow this is this is amazing. I’m surprised nobody’s thought of this before. This is completely untapped. There’s nothing like this.” Because they’ll ask you, you know who’s your competition.

You know your answer will be, “Well I don’t really have any. You know there are hospitals you can give birth or maybe there’s some home birth.” We had homebirth midwives in the area, but there are no birth centers. And it’s just such a new and interesting concept. It’s a very easy sell and I mean they’re not going to give away money, but they’re going to listen to you and you’re going to be able to get the doors open. And the other people it really works with are the payers and you need to negotiate for as best a reimbursement as you can from the get-go. One of the mistakes some birth centers make is if they’ll pay me anything I’ll take it. And it’s better to be out of network than to get a low reimbursement contract.

Spring: [00:29:04] I have a question about the hospitals near where you were at. Was there ever a time where you felt like they looked at this as competition to them? Or were you nervous about, in my community, there’s only one hospital and I’m afraid that they will see this as competition and become you know a roadblock in some ways? Did that come out for you?

Lesley: [00:29:24] Not really the hospital that I was currently delivering babies at, I did let them know from the beginning what my plans were and told them I wanted to do it as a partnership and they would be my transport facility and I wanted to keep my privileges there. And I virtually got no resistance from them or from the other hospital systems.

There had been more than one attempt to open a birth center over the previous ten years and for whatever reason it didn’t happen. And so that worked in my favor. I think they got, “Ah, yeah that’s been tried before. You know, that’ll never happen but whatever. If you want to try, fine.” And, so, some of it was luck and timing and that kind of thing but you really just need to be as open as you can. I can’t stress that enough to everybody in the maternity world in your area, whether the doula,s and the childbirth educators and the physicians, the hospitals all from the get-go and you can if you take the number of births in your community.

Whatever that is. We have a very successful birth center and we deliver about 300 babies a year. That’s still less than 2 percent of the births in our community. So you need to explain to them what a birth center is, “I’m going to have to birth rooms. And I planned this many births.” They will be like, “Well yeah you’re a ripple.” You’re going to really be true competition.

Ginger: [00:30:59] I think that’s so important spraying is people fill the void with their own fantasy numbers. So providing them is really important and also they would be the referring hospital for an amazing number of procedures or surgery or whatever might be needed. And so if that can be spun as a collaborative effort to keep those patients happy that is going to have lifelong service to them anyway. You know, look, let’s try it and you know you may find out in three years you want to buy it from me and we’ll just all be one big happy family.

Lesley: [00:31:38] Right.

Ginger: [00:31:39] Right. You’re taking the risk not them.

Lesley: [00:31:43] That’s a great way to introduce it to them is like, “Let me take the risk. Let me get it going and then in a couple of years if you’re interested maybe you will partner up on this or you can just buy me out and I’ll retire.”

Spring: [00:31:53] Thank you.

Ginger: [00:31:53] I think one of the challenges is, and I come back, you know, from the days of starting a birth center, you know, in 1979 that went on for 40 years. It just close to and is now reopening, Lesley, in a new framework.

Lesley: [00:32:14] Yeah, awesome.

Ginger: [00:32:14] But when you are the only sort of alternative in town you are so much under a microscope that the more fact-based information you can gather and share the less made up stuff circulates. And so I couldn’t agree more with Lesley. When you’re ready making yourself available to anybody wants to have a conversation with you. And in fact, invite them into the conversation. One of the benefits the Frontier students and graduates have and if my tally is right, that’s at least three of you on this call, is the requirement to attend the how to start a birth center workshop. So you’ve had an introduction to, how do I want to say this?

Well, I’ve taught in programs, two programs, where our students did not do that and went from teaching where we had a three-credit professional roles class to the last place I taught professional roles has now been even eliminated from the AMCB exam. The need to feel prepared that you are smart enough and able to run your own health care business is so critical, because the flip side is midwives stay in positions where they’re taken care of just like we were as nurses, If you came from a traditional model, and to be able to ground yourself in that kind of experience the AABC How to Start a Birth Center to get their giant manual, which I’m sure has changed from the ones I went to many years ago, gives you that piece that Lesley was talking about in the very beginning, which is the confidence to learn what you don’t know and just start finding out that information. Because it’s available to you. But when you don’t know what you don’t know when you feel more vulnerable.

Lesley: [00:34:34] And I could tell you that the reason, you know people ask me, “Why did you start a birth center?”Well, it was out of spite. I was angry where I was. I didn’t like the way I was being treated and I felt like they were going to get rid of us. And so I needed to create my own job or move and I didn’t want to move. I’d moved from that job. So I was happy where I was and it worked out really well. But that practice now has no midwives.

Ginger: [00:35:08] We just saw that happen in Kansas City. A large obstetric group at least 7 OBs have now had at least 15 midwives in and out of that group over the past 10 years. People leave because they get mad just like what Lesley said. And I just learned today they’ve completely wiped out the entire midwifery practice that had five midwives there and they’re all now sitting scrambling trying to figure out what to do and two of the midwives who have left years before started their own practice and now they’re thinking about starting a birth center.

So wherever you are on the trajectory, sometimes it takes a life event that just makes you mad enough to say, “Look I can do this.” You have to have some fuel to keep yourself going because it doesn’t happen overnight. Do you have a sense, Lesley, from when you started your community assessment sort of percolating in your mind to reality what that was for you?

Lesley: [00:36:12] I was hired at that practice because I had experience in a birth center. And there was a little bit at the interest with one of the midwives and the founding physician of starting a birth center, so the conversation was sort of around and then, you know, they hired some consultants, some business consultants, and that’s when we were kind of taken aback and thought, “Oh my gosh, they’re really using us as just trying to squeeze as much money out of us as possible and didn’t really value what we did as midwives is special.”

And so, I would say, from the time we had those consultants come in, until I was open about two years and surprisingly enough even though I did get angry and turn in my resignation, they asked me to stay until the birth center was open and they asked to be my referral physicians and here in South Carolina you have to have supervising physicians. And they kind of helped me keep my hospital privileges. Unfortunately, after a year, that did not work out very well. It’s just, you know, when you have seven physicians to consult with it’s hard to make two happy much less seven. So now we just have one and I’ve had the same one and he’s been great. And he was actually the founder of that practice and he left as well.

Agatha: [00:37:47] So my question is, can you guys hear me?

Lesley: [00:37:56] Yes.

Agatha: [00:37:57] OK, this is Agatha. What is your perspective on a new graduate thinking of opening a clinic or midwifery practice? Because I, you know, I, I try to gather opinions from different people and some tell me that it’s better to get a few years of experience under your belt and then try to, you know, jump into some kind of endeavor and others say well why not just start from scratch, because it’s a little bit intimidating for me, but I know that it’s something that I want to do. So, on the one hand, I’m like why waste time and then, on the other hand, it’s like I’m really insecure because I’m new when I might need connections. What’s your perspective? What would you think would be the best approach?

Lesley: [00:38:45] Well it’s difficult. There’s not one answer. For every person, there would be a different answer. I was a fairly new graduate. I graduated in the spring of 2004 in May and I opened my birth center in January of 2008. Quit my job in 06. So, but I’d been a labor and delivery nurse for many years before that.

And so it depends on your own skill level, your own confidence, your economic situation, your family situation. And, you know, I’m not going to tell you, opening your own business the first year or for sure the first year in many for a year or two after that. It’s like having a newborn baby. It requires all of your attention. So it’s not impossible. And there certainly are new grads that have opened their own practices just because it was their only option. They had to create a job for themselves and they did and did it very successfully. And I know of some that started birth centers right as new grads.

Ginger: [00:39:58] I agree with Lesley, Agatha. I think so much of how we make decisions about our careers is where we are at the moment. Financially, health wise, what are family dynamic and relationships might be like, student loans your own confidence in your clinical readiness.

Lesley: [00:40:24] And those are all impacted by who you’re surrounded by and people influence us highly in how we make big decisions in our lives. This is a big decision. It’s not to be assumed to be simple but, on the other hand, our founding midwifery mothers didn’t wait for you know five years of practice to go do what they did, right?

So, part of it, I think success is driven by one’s individual drive and my drive is high and low over my 40-year career based on what else I have going on in my life and what I can prioritize. And so I would agree with Lesley. Don’t let being a new grad put you in the category of, “You’ve got to go get experience” because I don’t believe you have to have labor and delivery experience to be a good midwife, even though both Lesley and I came from those backgrounds. That was sort of what it took for me to even get into midwifery school about 40 years ago.

I don’t think that’s true anymore. But I would say you’ve got to know your community pretty well before you make the decision. “Are there physicians who will support you?” is a big one in my book. Even though you may not have to have them. You’re in Florida. I know a lot about the rules in Florida. It’s a very strange environment to do health care and all the things that have to happen to give you a license and a permit to open any kind of a medical office. So I do believe that physicians are our best friends when we find that right match. And as a new grad, I would think you’d want to be pretty comfortable having someone you can talk to that you trust and they trust you.

Agatha: [00:42:41] Absolutely. Florida is definitely a land in its own little planet when it comes to healthcare. But, yeah, there’s a lot of factors that take into account.

Ginger: [00:42:57] Agatha, do you know Jenny.

Agatha: [00:43:00] I actually did clinically with her for two semesters. Yes, and she’s wonderful, so she’s one of my inspirations.

Ginger: [00:43:15] She’s a good friend of our’s and she’s getting tired. She needs she needs some people that take over her passion.

Agatha: [00:43:20] I know, but she’s in Orlando, so.

Ginger: [00:43:24] How far is that from you?

Agatha: [00:43:26] I’m about a three and a half, four-hour drive. But she was very open and I was able to do an internship with her for one semester for a grant and then I did my clinic, you know, my out of hospital clinicals with her, so I learned a great deal and I’m very inspired by what she’s doing there in Orlando. So I’m hoping to kind of follow her footsteps and do something similar here in the area of Miami and Broward.

Ginger: [00:44:01] She could have a better partner than Wendy. So if there’s some way you can mimic the model that she’s done with Wendy, it will have much power for what you’re trying to do.

Agatha: [00:44:18] Absolutely.

Lesley: [00:44:19] And my suggestion was going to be to try to find an internship in a clinic similar to what you’re interested in an opening which you’ve already done that. So kudos to you.

Agatha: [00:44:30] Yeah the doors open in the right place because when I was looking for a clinical preceptor I knocked on so many doors down here. And they would not open. There are not too many midwives down here in South Florida. And the ones that we have work with private practices and there’s too much yellow tape and paperwork to even try to set foot in a hospital or a precept at a birth. So I knocked on so many doors. So when she opened the door for me in Orlando I was like, “Oh I guess I’ll drive.” But it all turned out for the best because it’s the exact place where I needed to be.

Ginger: [00:45:18] Lesley, do you want to tell them, we’re not marketing AABC, but, in actuality, they are the expert at an educational program. Do you want to tell them what comes with that experience and how this community assessment plays into that?

Lesley: [00:45:37] Yes. So they have the How to Start a Birth Center workshop, which is a weekend course that you go to and they have usually somewhere between four to six of them a year throughout the country. So they try to get them in close enough geographical spots that you could at least drive to, unless, you know, you’re in Hawaii or something, but it’s usually very fun. They have, the instructors there are both administrative and clinical and you get a wealth of information and you get models of various types of birth centers, whether it’s for-profit, not-for-profit, an open model, which means kind of like hospitals, where the midwives have privileges to deliver babies at your birth center but they’re not employed by the birth center that and then those birth centers, the more typical model is they’re employed by it.

There are advantages and risk of all of that, plus they talk about budgeting and financing and money and they give you tools and basically, it’s like a recipe that you just have to fill in the blanks and follow the steps that they give you and then the most important thing is the resources. They’re not going to come out to your community and help you open a birth center. Ginger I can do that for you. But they’re not going to do that. But what they’re going to do is make sure that you have contacts and resources to get the information that you’re going to need.

And you can join, if you join, when you attend the how to start a birth center workshop, which if you pay to attend that they give you a discounted rate to join AABC as a developing birth center. Which gives you a lot of stuff and access to things online, but you can also be an individual member when you’re still in the, “I don’t know what I want to do yet.” phase of this and that’s much more affordable. It’s under $200. I want to say $150, but I’m not certain of that. And that’s a little bit more affordable for students and things but it gives you access to what’s going on in the birth center world.

Ginger: [00:47:56] I would also say that going back to the fact that we sort of dropped the professional aspect of midwifery education. I don’t know if those of you on this call have experienced that and now it’s gone or not. But all the principles that apply to how to start a birth center apply to how to start a midwifery practice. Which I’ve done twice in addition to starting a birth center. It is exactly the same. So there is another resource that could be valuable to you. It’s the Midwifery Business Network Manual. I think we’re on our fourth edition now. It’s available on the ACNM bookstore and it is not as robust, I would say because it’s really focusing on how to start a midwifery practice.

But it will, I think, be another valuable resource that can help you sort of navigate the concepts perhaps a little bit differently from different angles, but it’s exactly the same thing. What you need to do to really have a successful launch or a home birth practice for that matter. So those are very valuable for you if you haven’t heard of them. We have time for another question. Anybody want to throw one out there or any experience you’ve had on this journey that you’re thinking about?

Agatha: [00:49:39] I have a question about the survey, the community needs assessment. I know that it depends on you know what you’re looking for, but about how many questions and how much time did you have to dedicate to do the survey? How much time did it take you to gather the information that you needed to to get a good idea to get a good picture?

Lesley: [00:50:08] I think you could probably ask the questions beyond the demographic stuff like, you know, age and, you know, education level and that stuff, but your basic questions about their childbirth thoughts and feelings in 12 or less you want to keep it fairly short. You don’t want somebody to have to spend an hour answering your questions because they’re just not going to do it.

So you want them to be able to do it in five or 10 minutes. And, as far as your time, you know, once you decide what information you want it’s not going to take you very long to set it up and then depending on where you do online, I mean, like I said, I did it the old-fashioned way where I stood outside in front of grocery stores. We did, we got 500. There was three of us doing it and I’d say I did at least two-thirds of it myself.

And we probably had it done in a month. And that wasn’t standing up there every day. That was just on Saturday afternoons for three or four hours. You can get it pretty quickly. And it’s a lot of fun to tally the numbers up especially when you see them go in your direction. Nothing gives you inspiration like when you see that the community really wants you and needs you.

Ginger: [00:51:27] And that’ll inspire all those people that you live with that are worried about it too.

Lesley: [00:51:31] Yes, yes. You know, the first year so it was my expensive hobby, but it is no longer that. It hasn’t been in a long time. But, at first, it was just a little bit of a joke. It was like, “Is this a hobby or is this going to really be a business?” And it really is a very successful business.

Ginger: [00:51:55] Well we are going to wrap it up here at the top of the hour. We’re so thrilled you came on. We have a wonderful marketing and content team that works with us that will actually transcribe this entire presentation as well as put the recording up on our website which I think eventually we’ll build a YouTube library of all the webinars. In a couple of weeks, we’re going to be launching the beginning of the year with a discussion on salaries and what are you worth. It’s an issue that is critically important to protect our profession and one that seems to be more of a closeted conversation and an open one. So we’re bringing it out in the open and are going to help you and others learn a little bit more about fair salary negotiation principles and how that plays out across our country. So thanks for being on. Lesley any closing thoughts.

Lesley: [00:53:00] No, I just want to encourage everybody to follow your dreams. And don’t ever let anybody say you can’t. In fact, in my experience just tell me I can’t and I’ll show you I can and that’s exactly what ended up happening, so good luck to everybody and we wish you all well and hope you do well whatever road you end up traveling.

Ginger: [00:53:26] We help we see you again. It’s great to see this inspiration.



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