Life 'on-call' - making it work.

Recently, this question was posted on the IMUK Facebook page:

"I am really interested in the work/ life balance for family and relationships when on call all the time. How does it work?"

A really good question, and perhaps a concern that prevents people from working as an IM (insurance issues aside).  So this blog is for all you midwives, student midwives and aspiring midwives about the reality of life on-call and how midwives (IMs, NHS case-loading midwives, commissioned groups of midwives) find it not only workable, but balanced, rewarding, and fulfilling.

I have worked on call since October 2007; I have taken periods off, I've had periods where I have been on my knees, I have missed some family birthdays, I have even missed a family break.  There have been times I have totally resented it (and even tried to side-step for a bit), however the freedom to manage my working life, the autonomy I have as a midwife, the joy of seeing a family grow as you support the mother and empower her, outweighs the days when being 'on-call' can feel too much.

Working Hours
Developing my own self-imposed 'working times' was one of the first things I had to learn: initially I didn't do this as I was just so excited to provide the care I was offering.  What I quickly learnt was that not having my own 'boundaries' made me tired and resentful.  So now, I never work Sundays unless I am at a birth or it is early postnatal days; Sundays is family day, TV day, reading day; I won't answer texts (unless urgent) or check facebook / emails or make routine appointments.  I stipulate this to clients at booking and I have found that most women fully respect this.  My working 'hours' are 8am - 8pm, and only women in labour or urgent issues get my attention.  I home educate so most of my appointments are late in the afternoon so I can be there for my family.

Switching-Off
This is a real skill that takes time to develop; early in my IM career if a woman was 'imminent', getting to sleep was a problem.  What I have learnt in my time on-call is interesting; if I have not been called by 10pm, then I am very unlikely to be called out in the middle of the night.  I may get an early morning call, or a late evening call, but, in almost 6 years and caring for over 50 women, I have only been called out in the middle of the night a few times.  So if I go to bed without a call, I feel quite confident that I will get a full-nights sleep.

I have also learnt to tell women the days that are really inconvenient to me.... always spoken light-heartedly and with a smile, but since doing this women seem less likely to birth on those days.  I put it down the Oxytocin Factor - if they are worried about me not being there they release adrenaline and don't labour!  I only do this for really important things, like family birthdays and so forth - and of course I will be there if the baby decides otherwise anyway!

Having a Social Life
This was something else I struggled with; frightened to make commitments in case I got 'the call'.  Now, I just live life 'as usual'; I tend to drive myself places so I have the car if needed, women are asked to let me know if they think things are 'happening' so I can get home / sort my family/ make a decision about whether to go or not.  Generally, I will stay close-ish to home.  My family are really supportive and don't tend to mind too much if I can't make something; they do of-course have times when they feel the pressure of my work, but because there is so much time when I am available, around and participating, they get over it quickly.

Friends also know that sometimes I will cancel things last minute - but I guess knowing their friend is attending a birth must seem quite cool.  They certainly like to hear the birth story later!

Drinking is of course a bit of a no-no; turning up pissed to a birth might not be the safest way of practising.  I do have the occasional small glass of wine, and I like to make up for it when I am 'off-call'; personally I think my liver enjoys the time off.  And it saves me money.

The 'best-bits'
Supporting women and knowing what is important to them; not having to 'quickly' read notes and get to know the woman and her 'preferences'; practising 'hands-off' autonomous midwifery; managing my workload (choosing my hours outside of births); drinking tea and laughing with clients; continuity of care; taking my children to meet the new baby; wearing my own clothes (silly, but I hate tunics - so 'official'); being my own boss; lie-ins - no early shifts for me!; feeling proud of what I do; meeting fellow IM's and sharing stories and skills; meeting students - and learning from them as they do from me; having time with my family when I choose to; not waiting for the 'off-duty' to come out; catching babies with inquisitive assistants.......

The list is end-less.  Working this way is not always perfect, and there may be times in my life when working within the NHS will be the right thing at that time and having 'set' hours will be what I need.  Until that time, I will choose to work in this way - and fight to work in this way.

So I hope this answers the question for you - about what it's really like..... and maybe it might help you answer this question on survey monkey:

Would you work as a self-employed midwife?


angela xx

Independent Midwifery: Dispelling the Myths

"I bet your clients are really demanding?".  Sigh.  Nope, not usually.  In fact, I find the hardest bit of being an IM is dealing with such misconceptions and answering questions (from an NHS midwife) as that one.  I wrote previously about 'what we do', now however, it is time to dispel some myths about Independent Midwives (IM's):

IM's are Maverick and Risky
On the contrary; IM's have a large number of women who would be considered 'high risk' within the NHS and as such are seeking a midwife who will support them in their informed choices.  This means careful thought and planning, often involving a Supervisor of Midwives to help arrange the appropriate care.  It means being up-to-date with the latest research so that we can provide safe, effective practice.  There are risks to our job; but we work hard to keep these to a minimum whilst supporting women fully in their choices.

Women who use IM's are wealthy
Different women, from different backgrounds and with differing levels of personal income book with IM's.  Yes, I have had clients whose disposable income is enviable, however the vast majority of my clients have to work hard to find the money for my fees.  Or they simply can not find the money and then we try to work something out.  For most clients, their priority is to book with a midwife whom they know and trust  - and this often means making huge personal sacrifices.

IM's earn 'loads of money'
You can see that in the shiny 2005 Citroen Picasso I drive, and all the holidays I take - NOT!  Out of my fees I have to pay for my equipment, administration costs, petrol, training updates, tax, holiday 'pay' (being self-employed means when I am not working I am not earning), journal subscriptions,  etc etc.  IMs really do not earn huge sums - and we really do earn our money!  24-on call is not an 'easy' option and can take it's toll on family, friends and day-to-day life.

IM's Clients are demanding
If wanting to have one-to-one care with a midwife you know and trust, appointments in your own home, and feeling supported in your choices is considered 'demanding' then yep, my clients are very very demanding.  I do find however that this standard of care pays dividends in normal outcomes, high breastfeeding rates and family satisfaction.  And I always get tea and cake (hence my expanding waist line).  Women are really so demanding!

IM's don't want insurance
We do, we do, we do!  We just can't get it!  Honestly, every time you go to a birth, to hear the little voice on your shoulder saying 'this could be the one that costs your home' is not fun!  We do it because we can (not for much longer), we do it because we care, we do it because midwifery services should not be a 'one size fits all' option.  I do it for myself (terribly selfish), but knowing who I am going out to when I get called to a birth makes me feel like a safe practitioner.  Plus, I don't have to get to know the woman and her family, instead I can just offer my full attention and be 'with woman'.  It's fantastic.

Independent Midwifery is not for everyone, just as being a labour ward midwife, or a consultant midwife is not for everyone.  The important thing is that just as women should have choice, so too should midwives.  

There are many myths around Independent Midwifery and IM's, and the one that is most concerning is that is does not matter if we are no longer able to practice.  The demise of IMs will have catastrophic affects, and midwives within the NHS will find that their autonomy will be significantly threatened - the RCM know this and just continue to play footise with a government that is calling the shots.   Just look to countries where midwifery has been persecuted in this way, and then see how many midwives there are.  It is worrying.

Independent Midwifery must survive - and you can help.  You can share this blog with everyone and anyone who has an interest in midwifery or birth.  You can tell people the TRUTH about IM's.  You can watch 'Home Delivery' on March 21st and see how we work.  You can join our facebook page and learn more.  Women matter - IM's do too.

angela xx