Today, midwives in NZ are taking a case around gender discrimination to the High court. We are challenging the payments made for LMC (Lead Maternity Carer) midwives care provision to pregnant and new mums in NZ. We are saying that because midwifery is a traditionally and majority female workforce, it is paid at a lower rate than it would be if it was a male dominated workforce with a similar level of skill and expertise. We are challenging it as a human rights issue. As a gender issue.
And Boy oh Boy are people mad about it. They say it isn’t a gender issue. They say we knew what we were signing up for when we signed up. They say we are a bit shit, anyway. They say that we are trying to compare ourselves to doctors. They say we earn a good whack already, and if we don’t like it, we should leave. They say male midwives earn the same amount, so it CAN’T be a gender issue. They say that women are always whining about something. I don’t know why I read the comments. You get the gist. Here’s what our PM has to say about the issue. You guys are getting this, right? Ugh.
Of course it is a Gender issue. Midwives are mostly women. They provide health care: To women. And they do it because they care. People forget that when GP’s were in charge of birth, midwives still provided the labour care. The GP arrived (Generally at the last minute) and stopped the baby bouncing as it was birthed by it’s mother.. Obstetricians are the performers of surgery, or instrumental deliveries, the managers of high risk pregnancies and complicated childbirth and they do it with skill and expertise….. AND the assistance of a midwife. (They also do it with my and my colleagues utmost respect. they also deserve much more pay for their work than they get in the public system!) Midwives do all the things that need doing when the doctors aren’t around, from monitoring mum and baby to wiping brows, from managing emergencies to cleaning up vomit. And we are specialized, trained professionals, dammit.
Male midwives are still midwives, who are often accorded the privilege of finding out what it is like to be a second class citizen. They are looked at funny for their choice of profession “What is a male midwife anyway? A mid Husband?” (mid Wife means “With woman”. So no. But, thanks so much for the lame ass joke that we had never, ever, ever heard before). They get paid as if they were a woman, and turned away from jobs and training opportunities because they have the “wrong” genitals. They get asked if they are gay (none of the ones I have worked with are and of course, it wouldn’t matter if they were), and don’t they think it’s a weird job for a guy? This truth makes it clearer than ever that how midwives are paid is so much a gender issue! Because if it wasn’t a job that had a gender applied to every damn element of it, we maybe WOULD have more male midwives. Because men are JUST as capable of care, compassion, judgement, accountability and organisation as women. And these are the core competencies for the job.
Who do you compare the midwifery workforce to? What group of mainly men are specialized, medical care providers, with a responsibility for two lives, a 24/7 52 week a year responsibility for care provision, and the responsibility of two lives in every decision they make? For that, I don’t have an answer. But I am sure that as a group, we could come up with some ideas. Leave a message in the comments if you have a job description that compares. I am thinking maybe electricians? Or something?
So. I can’t resolve the “how do we decide who to compare to” question. But I thought I would try and add a little light to the subject of “what do midwives actually get paid?”
I broke this down by client, GST excluded, back when I was an LMC, to help decide whether it was financially smart to continue. I’ve added in the actual work and how I came up with the associated average hours, to make it more understandable to people who aren’t crazy enough to actually do this job.
Payment breakdown: (maximum figures stated) antenatal 1st and 2nd trimester:
This represents approximately 12 hours work. 6 appointments at 8, 12, 16, 20, 24 and 28 weeks approx one hour each (some are shorter, some longer. Booking appointments for example are often 2 hours, while an uncomplicated 24 week check may only need twenty minutes face to face time). Phone calls to answer queries, concerns and responding to any emergencies (miscarriage, bleeds, reduced movements, abnormal test results, unexpected findings (like twins or wrong gestation), reviewing results, associated paperwork, computer work, referral letters, medical certificates, paid parental leave applications and the like accounts for another six hours, on average.) (Some women will require few of those things, some, sadly may require much more. Managing someone with an abnormal scan result can involve up to ten hours of evening or weekend work, including consultations with specialist, referrals, counseling the Woman and her family etc). So 12 hours is a good average. Total payment: $307.50
Hourly rate: $26.
If a woman has a first trimester miscarriage, that work is still done, but the payment is a total of $179- $14 an hour.
If she discovers her pregnancy late or moves to the area late, the work remains the same, but the payment is $128- $10.70 an hour.
Third trimester: all the above work still applies: on call 24/7 for problems or emergencies, between 6 and 12 clinic appointments (depending on when a Woman labours, a birth at 42 weeks includes about six more visits than one at 38 weeks, plus extra referrals, clinic appointments, consultations, paperwork, and induction care. A preterm birth includes much more emergency care) so I allowed 14 hours as an average.
For this we are paid $297.00 or $21 an hour.
Labour and birth: for a first time mum the total maximum payment is 1117. A subsequent pregnancy- $876. An elective caesarean- $318. A home birth attracts an additional payment of $451, but this is used to pay a second midwife (required for around two hours) and purchase all one off single use supplies needed at a home birth.
Obviously it is difficult to estimate an hourly rate for labour and birth. This time includes all phone calls, home assessment, time in hospital/birth centre/home, three to four hours after the birth (including the immediate postnatal care, third stage, registering the birth, all associated paperwork, computer work and claims). Even a very fast labour is easily 8 hours work, but any are in excess of 24 hours. So I chose an average of 18 to establish my “hourly rate”. I did review 47 births to establish those numbers.
This gives an hourly rate of $62. Which is a bit more realistic. However for anyone not having their first baby, that sum is just a bit lower, at $48.66 an hour. An elective caesarean requiring approximately six hours of work, if no emergencies bump you, pays around $53 an hour.
Postnatal care. This again varies a lot, and additional to home visits, travel time and costs, referrals to GP’s, well child providers etc you are still on call for any maternal problems (mastitis, infections of post op cs wounds, endometritis etc) the woman calls you first if there are baby problems, for a referral to the appropriate service (paeds, gp, emergency dept). Breastfeeding support, parent craft education, post natal depression, all vary the amount of time each visit takes. But again, we want an average. So I went with 12 1.5 hour slots, 18 hours of visits, plus three hours of “phone/referral office work”. Total: 21 hours.
Again, some women have shorter visits as all is well. Some have more visits which take longer (I saw one woman three times in one day, for two hours at a time three days in a row for feeding problems)
We get paid either: $492 for women who have a day or three in hospital or a birth centre $23/hour
Or $553 for women who have a home birth or go straight home after birth- $26.33/ hour.
If a woman needs more than thirteen visits, we can claim an additional $159.
So. Hours per client, total: 65.
Payment total (averaged to allow for a mix of first time mums, subsequent mums, mums with miscarriages or late pregnancy loss and mums with an elective cs. I took one years worth of my clients, which was 47 women, six of whom miscarried and five of whom had elective cs and seven late bookers)
per client: $1728.
Which is $26.59 per hour worked, those hours reflecting a workload per client and an average (so sensible to acknowledge some women take less hours, some many more).
From that income I had to pay for my phone (essential) accountant, software, professional education and registration and insurance (compulsory, and not cheap), stationary, clinic rent, consumables, on call fees for other midwives for my days off, car, parking, petrol (hugely important), tax, ACC levies, advertising, website and all other costs of business, before taking what was left over as my “income”.
In addition and with no extra payment, I was on call 24/7 for all but four days each month, with two weeks holiday, during which I had to pay a locum to be “on call” for my antenatal and postnatal clients emergency calls, from the income already discussed.
We are legally not allowed to raise our prices or indeed charge women anything. The only way to increase income is to increase workload. It’s not self employment in the standard sense. I hope this helps people a little, to understand the issues.
All figures exclude GST. Figures for payments as at 2012, publicly visible here
Oh. And to establish an “average hours per week” : 47 clients in a year. 65 hours per client. Two weeks off: 61.1 hours per week.
This from my actual 2008 work figures. Because so many people think how many hours a week we work has any relevance to the contract as it is laid out. Which it really doesn’t.
And in case anyone wondered, I left LMC midwifery after doing this analysis.