Wellness & recovery services
Books and taxes for midwives and birth centers.
One global fee covering months of prenatal, birth, and postpartum care, Medicaid and insurance reimbursements that land weeks apart, and a birth pool and monitors to maintain. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
June came in at $11,500. Two Medicaid reimbursements from March births finally cleared, so I matched them back to those clients instead of counting them as new income.
- Global fee, self-pay clientGlobal maternity fees
- Medicaid reimbursement, March birthInsurance reimbursement
- Backup midwife payStaff and contractor pay
- Birth pool and monitor maintenanceEquipment maintenance
- Facility rentFacility costs
Why your books are different
A midwifery practice bills for months of care as if it were one visit.
A global fee bundles prenatal visits, the birth itself, and postpartum care into a single charge that can span half a year, and insurance or Medicaid often pays it out on its own schedule, weeks or months after the fact. A bookkeeper unfamiliar with maternity billing loses track of both.
-
1
A global fee is not one month's income
A global maternity fee collected at the start of care can cover a prenatal course that runs five or six months before the birth even happens, and counted as income all at once, it overstates the month it was collected while the months of actual care go unaccounted for.
What we doTracks global fees against the span of care they cover, so income lines up with the prenatal, birth, and postpartum work as it happens. -
2
Insurance and Medicaid reimbursements arrive on their own calendar
A Medicaid or insurance reimbursement for a March birth can land in June, and if it gets booked as new income instead of matched back to that birth, the books lose track of what each birth actually earned.
What we doMatches reimbursements back to the birth they belong to, so profitability per birth stays accurate even when payment lags months behind. -
3
Backup and covering midwife pay is a real staffing cost
A backup midwife who covers births, whether as an employee or a contractor, represents one of the largest costs in the practice, and misclassifying that relationship is an expensive mistake to make.
What we doKeeps backup and covering staff pay in its own line and flags the arrangement so the accountant can help get the classification right. -
4
A birth pool and monitoring equipment are real assets
Birth pools, fetal monitors, and emergency equipment represent real money the practice has tied up, and filed like ordinary supplies, that investment disappears from the picture of what the business owns.
What we doLogs birth center equipment as assets, so cost and upkeep are tracked correctly over time.
Your categories
The categories Gus keeps for a midwifery practice.
Set up once for how you get paid and what you spend. You never pick a category. He does, and an accountant checks it.
Money in
- Global maternity feesSelf-pay fees covering prenatal, birth, and postpartum care.
- Insurance reimbursementPrivate insurance payments, matched back to each birth.
- Medicaid reimbursementMedicaid payments, matched back to each birth, often delayed.
- Classes and consultsChildbirth education or consultations billed separately.
Money out
- Staff and contractor payBackup midwives, nurses, and support staff.
- Facility costsRent, utilities, and upkeep for the birth center space.
- Equipment maintenanceBirth pools, fetal monitors, and emergency supplies.
- Malpractice insuranceCoverage for the births attended.
- Licensing and permitsState licensing and facility permit renewals.
What we watch for you
- Profit per birth
Fees and reimbursements against staffing and supply cost, tracked by birth, so each one's real return is clear.
- Reimbursement lag
How long insurance and Medicaid take to pay, so cash flow gaps do not come as a surprise.
- Staffing cost share
Backup and covering pay against total revenue, so scheduling and pricing stay in line.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things midwives ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I matched it back to that March birth instead of counting it as new income, so you can see what that birth actually earned once payment finally came through.
That is above my pay grade to decide alone. I flagged how the arrangement actually works, and the accountant is looking at it with you.
I am tracking that against her span of care, so it will count as income across the prenatal visits, the birth, and postpartum, not all at once now.
The tax side
The tax side of a midwifery practice.
Most of what trips up a midwifery practice is timing global fees against months of care and getting staffing classification right before it becomes expensive.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Worker classificationA midwife or nurse who works your schedule and uses your facility is usually an employee, not a contractor, even if paid per birth or per shift.
- Equipment write-offsBirth pools, monitors, and emergency equipment can usually be written off the year they are bought. Bonus depreciation is 100 percent for property acquired after January 19, 2025.
- The pass-through deductionMost owner-operators can take up to 20 percent of business profit off their taxable income. It comes out right when the books are right all year.
- Quarterly estimated taxesSelf-employment tax runs 15.3 percent on top of income tax, and it is not withheld anywhere, so most owner-operators pay estimated tax four times a year.
Deductions midwives and birth centers miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Malpractice insurance
- Birth pool and monitor upkeep
- Facility rent and utilities
- Licensing and permit renewals
- Backup midwife and staff pay
- Continuing education and certification
- Emergency supplies
- Professional association dues
- Mileage for home births
- Marketing and website costs
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A midwifery practice's year, kept every month.
Births spread unevenly and reimbursements lag behind them. Your team keeps you ahead of the tax calendar through both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with global fees and reimbursements landing on their own schedules.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether reimbursement delays changed the picture.
- October
Before the year closes
Gus looks at whether new equipment or a facility upgrade is worth doing before December.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for midwives and birth centers. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions midwives ask first.
How does Gus handle a global fee that covers months of care?
He tracks it against the full span of care it covers, so income lines up with prenatal visits, the birth, and postpartum work as they happen, instead of landing all at once.
Our Medicaid reimbursements are always months behind. Is that a problem for the books?
No. Gus matches each reimbursement back to the birth it belongs to, so you can see what a birth actually earned even when payment took months to arrive.
Does Gus handle submitting insurance or Medicaid claims?
No. Gus keeps the books and tracks what comes in, but filing insurance claims is handled separately from this subscription.
My backup midwife covers some of our births. How should she be paid?
It depends on how the arrangement actually works. Gus flags it and the accountant helps determine whether she should be a contractor or an employee.
We're planning to hire another midwife on staff. Does that change anything?
It does add payroll, which this subscription does not run. Gus keeps the books tracking her pay and hours, and can point you toward what you will need for payroll separately.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
More in wellness & recovery services
We keep books for the business next door too.
- Birth doulas
- Breathwork facilitators
- Herbalists & apothecaries
- Hypnotherapists
- Lactation consultants
- Postpartum doulas & night nurses
- Reiki & energy healers
- Salt caves & halotherapy
- Sound healing practitioners
- Yoga therapists
- Acupuncturists
- Biohacking & longevity centers
- Cold plunge & contrast therapy studios
- Cryotherapy studios
- Float spas
- Infrared sauna studios
- Lymphatic drainage specialists
- Private practice dietitians & nutritionists
- Recovery lounges
- Red light therapy studios
- Stretch studios
- Health coaches
- Independent massage therapists
- IV hydration & drip bars
- Compounding pharmacies
- Durable medical equipment (DME) suppliers
- Elective 3D/4D ultrasound studios
- Independent pharmacies
- Medical billing companies
- Mobile nursing & concierge nurse services
What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever