Licensed Midwife and Certified Professional Midwife

There is no other way to start this other than by saying:
I passed the NARM exam with a 90% on the first try, and I graduated from MCU! NARM gave me the Certified Professional Midwife (CPM) designation. I applied for and was issued my midwifery license from the Medical Board of California on July 18, 2019!

It. Is. Finally. Done.

I can finally add these letters to the back of my name:
Marivette Torres, LM, CPM 

That’s it, folks, for this blog post. A quick update on my progress!!

Midwives: Worth their Price in Gold

Have you seen midwifery prices, and thought it was too expensive? Have you wondered why a midwife charges what they charge? Have you thought about asking your midwife for a discount? The following information is given to help you understand why a midwife charges what they charge. It is meant to help you understand your midwife and the price for midwifery care.

Plain and simple
Midwives have operational costs.
Midwives deserve to be paid a living wage.
Cost of living affects midwifery prices.
Home births and birth centers have different prices.
Midwives have expenses.
Midwives are trying to pay their own bills.
Midwifery practice is not about providing free care.
Midwifery is a livelihood and a way for midwives to earn an income.
Midwives need to pay the electric bill, phone bill, rent, mortgage, feed their families, etc.

What a Midwife provides
The following is an ESTIMATED breakdown to help you visualize the care Midwives provide. Some midwife’s breakdown could be more or less. Remember, this is your midwife’s TIME, knowledge, expertise, and one-on-one care that is being offered.

  • Initial prenatal
    2-4 hours depending on what is done during this time (some midwives break this down into several prenatal appointments)
  • 12-18 prenatal appointments
    Depends when you came into care…60 minutes long, sometimes up to 90 minutes
  • 1 – 5 labor checks
    lasting from 1 – 6 hours depending on your needs…these checks usually are the early labor checks when you think you are in labor, but then labor slows down or stops.
  • Labor
    Anywhere from 1 hour – 24 hours or more, price would depend on length of labor
  • Birth
    1 – 4 hours of the actual birth through the birth of the placenta
  • Immediate postpartum for birthing parent
    4-6 hours, sometimes longer
  • Immediate postpartum for the newborn
    4-6 hours, sometimes longer
  • 4 – 6 Postpartum appointments
  • On-call and 24 hour emergency line

AVERAGE $2,500 – 8,000

Midwives have monthly and yearly expenses (not every expense is on this list!)
• Handouts – ink and paper
• Reading materials – ink and paper, or purchasing reading material
• Up-to-date, safe equipment – constantly throwing out expired items
• Equipment maintenance
• Resuscitation equipment for birthing parent and newborn
• Certain medications
• Herbs
• IV supplies including IV fluids
• Licensing fees
• Liability insurance
• Gas
• Vehicle maintenance
• Food
• Childcare
• Lab
• Cleaning supplies
• Birth supplies
• Sterilization supplies
• Suturing supplies
• Oxygen tank refills
• Oxygen supplies
• Office supplies
• Office rent, utilities, etc.
• Cell phone
• Website
• Paying assistants or students
• Continued training in CPR and neonatal resuscitation
• Required training to keep their license
• Paying off midwifery student loans

After all this is subtracted from the midwifery fee they charge, they may have some money left over to pay their personal bills and hopefully save a few dollars. Most midwives are barely scraping by, and simply want to make enough money to live through the next month. Midwives take on several clients a month to be able to make a living wage.

Midwives don’t just catch/receive (deliver) the baby
A midwife doesn’t just come in at the end of labor to catch/receive the newborn. A midwife provides full prenatal and postpartum care that is tailored to each client’s individual needs. Sometimes this begins as early as 6 weeks of pregnancy. Midwives are with clients for hours upon hours providing one-on-one care. A midwife might be with a laboring person for 24 hours, straight, giving much needed care. Midwives also provide a newborn physical exam and can administer vitamin K injection in states where midwives are licensed. Midwives have a vast array of knowledge and resources to help families during their reproductive years. If you came into care late, the expenses remain the same, and sometimes are a little higher if things must be done quickly!

A midwife’s time is valuable, just like in any other profession. Midwives miss family birthdays and holidays to attend their clients births. Midwives will drop everything they are doing in a moment’s notice to go be with their clients during labor or birth. Midwives give 100% of themselves to their clients. When their client is in labor and ready to give birth, the midwives attention is solely on the care of their client.

A midwife also provides handouts to help with their client’s pregnancy education. They may provide herbs to use during labor, birth, and postpartum. They may give you lots of breastfeeding assistance. They will suture if any lacerations require repair. In some states, midwives can carry antibiotics for GBS positive clients, and they will administer this during labor. They can also give IV fluids, if needed. They can administer medications to stop immediate postpartum bleeding.

Midwives can’t pay their own bills 
Your midwife will never tell you that last month she didn’t have enough money to pay the home utility bill, because you weren’t able to pay her fee. Or a midwife may not tell you that their license must be renewed in a couple months, and they hope their clients pay their outstanding bill, so their license doesn’t lapse. A midwife will smile and give you the care regardless of your ability to pay that month, while your midwife goes without. This information is not meant to make you feel bad or guilty or shame you (although, I can imagine some people will, and for that I am so sorry), but simply to give you some insight into a midwife’s financial struggle.

Assistants and/or students
Your midwife, also, needs to pay her assistants their fair wages which can run anywhere from $500-$1500 depending on the cost of living for your area. Students don’t generally get paid, but as a struggling student myself, I could have benefited greatly if I had been paid, even if just for my gas expenses!

When you asked your midwife for a discount, and your midwife gave you a $500 or even a $1000 discount, that reduced your midwife’s ability to pay any expenses they may have incurred that month. Imagine if your midwife gave everyone a discount? Your midwife might need to get a second job just to pay the bills!

When we look deeply into the expenses a midwife has and look into all the care they provide their clients, midwives should be charging much more. However, midwives also want to make midwifery accessible, and will offer discounts and most will not charge the full amount of what they are worth.

Your investment 
Midwifery is an investment into your own emotional, mental, and physical well-being.
Nothing compares to the one-on-one attention your midwife will give you.
Nothing compares with having your baby in the comfort of your own bedroom surrounded by the people you love and who love you (if you choose to have them there). You get to know your birth them throughout your prenatal visits, so you know who will attend your birth. Everyone who attends is someone you have previously met!
Free-standing birth centers may have higher expenses and may charge more, but they also provide that same care you would get in a home birth!

Final thoughts and planning
Yes, midwifery care is a huge expense for families, but so are weddings, 1st birthdays, vacations, parties, etc. The average wedding is $15,000. (You can have a wedding for much cheaper, of course, especially if you simply go to the court house. But if someone is having a typical wedding in 2019, it’s going to cost near that price average above.) Many insurances will reimburse a portion of midwifery fees, but you still have to pay out-of-pocket initially. Not all midwives accept insurance, though.

Every penny paid to midwifery care is worth it! You can begin saving for midwifery care NOW by putting aside a little money every month, even if you are not pregnant! If you can, you might consider having a yard sale, selling baked items, using your tax refund, or starting a fundraising event to help pay for midwifery care. Ask if your midwife will provide you with a payment plan. If your midwife does, try as best as you can to make your monthly midwifery payments on time so your midwife can pay her bills.

With midwifery costs ranging anywhere from $2500 – $8,000, depending on your location and whether it is a home birth or hospital birth, planning now is important!

What did you do to pay for midwifery care? What other ideas do you have to pay for midwifery care?

Midwives really are worth their price in gold!

Gold on Weight ok for website.jpg


A Guide to the Difference Between a Certified Professional, Licensed Midwife and a Certified Doula

Not every service that a CPM, LM offers was able to fit under the CPM section, so only the main topics were included. It’s not an exhaustive list but a starting point for families to understand some of the differences. The Spanish version is available here.
La versión en español está disponible aquí.

Midwives-Doulas Handout ENGLISH

Una guía de las diferencias entre una partera profesional certificada con licencia y una doula certificada

No todos los servicios que ofrece un CPM, LM pudieren caber en la sección de CPM, LM, asi que solo se incluyeron los temas principales. No es una lista exhaustiva, sino un punto de partida para que las familias entiendan algunas de las diferencias. La versión en inglés está disponible aquí. (The English version is available here.)

Midwives-Doulas Handout ESPANOL.jpg

Prenatals or Client Meetings


Quick: What pops into your mind when you see the word “Prenatal?” Maybe prenatal vitamin? Prenatal care? Prenatal appointment?

Okay, so, what is a prenatal appointment? A prenatal appointment is a set apart time where you receive care from your care provider such as an obstetrician or midwife. If a pregnant person is using a midwife, this care will be personalized to their specific health needs and desires for birth. If they are seeing an obstetrician, this care will be personalized to the OB’s practice. Whichever care provider they choose, they will have monthly, bi-weekly, and eventually weekly prenatal care throughout thier pregnancy.

In my role as a doula, I cannot provide any clinical care at all. My doula services are limited to educational, informational, emotional, and physical support. This means that I provide education and evidence based information on pregnancy, labor, birth, and breastfeeding. This comes in the form of private classes, answering questions, and providing evidence based websites for parents to do their own research. Emotional and physical support is provided through labor in the form of gentle, caring speech, rubbing the back, arms, legs, or hands, offering sips of water, offering ideas on different positions to find comfort, support the partner, the use of a rebozo, and many other comfort-level methods. None of these methods are clinical in any form.

In my doula role, I provide two client meetings before birth to help familiarize myself with my client’s birth wishes and to create a birth plan. These meetings are informational and educational.

Now to the nitty-gritty that may upset some doulas. This is not a slight on any doula. Please stay with me, because the purpose of this post will be evident in the final few paragraphs: I have never called my doula meetings “prenatals” “prenatal appointments” or anything closely related to “prenatal.” I call them “client meetings.” I could never get into the habit of calling what I provide as a doula, a “prenatal,” because I am not providing any prenatal, ie. clinical, care whatsoever. Prenatal appointments imply, to ME, an appointment with a care provider such as an obstetrician or midwife for the purpose of clinical care. What I am providing, as a doula, is education, information, and a 2-hour class on labor comfort measures. That to me does not equal a prenatal. It equals an informational/educational meeting.

I say all of the above, because this is an area where the change of roles is considerably different to me. As a student midwife, I am now, officially, attending prenatal appointments with a licensed midwife. Because as a doula I always called them “client meetings,” it was a huge deal when I switched to calling clinical appointments a prenatal. As a student midwife, the prenatal consists of all things clinical, as they usually do with a care provider. There’s the urinalysis, weight check, blood pressure, pulse, externally checking baby’s position, listening to heart tones, and discussion of any symptoms and/or concerns regarding the health of the pregnant woman. I can do none of these procedures during client meetings in the doula role, but I can do all these things during prentals as a student midwife under the supervision of a licensed midwife.

Using these two terms for what they are intended is a huge significance for me, now, as I switch between the doula role and the student midwife role. When I’m hired as a doula, they are client meetings. When I attend an appointment with a licensed midwife, they are called prenatals. I’m ecstatic that I have the privilege of attending prenatal appointments with a licensed midwife, and that I have the opportunity to perform all the clinical tasks which are part of a prenatal.

To some people it may be a matter of semantics, and that’s ok. To this writer it is a sign of a vastly different role:  student midwife/ midwife apprentice.