[IL-CNM] midwifery model (was marketing CNM's

Darryn Dunbar runningstork at yahoo.com
Sat Feb 17 14:25:11 CST 2007

I don't know who or what to blame relative to midwifery labor support being a dying breed.  But let me list what I feel to be the most likely reasons.
  1.  Math  (Increased cost of practicing + Decreased reimbursement)
  2.  Quality of Life  (midwives have or are learning that having one is important)
  3.  Demand  (for whatever reasons--many of which could be listed/debated, increasing numbers of women seem to want the "granola midwife" model less and less...they want to schedule their IOL or C/S, have anesthesia and get it done on their terms)
4.  Survival of the fittest  (midwives and APN's have to sink or swim with the rest of the healthcare team)
  I'm not saying what your or other do is bad or wrong, Rita.  In fact, we know it's very RIGHT.  But it's getting down to brass tacks and fewer and fewer practices are offering.  To take it a step further, there are practices that can offer it, but do not.  And some who do offer, can and will do it, but women do not prefer it.
  It's a conundrum of the worse kind.
rsrlled <rsrlled at insightbb.com> wrote:
        v\:* {behavior:url(#default#VML);}  o\:* {behavior:url(#default#VML);}  w\:* {behavior:url(#default#VML);}  .shape {behavior:url(#default#VML);}        st1\:*{behavior:url(#default#ieooui) }                I think we have allowed our model of care with labor support to be a dying breed.   Even though I do much less labor support than when we were a 5 CNM practice (I am solo now in private physician owned practice) I still do a lot . If they sleep (with an epidural or pain meds) then I sleep or go to office . When we had 5 CNMs that shared call our evaluations ( we do the ACNM benchmarking postpartum eval) were always 3’s  with lots of great comments (“awesome care”  I love my midwives” ect)     Heck we hardly went to the bathroom ourselves we were in the labor room so much!  Now the evals are still  3 but with less of the effusive comments  I can’t do as much and am more tired as a solo CNM 
  I am payed a base salary plus some productivity.  If I do less I am payed less. I have developed some efficiencies to allow me to be away from office at labors and still meet all my overhead  bills and make a good salary. I average  10-12 births /month with  about  2/3rds IPA as payor . I also have a busy GYN practice. 
  If I am called away for a labor during office hours I add hours to my clinic later (over lunch and on days scheduled out of clinic) to allow me to catch up .I make rounds before or after office hrs and on lunch. My docs round for me on weekends unless I am in house for a birth.   I have full time RN (not an MA)  that does an hour long education visit at their first OB visit .  At 15-20 weeks she goes over the MSAFP info (again) She also does ½ hour education talks at 28 and 36 weeks . She presents the basic info and then I answer questions and fine tune. She makes most of my call back phone calls and notifies pts of abnormal labs by phone (normal go out by mail) and then schedules return office visits . We work in very close tandem and both believe in “spoiling pts”   That way I maximize my time with the pt.. I had a very hard time giving up the education talks and letting my nurse do it –philosophically I thought that was my job (and my passion).   If I have an induction
 I try to do them on my lighter office days and if I break water I do it after office hours so that get into active labor when I am available to be with them 
    Rita Ledbetter APN MS CNM
  Nurse-Midwife of Medical Arts
  Moline , Ill 61265
  As long as there are mothers upon the birth stool there will always be midwives

  From: il-cnm-bounces at luc.edu [mailto:il-cnm-bounces at luc.edu] On Behalf Of Darryn Dunbar
Sent: Thursday, February 15, 2007 10:31 PM
To: il-cnm at luc.edu
Subject: RE: [IL-CNM] marketing CNM's



    You make a great case.  And you're so right.  It's great your collaborating physicians are so supportive of your model of care.  Knowing you like I do, I imagine it's a great fit.  But I think the model of care that your practice and a handful of others in Ilinois offers may be an ailing or dying breed.  Midwives are being called on to do more with less.  To see a full schedule in the office while being on call, triaging women while caring for other laboring women.  Reimbursements are down.  Expenses (i.e., MALPRACTICE) are up.  You get my drift.


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Darryn W. Dunbar, APN/CNM, MS
  Certified Nurse-Midwife
  "Big Runner D"
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