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Two-midwife practice, one midwife on leave: Navigating a difficult conversation

by Cassie Moore, ACNM writer and editor

It is often said that there is no perfect time to have a baby, but this rang especially true for Melicia Escobar, CNM, who was half of a two-person practice when she became pregnant in the summer of 2010.

At the time, Escobar worked at Valley Birthplace and Woman Care, in Huntington Valley, PA, with just one other midwife, Barbara d’Amato, CNM, who founded the practice in 1987. When Escobar found out she was pregnant, she had to be upfront with d’Amato, for reasons both professional and personal: Escobar wanted d’Amato to be her midwife.

“At 10 weeks I said ‘I’m pregnant and eventually I’ll need to go out on maternity leave,’” says Escobar. “At 30 weeks, I started wanting to get into the specifics, like am I going to get paid, what are the logistics going to be?”

Escobar says she felt some trepidation at the thought of taking months off and leaving d’Amato with most of the work.

“In big practices it’s so much easier to swing a maternity leave,” says Escobar. “In a small practice, you feel guilty. Anybody should be able to take a maternity leave, but in a country with zero support for working moms, you have to just do it and hope it works out.”

The timing was also an issue because Escobar and d’Amato had been looking to fill a third midwife position. d’Amato said it was difficult to find an experienced midwife who was comfortable working in the hospital, the birth center, and at clients’ homes (midwives at Valley Birthplace attend births at all three locations). Finally, d’Amato found a midwife, made an offer that was accepted, and ramped up the number of clients in anticipation of the third midwife coming on board. But when that hire fell through at the last minute, it was too late to start the process over again. The upshot was that d’Amato covered the entire practice during the 12 weeks Escobar was out, delivering 40 babies, which more than doubled her usual load.

“I was in the office or the birth center or somewhere catching a baby,” says d’Amato, “and if I wasn’t doing that, I was home sleeping. My poor husband hardly saw me at all, my kids and grandkids hardly saw me at all.”

During this period, d’Amato only called for backup once so she could lie down for a few hours (her client was in early labor and d’Amato was back awake and attending to her at 4cm).

Escobar admits this type of situation “puts a strain on the practice.” For those in a similar situation, she says it’s best to be upfront as early as possible. “Hammer out all the details, make a plan, and go with it so nobody feels bad or remorseful or bitter,” she says.

Looking back, d’Amato says she wishes she had known about Escobar’s pregnancy a few weeks earlier so that she could have adjusted her plans accordingly.

“I wouldn’t have accepted so many people in the practice if I thought there was any possibility that I would be on my own,” she says “but because we were already thinking about hiring a third midwife, we opened the floodgates.”

Escobar returned from her maternity leave last summer and is back working at Valley Birthplace, where she says her baby, Mona, has inadvertently been to three births now!” She and d’Amato have just welcomed a third midwife to their practice, and d’Amato adds that she may begin looking for a fourth later this year.

“If I have one person down, we’re so busy right now that two people can’t swing it,” says d’Amato. “It’s good news from a business standpoint.”

Posted 2/10/2012 8:39:53 AM



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