November 2008

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.


Thinking about making a donation to a great cause? Please consider MOMS in your list of respected and proven organizations.  MOMS will return to Salone (Sierra Leone) in late January and we KNOW they have a wish list!  Where to reach them is listed at the end of the article.  Read on!

2 Bay Area women train midwives in Sierra Leone
Meredith May, Chronicle Staff Writer
Sunday, November 2, 2008

Retirement is anything but slow for two Episcopal deacons from San Francisco.

Each year, the Revs. Christie McManus, 60, and Patricia Ross, 57, journey to Sierra Leone to help deliver babies in remote villages with some of the highest infant mortality rates in the world.

“Doing this fits in with my core values – I have the knowledge and money and if I don’t share it, that’s not doing what I was created to do,” said Ross, a certified midwife.

Both women, who worship at St. John’s Episcopal Parish in Clayton, wanted to do something useful with their golden years. So they became MOMS – Midwives on Missions of Service, which is a nonprofit helping West African women deliver healthy babies.

Together, the pair turned MOMS from an Oregon-based distance learning course for midwives into a traveling midwifery and maternal health education program. MOMS has a board of directors and a few volunteers, but it’s largely a nonprofit of two – McManus and Ross travel several times a year to Sierra Leone for six-week stints to lead the courses and meet with government officials. Their next trip is in January.

In the past two years, the San Francisco women have trained 97 women in 33 villages in basic prenatal care, birthing techniques and postpartum procedure. They rely on small individual and corporate donations and donated medical supplies, and they host baby showers in the Bay Area to collect baby blankets, clothes and toys.

MOMS was invited by the Sierra Leone government to work in the Kailahun District – the epicenter of the country’s civil war during the 1990s. Many of the women who survived the bloodshed tell stories of hiding in the rain forest while their husbands were killed by rebels wielding machetes. Many women were raped; others had their babies brutally cut from their bodies.

“So many of the buildings are still burned out – really, not much has come back,” McManus said. “There are no stores; people sell things out of little wooden kiosks.”

In a country of 5 million, there are fewer than 150 doctors, according to MOMS.

The lifetime risk of dying during pregnancy or childbirth in Sierra Leone is 1 in 8, according to UNICEF and the World Health Organization. Many women cannot afford a doctor visit or simply can’t get to a clinic when the pitted dirt roads wash out during the rainy season.

Cell phone reception is spotty, making it hard to arrange appointments with a doctor. Many women are too weak to make the two-day walk to a clinic, or can’t afford to leave their crops and risk the chance of their food sources withering.

For these reasons, more than a quarter of all Sierra Leone children die before age 5 – the majority in their first six months, according to the United Nations.

When Ross and McManus first arrived in West Africa in 2005, they found women giving birth in what amounted to an “old chicken coop.” There was no doctor, no ambulance, no emergency room. Instead, women were attended to by volunteer traditional birth attendants – a worldwide designation for community members with a month of government childbirth training.

During that visit, one woman bled to death on the floor and seven babies died during or shortly after birth due to malaria and malnourishment.

“It was gruesome,” Ross said.

Ross and McManus were shocked to see birth attendants pushing on women’s stomachs during birth – which can jam the baby into the pelvic bone or rip the placenta. Once delivered, babies were wrapped up in a blanket without an exam. Instead of waiting for the afterbirth, when women naturally release the rest of the placenta, birth attendants were pulling them out.

So on a return trip in 2006, Ross and McManus started holding classes in a village called Pellie, with translators who could repeat their words in the Mende language. More than 50 West African women showed up for the lessons, many of them walking for several hours from their homes. Through skits and plays and songs, the students learned about nutrition, sanitation, breast feeding, female anatomy and family planning.

On their June 2008 visit, Ross and McManus found that a female health network was starting to form. The birth attendants had begun routinely checking on new mothers. They helped one woman with an infection get to a clinic.

“That undoubtedly saved that woman’s life,” McManus said.

A few of the women had named their newborns after McManus and Ross.

In their assessment reports for the Sierra Leonean government, McManus and Ross recommend placing midwives with a team of traditional birth attendants in rural clinics so there’s at least some expertise and a place to go for minor pregnancy needs.

They are working on creating a second tier of “advanced traditional birth attendants” who could monitor women’s prenatal care and develop connections with urban clinics to help village women make the journey in emergencies.

Ultimately, they want to pass on their knowledge so there’s no need for MOMS in Sierra Leone anymore, McManus said.

“That’s what our faith is about – making the world better, not worse.”

For more information:
MOMS: Midwives on Missions of Service
215 10th Ave.
San Francisco, CA 94118
(415) 387-1126

Please consider sending a thank you E-mail to Meredith May at for sharing the gift of women working together globally!

America is pretty unique in the type of childbirth prep our society recognizes.  Did you know in many countries, many cultures our way of birth prep is quite odd: all gather and sit in a hospital provided room or have a workbook and sit in a classroom style?  

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