The same numbers, written three times
Blood pressure, fundal height and fetal heart tones go on the visit sheet, then the flowsheet, then the summary you keep for yourself. Nothing checks that the three agree.
6.5 hours a week
Prenatal record, transfer ready
Chart the prenatal visit once, and walk into the hospital with a summary they can actually read.
MidwifeLedger holds the whole antepartum course in one ruled flowsheet, flags the criteria your consult protocol cares about while you are still typing, and prints a one page transfer summary in under a minute. It was built with licensed midwives carrying twelve to forty clients a year, not adapted from a hospital system.
- 431 US practicescharting daily across 38 states
- Encrypted US hostingwith a signed BAA on every plan
- One afternoonto move an active caseload over
The paperwork tax
The birth went well. The charting is what is still open at 11pm.
Every midwife in a solo or two person practice runs the same second shift: rewriting the visit notes, chasing a lab result, and rebuilding a history for someone else in a hurry.
Transfers assembled under pressure
A transport at 3am means photographing a paper chart or reciting a history from memory while the charge nurse waits with a clipboard.
22 minutes per transferScreens that slip past the window
The one hour glucose, the anatomy scan, the third trimester group B strep swab. Miss the window and you are apologizing to a client who trusted your calendar.
1 in 9 chartsLicensing reports rebuilt by hand
The annual statistics your board wants sit inside forty paper charts. Most midwives lose a full weekend to counting outcomes that were already recorded.
14 hours each renewal
How it works
Four steps, and the record does the rest of the work
The flowsheet mirrors the visit you already run. You are not learning a hospital chart, you are typing into a ruled column that reads like the one in your bag.
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01
Open the client and set the dating
Enter the last menstrual period or the dating scan and the whole schedule builds itself: visit intervals, screening windows, and the postpartum sequence. Change the estimated due date later and everything downstream moves with it.
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02
Chart the visit in the ruled column
One column per visit, holding weeks of gestation, blood pressure, urine, weight, fundal height, fetal heart tones, presentation, edema and your narrative. Type it on a tablet at the table, or on the laptop in the car afterward.
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03
Watch the flags as you enter values
Your consult protocol is written into the flag set, so a rising diastolic, a fundal height falling off the curve, or a missed twenty-eight week screen raises a mark on the row while you are still with the client. You decide what it means, the record just refuses to let it go quiet.
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04
Print the transfer summary
One page: dating, history, allergies, group B strep status, the last three visits, active flags, medications and your current assessment. It prints from a phone, a tablet or the practice printer, and receiving units read it without asking a single follow up question.
What is in the record
Built around the antepartum course, not around a billing screen
Six things the platform does that a general practice EHR will not do for a midwife carrying her own caseload.
The ruled prenatal flowsheet
Every visit is one narrow column and the whole pregnancy reads left to right, the way a paper flowsheet does. Scroll back nine months and the trend in blood pressure or fundal height is visible without opening a single note.
Risk flags you write yourself
The flag set ships with the criteria most state protocols share, then you edit the thresholds to match your own practice guidelines and your consulting physician's agreement. A flag never charts for you, it just makes sure the value is seen twice.
The one page transfer summary
Generated from the record, never retyped, and laid out in the order a labor and delivery team reads: identity, dating, allergies, group B strep, pertinent history, active flags, then your assessment. It fits on one sheet on purpose.
Screening windows that hold
Each screen sits on the calendar with its window, not just a due date, so a client who reschedules twice still gets the glucose test inside the right weeks. Open windows show on the caseload board every morning.
Postpartum and newborn in the same chart
The birth summary, the newborn exam, the metabolic screen and the six week visit continue the same record instead of starting a new file. Outcomes are recorded once and feed your statistics automatically.
Board reports and superbills
Annual licensing statistics assemble from the outcomes already in the chart, with the counts your board asks for and a line item audit behind every number. Superbills export with the CPT and ICD-10 codes community midwives actually bill.
What changes in practice
The numbers midwives report back after one full season
These come from practices that moved a live caseload over and kept charting for at least six months. They are averages, and the range behind each one is wide.
51 sec
Median time to a transfer summary
Measured from opening the chart to a printed page. The record is already complete, so the summary is a rendering step rather than a writing task.
5.8 hrs
Given back each week
Duplicate entry is gone, and the visit is closed before the client leaves. Most of the recovered time comes from evenings that used to be charting evenings.
97%
Screens completed inside the window
The caseload board surfaces open windows every morning, and the schedule reflows when an estimated due date changes, so a rescheduled visit no longer pushes a screen past its limit.
14 to 40
Clients carried without adding admin help
Practices that grew their caseload through a season did it on the same staffing, because the charting load per client stopped scaling with the number of visits.
A Tuesday on call
Where the platform sits inside an ordinary week
Nobody buys software to admire it. Here is the shape of a normal day for a midwife carrying eighteen active clients, with the record doing its part quietly.
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7:40
The caseload board over coffee
Four clients due for a visit this week, one glucose screen with six days left in its window, and a group B strep swab that came back positive overnight and is already pinned to the right flowsheet row.
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10:15
A thirty-two week visit at the client's kitchen table
Tablet flat on the table, values typed as they are measured, the client watching her own fundal height curve fill in. The visit closes before you put your shoes back on, and no note follows you home.
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14:30
A blood pressure that will not settle
The second reading crosses the threshold you set with your consulting physician, so the row raises a flag and the chart offers the consult note template. You call, you document the call, and the whole exchange lives in the same record.
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02:05
A transport in the middle of the night
You print the transfer summary from the phone in your bag while your assistant loads the car. The receiving unit gets one sheet, the client gets a clinician who read her history before she arrived, and you get to keep your attention on her.
From the practices
Midwives who carry their own call have been using this since 2023
No pilot programs, no logos we borrowed. These are three practices that pay for the platform every month.
I transferred a client at thirty-nine weeks for a prolonged second stage last winter. I printed the summary in the car, handed it over at the desk, and the resident read it and asked me two questions instead of twenty. That has never happened to me in eleven years of practice.
What sold me was that the flowsheet looks like my paper one. I did not have to relearn how I think about a pregnancy. My apprentice picked it up in a morning, and my consulting OB now gets a record he can actually read when we call him.
My licensing renewal used to eat a whole weekend of counting. This April it took forty minutes, and every number had the charts behind it if the board asked. That alone is worth what I pay for the year.
- 431US practices charting on the platform
- 68,900prenatal visits recorded in the past year
- 4.8 / 5average rating from practices in their second year
Pricing
Priced for a practice, not for a hospital system
One monthly figure, unlimited clients on every plan, and no charge per chart or per transfer summary. The safety features are identical at every level.
Solo Midwife
$49 per month
For one licensed midwife carrying her own caseload, with or without a student.
- One clinician plus one apprentice seat
- Unlimited clients and prenatal visits
- Full ruled flowsheet and visit notes
- Automatic risk flags with editable thresholds
- One page transfer summary, unlimited
- Chart and caseload export at any time
- Signed business associate agreement
Most practices start here
Practice
$109 per month
For two to four clinicians sharing call, a caseload board and one set of protocols.
- Up to four clinician seats plus apprentices
- Shared caseload board and call handoff notes
- Practice wide flag set with per client overrides
- Lab attachments pinned to the flowsheet row
- Superbill export with CPT and ICD-10 codes
- Annual licensing statistics report
- Same day support from a midwife on our team
Birth Center
$229 per month
For a licensed birth center running rotating staff, students and a facility record.
- Unlimited clinician and student seats
- Facility level audit trail and role permissions
- Room, equipment and supply logs in the same record
- Quality assurance dashboard with outcome tracking
- Multi site reporting for accreditation review
- Custom transfer summary layouts per receiving hospital
- Onboarding session for the whole clinical team
Every plan is billed monthly in US dollars and can be cancelled at any time from your account settings. There is no setup fee, no annual contract and no charge for exporting your records when you leave.
The transfer page
What the receiving unit actually gets
We rewrote this page eleven times with charge nurses and midwives reading it side by side. It is one sheet, in the order a triage team reads, and nothing on it was typed twice.
Top band: identity and dating
Client name, date of birth, gravidity and parity, estimated due date with the dating method, and current gestational age calculated at print time. Blood type and antibody screen sit on the same line.
Middle band: the clinical course
Allergies, medications, group B strep status with the swab date, pertinent history and the last three prenatal visits with their values. Anything flagged during the pregnancy is printed in the margin with the date it was raised.
Bottom band: today
Reason for transfer, your assessment, vital signs from the current encounter, fetal heart tones with the method used, and your contact number. The signature line carries your license number and state.
Birth Center plans can hold more than one layout, so a practice that transfers to two hospitals can print the version each unit prefers without editing anything by hand.
Records and responsibility
How we handle a chart that a family will read years from now
A prenatal record is a legal document and sometimes a keepsake. We treat both of those obligations as part of the product, not as a policy page.
Encrypted, audited, and yours
Records are encrypted at rest and in transit and held in United States data centers. Every open, edit and print is logged with a name and a timestamp, and you can export that audit trail for a chart review or a board inquiry without asking us for it.
Amendments that keep the history
Correcting a value never erases what was there before. The chart shows the amendment, the original entry, who made the change and when, which is exactly what a records request or a peer review needs to see.
Signed agreements on every plan
A business associate agreement is included at $49 per month, not sold as an enterprise add on. Access is scoped per client, so an apprentice sees the charts she is carrying and nothing else.
Offline is a normal night
Rural driveways lose signal. The chart holds visits entered offline on a tablet and reconciles them when you are back in range, and the transfer summary renders locally so a weak connection never stands between you and a printed page.
Who this is for
An honest read on whether MidwifeLedger fits your practice
We would rather lose a subscription than watch a practice fight a tool that was never shaped for it.
It fits well when
- You are a licensed midwife attending home births or working in a birth center.
- You carry between 10 and 120 births a year, alone or with a small team.
- You have a written consult and transfer protocol you want the record to respect.
- You want the chart to travel with the client to a hospital, not stay in a drawer.
It is the wrong tool when
- You need a full hospital inpatient record with order entry and pharmacy.
- Your practice is primarily gynecology or well woman care rather than maternity.
- You are contractually required to chart inside a health system's own platform.
- You want a scheduling and marketing suite first and a clinical record second.
Straight answers
What midwives ask us before they move a caseload
If the answer you need is not here, write to us directly and a person who has worked in a birth center will reply.
Solo Midwife is $49 per month, Practice is $109 per month, and Birth Center is $229 per month. Every plan includes unlimited clients, the full prenatal flowsheet, automatic risk flags and the one page transfer summary. The difference between plans is the number of clinicians on the chart and the depth of the reporting, not the safety features. Billing is monthly and you can cancel at any time without a penalty.
Most solo midwives are charting live within one afternoon. You import your active caseload from a spreadsheet or type in the twelve to twenty clients you are currently carrying, and the flowsheet is ready as soon as the estimated due dates are in. Practices with two or three clinicians usually take a week, because they want their consult protocols mirrored in the flag set. We do the flag configuration with you on a call rather than handing you a manual.
Records are stored encrypted in United States data centers and every read and write is written to an audit trail you can export. Only clinicians you invite to a chart can open it, and access is scoped per client rather than per practice. We sign a business associate agreement with every plan at no extra charge. We do not sell, mine or share client records, and we never use them to train anything.
Lab results from Quest and Labcorp can be attached to a visit and pinned to the flowsheet row they belong to. Charts export as a tagged PDF or a CSV that your billing service can read, and the superbill fields map to the CPT and ICD-10 codes midwives actually use. We also produce the vital statistics fields most state licensing boards ask for in their annual report. If you use a system we have not met yet, send it to us and we will tell you honestly whether it fits.
You can cancel from inside your account settings at any time and the plan ends at the close of the current month. Before you go, export everything: full chart PDFs per client, a CSV of the whole caseload and the raw attachments. The records belong to you and your clients, not to us, so we do not gate the export behind a support ticket. We keep the account recoverable for thirty days in case you change your mind, then it is deleted.
Paper is fine right up to the moment you are handing a chart to a labor and delivery charge nurse at two in the morning. MidwifeLedger keeps the visit rhythm you already have, because you can chart on a tablet at the kitchen table with the client reading along, and it prints. What changes is the ten minutes of copying, the missed twenty-eight week screen, and the phone call three days later asking you to reconstruct a blood pressure trend. Several midwives on the platform still keep a paper copy in the client bag, and that is a reasonable thing to do.
The Birth Room Ledger
The magazine for midwives who keep their own records
Practical reporting on the clinical craft, licensing rules, and economics of running a solo or small community midwifery practice.
Talk to us
Bring one real client chart and we will build it with you
Thirty minutes, screen shared, using a caseload that looks like yours. You will leave knowing whether the flowsheet fits the way you practice, and we will tell you plainly if it does not.
- We answer every request within one business day, and a midwife reviews it before we reply.
- The demo is a working chart, not a slide deck.
- No card is asked for at any point in the conversation.
- If your state protocol needs a flag we do not ship, we build it during onboarding.
Prefer to write instead? Reach the team at jimenezjulien42@gmail.com and we will reply from the same inbox.
Client records are never part of a demo. We work from sample charts unless you choose otherwise.