Working in private practice

Someone said to me recently, "Being a private midwife is a lifestyle".  I really related to that comment.

Many of the women who see me for their care ask me at some stage what I do all day.  They see me in appointments but often wonder how the rest of my time is spent.

Midwifery work is divided loosely into appointments (antenatal and postnatal), births and attending urgent issues that come up (eg bleeding in pregnancy, concerns about baby and so on).  However, there is also a large amount of "other stuff" that needs to be attended to.  I find that my time is split between being a midwife, practice manager, receptionist, accountant, marketing manager and researcher. 

As an eligible midwife, I need to attend at least 40 hours of continuing professional development each year, as well as having up-to-date and evidence-based written policies for my practice.  Each form that I use, every educational handout I provide - has all been developed by me for the women in my care.

In my day-to-day practice, the mornings are generally spent in consultations with pregnant women and new Mums and babies, while the afternoons are spent in home visits of new Mums and babies.  I find that travel does chew up a lot of time, especially in our Sydney traffic.  I drive about 20,000km each year for work and my car needs to be in good condition and reliable all of the time.

Births and urgent issues of course take priority over everything else, so if someone is in labour, I re-schedule the appointments for the day to welcome the new baby.  Luckily, the women I care for are very understanding when this happens! 

In my practice, I'm very big on providing continuity of care from early pregnancy because I find that this gives the best outcomes.  I think that early pregnancy is a really important time for a woman and baby, and there is a lot that I can do to promote health and wellness early on that often makes a difference as the pregnancy progresses.  Consequently, I am on call for each woman for around 40 weeks (eg week 6 - 40 of pregnancy + 6 weeks postnatally). 

Between each appointment, I prepare hand-outs and other resources for the next visit, file any test results that might have come through, and attend general administration (preparing the file, storing the file after discharge, preparing paperwork for the back-up booking into the hospital and writing any referral letters or discharge summaries as needed).  So there is actually quite a lot of paperwork when you think about it.

As well as all of that .... there are things like updating statistics after each baby is born and reflecting on my practice outcomes so that I am constantly improving and providing better care.  The library is regularly updated with new books, the birth kit and midwifery supplies are checked before and after each birth to ensure that supplies are in date and that there is sufficient quantities, or else an order is placed.  There is the quarterly BAS which seems to come around too fast, and probably a multitude of other things I have not written about here.

Each day is very varied, and I never know at the start of the day exactly how it might go.  I might have a whole day of appointments planned and then postpone most of those visits for a new baby whose arrival is imminent.  I might have a day off planned but end up doing a home visit if a new mother is needing help feeding her baby.  I love the unpredictability of this work.  It keeps me on my toes, and the variety is very refreshing: in one day I might attend a birth, do a postnatal home visit and also do an antenatal visit.  I use all of my midwifery skills and get to really understand how each action impacts the ongoing journey through pregnancy and birth. 

So I hope that this has given some insight into what it is like to work as a private midwife.  It is incredibly rewarding, inspiring, beautiful and incredible, but it is also tiring (at times) and I can never make any firm arrangements because my practice is the priority always.  Would I recommend private practice?  Definitely!  It's the best way to work as a midwife and I wouldn't like to work any other way.