Denise Tiran: Making the decision to work for yourself

Denise Tiran is a midwife, lecturer, complementary practitioner and an international authority on maternity complementary medicine. In her new book, The Business of Maternity Care, she offers advice and guidance for midwives and doulas who want to establish a maternity-related business, offering services such as pregnancy complementary therapies, antenatal classes, lactation support or full doula care. Read an extract below in which Denise discusses why more people are looking to set up their own businesses in this field.

Midwives working in the NHS are increasingly disillusioned with the care they are able to provide for women (discussions with numerous midwives on courses, at conferences, by telephone and on social media). Many feel that the demands of midwifery practice today do not meet the ideals that caused them to enter the profession in the first place. The workload is phenomenal, with a risk-averse dependence on physio-pathological monitoring and the prevention or management of complications. Midwives have little time or energy to provide the psycho-emotional and social support that is so much a part of holistic maternity care.

Long shifts leave them exhausted, although this does mean that they have more days off in the week. However unrealistic and unhealthy shift patterns in which midwives are expected to transfer from day to night duty and back again within a week mean that they spend off-duty time recovering and resting which may have a potentially deleterious effect on their health and family life. Older midwives may struggle to cope with the physical demands of the work, and many opt for retirement earlier than they might otherwise have done, further depleting the dwindling workforce.

As a result, midwives are increasingly choosing to set up in private practice or to establish other businesses aimed at enhancing women’s experiences of pregnancy, birth and early parenthood. Many midwives telephone me to discuss working for themselves and what started as a dribble of enquiries a couple of years ago is fast turning into a deluge. Many want to offer some private services whilst continuing to work part-time within the NHS or for one of the emerging private companies which provide full maternity services. Some midwives are keen to work as doulas so that they can be “with woman” without the litigation-conscious bureaucracy of the NHS or the legal responsibility of conducting births on their own accountability.

There is also, of course, a market for those who are not midwives but who actively choose to work as doulas. Often these women (and sometimes, men) have worked in jobs which have become mundane and unfulfilling and, despite potentially taking a reduction in income, become committed to working in a caring role. Some doulas come to the role as a result of their own positive birth experience and then wish to help others to achieve that for themselves. Alternatively, those who have had a negative birth experience may be motivated to help others avoid similar circumstances. Many doulas might have considered training to become a midwife, but for various reasons decide against it, preferring to offer services for pregnant and childbearing women in a manner of their choosing.

It is important to decide if going into business is for you and why you are considering it. Are you running away from a situation that may have become intolerable, or towards an ideal? If you are a midwife simply trying to get away from a difficult work environment this may not be the best motivation for working for yourself; it may set you up to fail and should not be the only driving force behind your decision, although it may be a trigger to the overall process. Similarly, for doulas, while personal experience can be valuable in formulating your own opinions about what you would choose for maternity care, it is important not to permit your own feelings to colour your ability to decide objectively about going into business. On the other hand, if you decide that you want to make a difference, you want to help families to achieve a satisfying pregnancy and birth experience that they are unable or less likely to achieve from merely receiving standard NHS maternity care, this will present an outcome for which you can aim.

Are you a midwife or doula interested in setting up your own business? Let us know in the comments below!


The Business of Maternity Care
A Guide for Midwives and Doulas Setting Up in Private Practice

Denise Tiran

This is a guide for midwives and doulas who want to set up a private maternity-related business. Included is advice on business issues such as marketing and pricing, and debate around the professional, legal and ethical issues. There are also activities and exercises to help the reader set up their business, as well as case studies throughout.

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