What Being a Home Birth Midwife Is Actually Like

I was an L&D nurse at St. Charles for eleven years. I was good at it. I liked the clinical work. I liked the families. What I did not like was watching interventions happen because of the clock. That's the hospital reality. You're not on your body's timeline. You're on their shift schedule, their bed availability, their liability calculations.

I remember this one labor, I must have been about seven years in. The woman was doing beautifully. Progressing, coping, her vitals were perfect. Baby sounded great. But she'd been there nine hours and the attending wanted to start Pitocin because of "failure to progress." Nine hours. That's not failure. That's a Tuesday. But the chart needed a number and the number said move it along.

I went home that night and told Dale, that's my husband, I said I can't keep watching this. And he said, "Then stop watching." Which is about as many words as Dale uses for anything. But he was right.

While working nights, yes. I did a MEAC-accredited program, distance learning with clinical intensives. I'd work a twelve-hour night shift, sleep four hours, and get on a call with my preceptor in Portland. For about eighteen months. It was, I mean, I was in my late thirties and I don't think I was fully awake for any of it. Dale handled everything at home. I passed the NARM exam in 2010.

My first solo home birth was actually a family I'd cared for as their L&D nurse. The mom reached out because she'd had a bad experience with the interventions during her first birth, at the hospital where I worked. She found out I'd gotten my CPM and she called me. That was it. I left the hospital. Never went back.

I take three to four births a month. That's my max. I could take more. The demand is there. Bend has grown a lot. But three to four is the number where I can still be the midwife I want to be. Each client gets twelve to fourteen prenatals, each one is sixty to ninety minutes. I do home visits for most of them. So a typical week is maybe six to eight prenatals, one or two postpartum visits, and then I'm on call for whoever is in their birth window.

On call means on call. My phone is on. Dale knows. Kristin, that's my backup midwife in Redmond, she knows. My bag is packed, it's in the car. If I go to the grocery store, the bag comes with me. If I'm at my daughter Jennie's place in Portland, I have to be able to get back in three hours. That part doesn't change. Sixteen years in, I still don't sleep through a full night when someone's in their window.

The phone. Honestly. Not the births. The births are the point. The phone is the tax.

I'll give you an example. A Tuesday a few weeks ago. I got a call from a woman who said she found my name on some website. I don't even know which one, there are a few now. She was lovely. Very nervous. She wanted a home birth. She'd done a lot of reading. We talked for probably forty minutes. Forty minutes into the call I asked about her history and she told me she was thirty-six weeks with twins and had a prior classical cesarean incision.

That's high risk on three separate counts. I can't take her. I wouldn't take her. That is not a safe home birth candidate by any reasonable standard. And I spent forty minutes of my life getting there. Forty minutes where I could have been charting, or resting, or on the phone with someone I could actually help.

And the worst part, the thing that sat with me the rest of the night, is I don't know if she found anyone. I gave her Dr. Orozco's number at St. Charles and a few other names, but at thirty-six weeks with twins and a classical scar, she needed a high-risk OB two months ago. I felt terrible. For her. But also, if I'm being honest, for my own time.

I can. The L&D nurse in me never turned off. I can hear when someone is performing excitement about home birth but is actually scared. I can hear when someone has done zero research and is calling me because they saw a TikTok. I can hear when someone doesn't understand what it costs. I can hear all of it in the first two minutes.

But I still can't hang up. Because it's a pregnant woman. You know? She's telling me about her pregnancy and her hopes and I just, I can't be the person who says "let me stop you there." Even though stopping her there would save us both a half hour.

I have a... thing. Dale has a friend who "does websites." He built me something on Wix in 2018. It had a stock photo of a woman in a bathtub and my phone number. The phone number was wrong for three months and I didn't know until a client mentioned she couldn't reach me.

I stopped sending people to it. I've been word of mouth since I started and it's never been a problem. My clients refer their friends, their sisters, their neighbors. I have never once had a slow month.

The problem isn't getting found. The problem is that the people who find me through Google, or whatever website that woman found me on, they're often the ones who aren't a fit. My word-of-mouth clients come pre-vetted. Their friend told them what it costs, told them what I do, told them what kind of birth I attend. The Google people come in cold. That's where the forty-minute phone calls happen.

I'd want them to know the basics before they call. Are you in Bend? Okay. Do you have one baby, head down, no major complications? Okay. Can you afford four to seven thousand dollars, or does your insurance cover CPM care? Okay. Is your due date more than eight weeks away? Okay. Now call me. We'll have a great conversation.

That's four questions. If someone answered those four questions before picking up the phone, I'd get my evenings back.

Because I kept standing in the room watching someone else make the calls. Not bad calls, usually. But I'd be supporting a client through labor and the midwife would make a decision and I'd think, I would have waited another hour. Or I would have suggested a position change first. Or I would have checked in differently.

After six years of that, Renee, that's my mom, she said something that stuck with me. She said, "You keep coming home talking about what you would have done. So go do it." She's a retired postal worker. Very direct. She also thought I was insane for leaving a steady doula practice for three years of school and clinical hours with no income. She still brings that up.

National Midwifery Institute. It's a distance program with clinical preceptorships. I did my clinicals in Detroit, which meant driving two and a half hours each way from Grand Rapids. Sometimes I'd drive there, be on call for twenty hours, attend a birth, drive back, and go to my doula client's prenatal the same afternoon.

Marcus, my partner, he's an electrician. We share a car. So on my clinical days he'd take the bus to his job site and I'd take the car to Detroit. We did that for a year and a half. I don't think either of us fully processed how hard that was until it was over.

I passed the NARM exam in 2023. Britt, she went through school with me, she practices in Kalamazoo now. We still call each other when something weird happens at a birth. Which is more often than you'd think.

I take two to three births a month. I need every single one. This is not a business where you start and immediately make a living. My fee is $5,200 for a full package. That's on the lower end for this area. After supplies, malpractice insurance, gas, continuing ed, my net is maybe, I don't know, maybe $3,200 per client? Sometimes less.

Three births a month at that rate is about $9,600 before taxes. Marcus makes more than me. We don't talk about that.

Oh, the prenatal that wasn't. Yeah. So I drove fifty minutes to a client's house in Wayland for a scheduled prenatal. I get there. She's not home. I text her. Nothing. I sit in my car. It's February. It's cold. I'm sitting there with my birth kit in the trunk and my bag of instruments in the front seat and I'm just... waiting.

Twenty-five minutes later she texts me, "Sorry, running late at Target!!" Two exclamation marks. I sat in that car and I had this whole internal debate about whether I can afford to fire a client. Because this was the second time. And the answer is I can't. I need three births a month and she's one of my three. So I waited. She showed up at the forty-minute mark with bags from Target and a Starbucks and she was very sorry and the prenatal was fine.

But I sat in that car and I thought about the six years of doula work, the eighteen months of clinicals, the NARM exam, the $14,000 I still owe on school loans, and I'm sitting in a driveway in Wayland, Michigan, in February, waiting for someone who's at Target.

The business. All of it. Nobody teaches you the business part. They teach you how to resuscitate a newborn. They teach you how to manage a shoulder dystocia. They do not teach you how to send an invoice to someone you just held while she cried through transition. They do not teach you how to market yourself, or how to do your taxes as a sole proprietor, or what happens when an insurance company denies a claim using a billing code that doesn't exist.

I spend, honestly? Maybe 40% of my time on clinical work. The rest is admin. Billing. Charting. Driving. Following up on insurance. Posting on Instagram because apparently that's how people find midwives now. I did not go to school for any of that.

That's the one thing the doula years gave me that nothing else could. I can read a room. I walk into a prenatal and I can tell within thirty seconds if the partner is on board. You can see it in how they sit. Whether they're leaning in or leaning back. Whether they ask questions or just look at their phone.

Last month I had a prenatal where the partner was clearly, deeply uncomfortable with the home birth plan. He didn't say anything. But he was sitting on the arm of the couch, not on the couch. Arms crossed. Looking at the doorway. I named it. I said, "It looks like you might have some questions about this." And he just, he opened up. He was terrified. His mother had a traumatic hospital birth and he thought home birth meant no medical care at all.

We talked for an hour. About transfer protocols, about the equipment I carry, about what happens if something goes wrong. By the end he was asking good questions. Real questions. That conversation is why I do this. But that conversation doesn't happen if I can't read the room. And reading the room is not something you learn in midwifery school. That's six years of sitting with laboring women as a doula. That's the training nobody lists on a credential.

Nine years. Third grade, Medford. I loved it. I was good at it. I liked the structure, the lesson planning, the kids. What I did not love was the politics and the pay, but that's every teacher's story so I won't bore you with it.

What changed everything was my third baby. My first two were hospital births. Fine. Nothing dramatic. But for the third one, Mike, that's my husband, he teaches high school science, he suggested a home birth. He's the one who brought it up, not me. He'd been reading about it. I thought he was out of his mind. But we met with a midwife and something clicked.

The birth was, I mean, I don't want to be one of those people who says "life-changing" about their birth, but it was. It was my living room. My couch. My music. My kids were asleep upstairs. The midwife sat in the corner for most of it. She was just there. Present but not directing. I had my baby at 2 AM on the living room floor and my older kids met their sister at breakfast. I called the midwifery school the following week.

It saved my life. That's not an exaggeration. I was solo for the first four years and I was burning out. You cannot be on call 24 hours a day, 365 days a year, and stay sane. I don't care how much you love the work. The on-call alone will eat you alive.

Cara joined me eight years ago. She's ten years younger, very organized, very tech-forward. She's the one who's been trying to get me off the paper planner. We split call. I take Monday through Thursday, she takes Friday through Sunday, and we alternate weeks for births. We have Sophie now, she's 24, just graduated, she's our birth assistant.

Between the two of us we take four to five births a month. That's sustainable. More than that and the prenatals start stacking up and you're rushing through appointments, which I won't do. The teacher in me can't help it. I need to explain everything. My prenatals run long because I teach.

A couple weeks ago. Client in Talent, which is about twenty minutes from my house. She called at 2:10 AM. Contractions five minutes apart. I called Sophie, she met me there by 2:45. Cara was on backup but it was my call night.

This was a second baby. First one was born at a birth center in Medford. She wanted to be home this time. She was a good laborer. Strong. Quiet. Her husband made coffee at 5 AM and I remember thinking, this is the part that never gets old. It's 5 AM and there's coffee and a woman is working through contractions in her bedroom and it's exactly where she wants to be.

Baby was born at 4:12 PM. Fourteen hours. Healthy, perfect, 8 pounds 2 ounces. We did the newborn exam, I stitched a small tear, we got her settled, nursing went well. Sophie and I cleaned up. I left around 5:15.

My son had a soccer game at 5:30. I drove straight there. Muddy field, Ashland rec league, the other parents are sitting in camp chairs with their coffees. I stood on the sideline and watched my kid play soccer and nobody there had any idea where I'd been for the last fifteen hours. That's the job. You move between worlds.

They run long because I can't stop teaching. I know this about myself. A family comes in with a question about, I don't know, Group B strep, and twenty minutes later I've drawn a diagram and explained the evidence and the risks and the alternatives and they're looking at me like they just want to know whether to take the antibiotics.

Cara is the opposite. She's efficient. She answers the question, moves on. Her prenatals are forty-five minutes. Mine are seventy-five. We've talked about it. She's right that I could streamline. But the families who choose me, they choose me because of the teaching. They want the long version. At least that's what I tell myself.

The problem is the phone calls. New inquiries. Someone calls and says "I'm thinking about a home birth and I have some questions" and forty-five minutes later I've basically done a free prenatal over the phone with someone who hasn't even committed. The teacher in me cannot say "look, this is a paid consultation." I just, I start teaching. Every time.

Sequencing. From teaching. In third grade you learn to recognize when a kid is following the steps and when they're skipping ahead or stuck. Labor has a sequence. It's not just about dilation numbers. It's the sounds she makes, the way she moves, when she stops talking, when she starts vocalizing, when her eyes close. There's an order to it.

I trust the sequence more than any single measurement. If a woman is 4 centimeters but the sequence says she's in active labor, she's in active labor. If she's 7 centimeters but the sequence says she stalled, something is off. That's not clinical training. That's nine years of watching eight-year-olds learn to read. You develop a sense for progression. Whether it's a kid sounding out words or a woman moving through labor, the pattern is the pattern.