In the two years since I last posted, I have made some significant changes in my practice. The biggest change is that I have begun working collaboratively with Laura Gilbert, CNM and Lynn McDonald, CNM. It has been one of the best decisions of my life. Both of these ladies have practices that I have used as role models for my own practice. One of the things that I value about both of them is their willingness to turn clients away if they have reached their practice limit in a given month or if they feel like the client is a good fit with them.

I have a hard time saying no. I'm a people pleaser. So I'll take on clients that I have reservations about, telling myself that "it will be OK. It will work out in the end." One of the clients that I had the most reservations about, but that I took on nonetheless, left my practice because she was arrested and sent to federal prison for drug trafficking (!) I had a gut feeling that something wasn't right, but I didn't say "no" to her. Lesson learned.

My official number of clients in a given month is 7, although I will go up to 10. I had a crazy month in February when I had 13 clients due, but I decided then and there that I won't put myself in that position again. Not only was it hard on my physically, but it was hard on my practice as well. In rushing around putting out fires, I neglected some business items that I still am attending to all these months later.

I value client care. I value keeping appointments on the day that they are scheduled. I also value spending time with clients and being attentive to their needs instead of rushing from one place to the next. I'm often behind schedule because of this. But the clients know that I will show up sometime on the appointed day, or I'll be there the next day.

I value client-led labor attendance. I ask clients to call me when they suspect they are beginning labor so that I can plan my day accordingly, and I ask them to call me to come when they want me there, especially for home births. I may be there for hours, or I may be there for minutes. If I need to borrow a couch for a rest, I do. It is the client's call, not mine. I do like to arrive more than mere minutes before the birth, though!

I tend to clients at the expense of my practice and my personal life. It's much easier to manage when I have a client load that I can handle, which in my experience is about 7. I have a couple of months coming up that are lighter, and I intend to savor those months.