Worth

I'm closely following a thread on one of the many midwifery Yahoo groups I belong to. This particular thread is about midwives who provide sliding scale or reduced fees. Lots of great points have been made, and it's interesting to read the perspectives of midwives that vary based on age, marital status, geographic area, and level of experience.

The young/new midwives (myself included) are so eager to work as midwives and put our passion and training to use that we happily accept a whole wide range of fees from clients. The older/more experienced midwives, in general, do not offer sliding scale. Part of this makes complete sense, in the "you get what you pay for" way, where more experienced midwives are worth a higher fee. However, the big difference in opinion really comes down to experienced midwives being burned by clients and feeling resentful that they have had to struggle their whole career just to maintain a less-than-comfortable lifestyle. As one midwife pointed out, all of us younger midwives should be automatically putting aside a third of our payments to save for retirement. Yet, I can't even think about saving for retirement until I know I have enough money for our weekly groceries. We advise our clients to eat healthy, organic foods, but I can't afford them myself. If I wasn't married, I wouldn't even be able to afford a nice place to live.

Another midwife wrote that her clients who could really use a low fee (single, unemployed, or very low-income) rarely asked for it, and those who did often offered to compensate by bartering, working in her office, or cleaning her home. They valued her services, were considerate of her time, and were rarely high-maintenance. As a result, she said, she never turns anyone away for not paying, but she also never offers a reduced rate unless asked.

I have to admit that I totally struggle with charging a fee that reflects what my services are worth. I always have. I know doulas who are way less experienced than I am who are charging almost twice my fee. I thought I would automatically have more confidence with charging a fair fee once I became a midwife, but sadly, I don't. Yet. I'm getting there.

What I find interesting, from my own experience, is that I have rarely been questioned about fees by the women themselves. The vast majority of my doula and midwifery clients value the services I can provide and will let me know if my rate is outside their capacity to pay, but they don't ever challenge it. The men, on the other hand, occasionally do. I know there have been multiple men who encouraged their partners to interview and hire only low or no-fee doulas, as they either didn't understand what a doula could offer or they understood but still didn't respect the value. I know, because I've been that low-fee doula meeting clients in their big, beautiful homes, who are not the least bit financially-strapped, and who just want a bargain.

I wasn't resentful when I was new, because I figured my lack of experience meant my services weren't all that valuable. Now, at least I know better. I mean, I just safely facilitated an unplanned home birth on my own. Yes, everything turned out fine, but had there been a shoulder dystocia, postpartum hemorrhage, breech baby, or prolapsed cord, I still would have known what to do to protect both the mother's and baby's lives. That's worth something. I'm finally starting to get it.

I don't want to end up being resentful of clients. I still plan to offer reduced rates for families who have a true financial need. But, the value and respect must be there. I really don't even want to work with families who say they can't afford my fee because they're saving to buy a house or a car, or whatever. How much would someone have to pay a man to leave his home and his family in the middle of the night so he could patiently attend a laboring woman, be respectful of the woman's wishes, and lovingly care for the woman, her baby, and her entire family, putting his needs last? I mean, really.

Yesterday, I had a prenatal visit with a client. She (happily) paid her full remaining balance and gave me a bag full of fruit as a nice gesture. I was thrilled. I'm worth it!