Planning to have a baby next year and maybe a payment plan is easier on your budget?  Try a Health Care Flexible Spending Account!  By definition your registered midwife’s care is likely to be reimbursed, “Expenses for medical services prescribed by physicians or other health care providers acting within their scope of licensure can be reimbursed under a HCFSA.” (Federal FSA)  Check with your tax advisor!

Citizens for Midwifery researched the Effects of Hospital Economics on Maternity Care.:

Hospitals can increase their income by reducing their fixed costs (equipment, buildings, staff) and/or by increasing efficiency (more patients or billable events per unit of time). For maternity care, decreasing the amount of time each patient is in the hospital (hurrying labor along) and increasing the use of lab tests, drugs and other billable treatments are ways of increasing income for each birth. The more technology and the more tests and procedures that can be performed (and billed for), the greater the differential between costs to the hospital and what the hospital charges. In other words, as care gets more complex, the costs increase but the profit margin goes up even faster.

Start thinking about your budget now.  First, take out your health insurance policy if you have one.  Really read it.  Do you have a co-pay?  For every prenatal visit, hospital visit, etc.?  Do you pay a deductible with a cap on the deductible?  No cap on the deductible, just an outright percentage no matter how high the bill (out of pocket)?  Do you have co-pays as well as out-of-pocket?  Do you have a deductible, percentage and co-pay?  Do you pay out of pocket for every test, prescription, etc.?  The point is everyone’s insurance coverage is different and it’s up to you to sit down and do the math.  Many parents have realized after the fact that the amount they end up paying for their medical birth turns out to be the same cost if not more than their cost would have been for a home birth.  Just hearing the words insurance “doesn’t cover” makes most people automatically say “we can’t afford a home birth.”  The truth is with home birth you end up paying for all the things insurance isn’t meant to cover: home visits, nutrition counseling, alternatives to medicine and technology, phone calls at 3:00 a.m. where you aren’t told to come in for an u/s in the morning or overnight observation but rather talked through what you’re feeling and if necessary let’s meet in your home or the birth center (aka “time”) and not paying for things not proven to show any benefit.  All the things that many women have expressed would make all the difference in the world to their satisfaction with their care: the personal touch, the in-touch.  In summary consider this from Kathy Petersen‘s experience paying for her home birth:

Re: insurance for home births — I didn’t have health insurance either time I was pregnant, so had to pay all the costs out of pocket. Each time it was between $3000-4000 for a home-birth midwife with all the trimmings (I got a labor pool one time, had to go to the back-up doc both times, etc.) One of my friends had a C-section for transverse lie when her water broke, and her hospital bill was $25,000, of which her insurance paid 80% and she was liable for the rest — $5,000. I was incredibly surprised at the amount of the bill, and think she should have contested at least some of the charges (since she wasn’t even in the hospital a full 48 hours, and it was an uncomplicated C-section — no infection, etc.), but her portion of the charges was more than my entire cost. Since planned home-births have such a low C-section rate (I think it’s probably less than 5%), even paying out-of-pocket for a home birth could conceivably be less than paying a percentage of a hospital birth if you’re one of the 30% of women who end up with a C-section — especially when that C could have been avoided by avoiding unnecessary interventions.

Consider all the options you have in both settings.  You really do have the option of home birth.  The trick is believing you have that option.  We are so firmly ingrained with the idea that birth MUST take place in a hospital, no question.  Every psychologist knows this: repeat something often enough and everyone eventually believes it.  Birth no longer takes place in our homes where we have a firmly rooted belief that is the one place we can exercise our right to take care of ourselves.  Birth today takes place outside of the home 99% of the time and that is why it’s so hard to believe home birth is safe.  That is where the mental power to change your perception about birth lies: who owns your body when you step outside your house?  What will you do to be confident you have explored every birth care option with education, not fear?

Third, are you thinking ~ as a healthy woman ~ the insurance coverage is worth the price to:

  • be told you can only choose from this list of care providers and
  • with all of them you have to either compromise on your ethical beliefs about your care and your baby’s rights
  • be told you’ll be fired from their care if you don’t do EVERY thing they tell you to do causing you to go along with their care or lose that insurance coverage
  • argue constantly with care providers to be allowed to have the home birth experience but have it in the hospital…
  • then often times have to start a new battle in the midst of labor with the hospital to have the home birth experience
  • be presented, in the midst of labor, with a document for you to sign waiving them of all liability for you choosing not to have a cesarean right then and there when they tell you they’re going to do one

The above alone will take your low risk birth to the risk category as care providers read you with higher blood pressure every time you’re in their office and distress during labor!  It’s not a crazy phenomenon.  It happens and moms easily miss that connection and if they comment on it someone is going to joke about it.  But intentional delivery is not a laughing matter to the mother who never wanted an un-necesarean.

All around the world women with otherwise uncomplicated pregnancies are being recruited to consent to having their labor exposed to all the interventions that are known to cause higher rates of cesarean.  That is the true cost of insurance driven birth.  Women unwittingly offering up their bodies and their babies’ bodies; the bodies of women and babies they will never meet will later feel the reverberations of their innocent unknowing cycle of naive participation.  It’s not about whether or not birth is safe.  It’s about whether or not the technology, the drug, the protocol for the drug/intervention is safe enough.  Make no mistake about it the FDA’s definition of safe is not the same as Noah Webster’s.

Most women assume that the drugs offered them by their obstetricians during pregnancy, labor, birth and lactation have been approved by the U.S. Food and Drug Administration as safe for use under those condition. The fact is, there is no maternally administered drug that has been proven safe for the fetus. Nor is there any law or regulation that prohibits a physician from prescribing or administered to a childbearing woman a drug that has never been approved by the FDA as safe for such use.

True cesarean scenarios happen, but not at the outrageous reported rates of 40+% in some hospitals.  Not everyone wants to go without pain meds.  Not everyone believes the risks of ultrasound always outweigh any benefits.  Not everyone is comfortable with waiting 42 weeks and more before going into labor on their own.  That doesn’t give a practitioner carte blanche.

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