What midwives do all day.

 Midwife in Hinche, Haiti with her pile of charts on clipboards. The midwives loved when the volunteers would do their rounds so they could catch up on paperwork. We loved doing patient care all day and not having to chart at all.

Midwife in Hinche, Haiti with her pile of charts on clipboards. The midwives loved when the volunteers would do their rounds so they could catch up on paperwork. We loved doing patient care all day and not having to chart at all.

People say how lucky I am to “catch babies” all the time and be around newborns. They are in awe that I could be a births and experience the joy of new life “all the time”. However, they are sorely wrong when they imagine that I get to work with women and babies “all the time”. Working as a midwife more often than not looks like this:

 What this Alaskan midwife’s pile of clipboards looks like.

What this Alaskan midwife’s pile of clipboards looks like.

4 out of 5 tasks in any given day are not related to patient care. It’s not just midwives feeling this paperwork burden. I’m sure you have heard about physicians, PAs and nurses under the same pressure. Like this article in Forbes reporting on a study that found doctors spend ⅔ of their time on paperwork. And, they report it’s getting worse every year. 4/5s of my time or 2/3rds? It depends on the day. But I count on every visit generating an equal amount of time on writing letters to employers, calling the lab, letters back and forth to insurance, ad nauseum.

Peeps are sorely wrong when they imagine I get to spend all my time helping pregnant women, catching babies, counseling breastfeeding and cuddling newborns all day.  

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Even my daughter….

(…thinks that’s what I do when I leave the house)

Just like doctors and midwives, nurses spend more time doing paperwork than doing patient care. This is one of the major reasons I think people need to hire a doula or bring experienced support into the hospital with them. No matter how awesome your nurses are, they could lose their jobs by leaving their keyboards too long in order to physically support you.

I don’t want to complain too much. I am grateful for many things.

  • I am grateful to have access to insurance billing and medicaid reimbursement for low income families.

  • I am grateful that we have access to technical training, accountability for all the midwives in the state, statistics and a support network.

  • I am grateful We can do heart defect screens, metabolic testing, have access to lab & diagnostics, have easy access to physician consults…

But with all of this modern medical access comes modern medical paperwork!!!

What can we midwives do? Often I consider switching back to a cash practice. Yet, I don’t believe I would be able to serve very many families that way. We all sacrifice big time to pay into the health insurance machine. We want to “use” their insurance. Or I could work as an unlicensed midwife in a state or country that allows it. 90% of my paperwork is insurance and state mandated charting and reporting. I have to report or communicate with at least 4 state offices every time I have a birth. Sometimes more.

What are the solutions?

I have been moving back to a paper charting in the room which is a huge leap against the current trends to electronify everything. Electronic charting was supposed to save time but did the opposite. This Business Insider article sums it up well:

..the more our country spends on traditional EHR software, the more time providers must spend on them, the more dissatisfied they become, the more frustrated patients feel, and the more expensive health care gets.

Any suggestions?! Someone out there have any idea how we can ease this burden so that I can see more mothers and babies and spend less time on the paper?