Justifying the cost when insurance would cover every penny of a hospital birth

[CamoShades]

I think the thread title is pretty self-explanatory.

I'm not at all looking to start a debate; I'm genuinely interested in knowing how you homebirth mamas justify the cost of a homebirth if you have great insurance coverage -- that won't pay a penny of a homebirth -- and how you justify the cost to your SOs.

Our insurance coverage is FABULOUS (both maternity care and in other areas). But it would cover NOTHING for a homebirth. And I'm admittedly not as crunchy as most here, though there is a lot of good information that really makes me think, so I like to read along and post occasionally. So for me, justifying spending about $3,500 on a homebirth when my insurance is picking up every penny of my prenatal care, hospital delivery and postpartum care (not to mention everything associated with my child's care until the time he or she is 18 -- which I know will probably change by then), is really hard. And even harder would be convincing my husband to shell out the money. It even took a bit of persuasion to get him to agree to hiring a doula for $600.

FWIW, I don't even know that I'd want a homebirth, and I don't know tht my husband would agree to it if I did; I'm just genuinely curious what those of you who have great insurance coverage tell yourselves to justify the out-of-pocket cost.

[Crispie]

Well, for us, we had already had three hospital births prior to our decided homebirth.

I started by telling my DH that I did not want to have to hire a babysitter, pack for a hospital stay and go through watching everyone else handle MY baby (first bath, shots, eye goop etc) while I sat, once again, "helpless" in a bed. It's just not fair.

I began to research homebirth and found wonderful statistics even at WHO's website about how safe homebirth is, and even somewhere that it was safer than a hospital birth for a normal pregnancy. Basically all that was needed was for some "professional" (midwife/obgyn) to "diagnose" me as "normal." (low risk) Once we started listing reasons why homebirth seemed worth it, the list was extensive...No outside germs (including H1N1) floating around, (or at least minimal germs), No strangers touching our baby, no need for ID and security bracelets, complete control over needles for myself and my baby, no hospital food, no wondering when we should head in-or being afraid to call our babysitters too soon or too late, there's an amazing stress relief in all of that, as well as much empowerment! There's more but this post would be so long :P

What really sealed the deal was me just asking DH to go check out a midwife with me. He's SO detailed about money and bills and the price quoted was $3500 for us. He was not happy, but he was willing to humor me. He told me later he was certain we'd not return due to the money. Once we were in the door though...lol....we were sold. Our mw was totally willing to take payments, and even knocked off $500 because she knew our finances were tight. She's also done bartering with her clients...her bathroom and kitchen have been remodeled and her porch rebuilt-all as forms of payment. You never know what they will be willing to do/work with unless you go meet and see. She also had a huge list of reasons why it was worth every penny and also explained she was willing to work with us because she hated to see my dreams of homebirth washed away due to financial issues.

ETA: in addition it helps to remember that if anything warrants further testing, or further medical help, the insurance for us will kick back in, and our cost won't keep going up and up and up. $3000 was it. period. DH likes working with solid numbers like that if you know what I mean. end edit.

I don't know if that helps answer your question, but I at least want to say that you're asking the right questions! My husband surprised me with how willing and "gung-ho" he was after we finally met the mw and his questions got answered. Surf the net, visit the midwife organization sites, the World Health organization sites, bookmark, take notes and if you're like me you'll be so excited and spewing with information that DH won't be able to help getting caught up in it.

Best of luck to you, in whatever you decide-for a happy healthy warm bundle of baby soon!

[notjustmamie]

Well, coming from my first birth in the hospital where I didn't pay a penny, I wouldn't go back (without medical need) if you paid me.

In the hospital, I was made to fit into their program. My labor stalled when we arrived; I wasn't allowed to go home because I was dilated past 4 cm so I was considered in "active labor." When I went another 6 hours with little progress, they insisted I needed Pitocin because, "If labor is too long, the baby will get hurt" (mind you, the total length of my labor at this point was only about 15 hours). Even though I'd been assured I could eat and drink in labor, once I was admited, I was restricted to clear fluids. Once DD was born, she was given to me for snuggle time, but no one suggested I try to get her to BF. After a few minutes, they took her across the room and bathed her (we'd asked to delay her first bath). After about an hour, they took her to the nursery for some test or other and we were told DH could not go with her. She was not returned to us for more than an hour. Since I had given birth after 6:00 PM, the cafeteria was closed. They had set aside a tray for me with a ham sandwich and a cup of fruit, but that's all I could have to eat (since visiting hours were over, if DH had gone out for more food, they wouldn't have let him back in). Because L & D had been so busy that day, I had to share a PP room with another mama. DH was not allowed to stay with us. When it was finally time to go, we were required to take DD out in her car seat. We didn't have an infant bucket, so we had to uninstall it, strap DD in to ride out of the hospital doors, then take her out of the seat, reinstall it, and strap her back in--and did I mention that this was after 10:00 at night, in the middle of February, in Chicago?

Anyway, these are just a few of the reasons I wouldn't want to go back. The biggest one is that, in the hospital, I felt I had to fight for the very few things I wanted that were out of the norm. I hadn't really considered that would be a problem, since generally I enjoy a good fight, but I discovered I have no stomach for it in labor. For me, my own piece of mind, knowing that I (and my child) will be respected, not separated, and encouraged to birth in the most natural way possible is worth far more than the few thousand dollars we've had to come up with to pay the midwife.

[broodymama]

DH is in the military so DS' hospital birth was 100% covered. I paid out of pocket for homebirths with DD1 and DD2 and will do so with this babe also, even though it will be financially challenging this time around. The comfort and peace of mind I get from birthing at home, the confidence in my midwife and her intentions, being treated as an individual and not a cog in a machine, not having to deal with refusing "routine" hospital policies while I'm in labor - all of those (and more) are what made paying for my homebirths worthwhile. For me, the difference between birthing in a hospital and birthing at home is like the difference between trying to have sex in the middle of a crowded bus station or at home in the privacy of my own bedroom. The first can be done, but is not my preferred location.

[Lirazel]

I had to make the same decision for homebirth: free or $3000? I'm such a stickler for saving money that I'm kind of surprised at how comfortable I am paying that $3000!

I had been going to a hospital-based midwife group, but started thinking about switching when I began to feel like I was just being put through "the system." They did not treat me like an individual. I just had to do what everyone had to do without any regard to my lifestyle and very little flexibility in regard to my opinions. Also, since it was a group there was no way to build a relationship with a midwife so she could know what would help me during labor. When I began talking to homebirth midwives and especially the one we ended up choosing it just "clicked." It was absolutely what I wanted and DH got right on board with me.

Some of the things I feel like I am paying for with my $3000 are:
increased comfort by being in my own home and therefore better relaxation and a potentially more comfortable and efficient labor
no fighting with anyone about what I want for me or my baby
my own rules rather than hospital policy
a person delivering my baby who has built a relationship with me and can better understand what I need
my own food
no uncomfortable car rides to or from the hospital
resting in my own bed afterwards (with DH and baby all together!)
visitors/check-ups on my own schedule - no nurses or photographers or blood tests or whatever popping into my room at all hours

Even though I've never done a hospital birth (this is my first baby) so don't have anything to compare it to, these factors sound absolutely worth the money. I am so looking forward to it!

[engineer_mom]

Are you sure your insurance won't cover it?

[Bmorefarmgirl]

when we found out i was pregnant, we visited a fsbc, a hospital-based midwife practice, and met with a hb midwife. we decided on a home birth when we found out that the care at a fsbc and at home were identical. in both cases, we would have to transfer to a hospital by car or by ambulance in the case of complications. the fsbc had 4 midwives, and i would not know until i went into labor who would be my midwife. it was 45 minutes away. the hb midwife has an assistant, but other than that, it is her and only her that i see for all my prenatals and the birth. she visits my home once post-partum and the birth assistant comes once pp as well.

for me, the hospital was not even a real option. the hospital-based midwife practice also had 4 midwives, and no way of knowing who would be my baby catcher. they also work in a very busy hospital, so i could be stuck who-knows-where in labor waiting for my own room to give birth in. they have a tub, but only one, so if it is in use, i would be out of luck. they have a great OB there who delivers breeches, but also no way of knowing he would be there in the case of a complication.

then there are the germs, the room rules, the testing. those things would not be as big of a deal in a fsbc, but even there, i would just have to pack up all my stuff 4 hours after giving birth and drive 45 minutes home. with no difference in emergency care (our house is as close to a hospital as the birth center is), it did not make sense to drive that far every single month for visits and then the birth.

another big bonus is that my husband works from home one day a week, so we just schedule my appointments when he is working at home, and he can be at all my prenatals! it is awesome that we are both getting equal face time with the midwife.

i also just really LIKE my house! it is my house. i know where everything is. i know what it feels like to not feel well when i am in my own house, so i know where to go for comfort, relaxation, distraction, food, drink, etc. i won't feel bad for leaving a mess somewhere or dirtying every towel in sight or wandering around or going outside. i feel it will just be much more comfortable physically and mentally.

[CamoShades]

Originally Posted by engineer_mom

Are you sure your insurance won't cover it?

Of course I'm sure. I have an HMO, and my insurance doesn't even cover hospital-based midwives. I've done the research.

But, of course, that's not what I asked about. Thanks for all the thoughtful answers so far. It really does give me something to think about. The money isn't an issue for us -- we're not wealthy, but we definitely have the cash lying around (which actually would lower costs, from what I can tell, to about $2,700). Even so, it's still really hard for me to justify spending that money. And I know it would be REALLY hard to convince DH to spend the money (and get on board with the idea of a homebirth). People in our circle just don't "do" that, if you know what I mean.

[berry987]

Homebirth for me is partially covered, so I'm not in the exact same boat, but a hospital birth would be nearly free ($10 co-pay) on my prenatal visits. So it's still more expensive for a HB.

My situation was like others - I had an awful hospital birth (induction) with my first child. I actually had a MW, but she was not a homebirth MW and I've since realized that not all MWs are created equal. During the labor I felt they were rushing - checking me often, complaining I wasn't dilating fast enough. I told her I wanted to go natural, pain-med free and she laughed. Said "first time mom's always say that." They decided they wanted to baby out so I was given the max dose of Pitocin and my body just about ripped in two. They didn't seem to care about the immense pain they caused by jacking it up so suddenly, just told me to "get an epidural if it was so bad." The baby felt forced out of my body and I had a 4th degree tear and he aspirated meconium. He spent a week in the NICU. I went to recover in a shared PP room with a woman who DID NOT STOP TALKING or watching TV (at 2am!). My DH had to stay at a nearby hotel. I hated every minute of it. I cried myself to sleep my first night in the hospital - alone in my bed, in pain, without any support.

So I chose HB for my next two and they were incredible, wonderful, empowering and I did it. No problem. They work everyone up to think natural birth can't be done or you have to be this pioneer woman with no fear of pain. I did it because I had great support from my DH and a wonderful MW who kept telling me I could do it...who cheered me on and HELPED me do it. I felt supported.

So now I'm pregnant with #4 and HB is the only way to go for me.

I just want to add - I'm not "crunchy" from outward appearances...I'm really not that crunchy in general. I don't know another soul who has had a HB or even a birth center birth (except on MDC, of course!). Everyone here goes to the big hospital nearby and has a traditional, epidural birth. I live in a very mainstream, fairly conservative area. So people here don't do it either. And my ILs are completely against HB - they think we're nuts and we actually got in an argument when I was planning my first HB. But I don't care - I know it's right for me.

[***edgar]

Well,I don't believe i have to justify anything to anyone, least of all myself.

I believe that this is the best option for me. Right now the system id not set up to cover HB's (although mine covered about 1/3). I have the money to pay out of pocket (my midwife took payments)

Simple.

Some people will spend hundreds on shoes. They don't have to justify, they just do.

[HisBeautifulWife]

We watched The Business of Being Born.

[MamaMelis]

My insurance officials "position" on HB is that they do not cover it. We have to pay $3,900 out of pocket vs. literally about $0 for a hospital birth. My midwife tells me that she has very good rates of reimbursement with our insurance, but there is no guarantee that we will be reimbursed a cent.

This is likely our last birth, and I would regret the rest of my life letting a dream of mine be unmet because of $4000.

After two hospital births I am pretty well convinced of my inability to have the birth that I want at a hospital (at one of the hospitals near me anyway).

I don't feel that I need to justify what my entire body and heart are telling me to anyone, certainly not the almighty dollar.

People in my circle don't "do" this either (very, very literally), but then again, I don't make decisions for my family based on consensus This is right for us, so the price is worth it.

[Emmeline II]

Originally Posted by CamoShades

Of course I'm sure. I have an HMO, and my insurance doesn't even cover hospital-based midwives. I've done the research.

But, of course, that's not what I asked about. Thanks for all the thoughtful answers so far. It really does give me something to think about. The money isn't an issue for us -- we're not wealthy, but we definitely have the cash lying around (which actually would lower costs, from what I can tell, to about $2,700). Even so, it's still really hard for me to justify spending that money. And I know it would be REALLY hard to convince DH to spend the money (and get on board with the idea of a homebirth). People in our circle just don't "do" that, if you know what I mean.

I just bought a laptop. For $85 I could have picked out an artsy cover; it did not affect the function, it just looked nicer/personalized.

I think you are looking at HB as something superficial--just a more personalized service that does not affect the "function" of birth. Looking at it from that point of view, sure, it would be hard to justify the cost. But homebirth is a completely different "product" than a hospital birth.

[lynsage]

I told my SO that no amount of money would be worth me losing my limbs as a result of a hospital-borne infection like this woman http://www.clickorlando.com/news/11495680/detail.html .

Mothering ran an article about hospital birth fatalities called "Masking Maternal Mortality" by Ina May Gaskin that was quite compelling. I would have him read that, and if he's still not on board, tell him that he's welcome to push a baby out of his body in a room full of bright lights and hollering nurses if he wishes, but that's not what you want for yourself

[RPS67]

I had 4 hospitals births (of all different flavors except c-section) before our son was born at home 3 years ago. I didn't have insurance at the time because I had been laid off at 7 months pregnant, so my desire to have a homebirth fit well with our finances at the time.

SO wasn't sure at all about it, but he was very assured after meeting with our midwife and seeing how she handled some issues that came up. I'm due in January again and even though I have insurance this time, we're planning another homebirth. Insurance does cover some of it, but we are happily paying our part and would pay 100% without hesitation.

SO is cheap. Not frugal -- cheap. There is no way he would pay for a homebirth out of pocket unless he felt is was truly worth it.

My labor with DS was much easier than the others because I was in a familiar place. Even though I had contractions on and off for almost 14 hours, true labor was really only about 90 minutes. I could do what I wanted, whether it was move around or get in the bathtub, whatever.

My mw was with me when I needed her and she provided the exact kind of support I needed. I always hated how OBs would run in at the last minute to catch the kid, but couldn't be there the whole time you were laboring.

Right after my son was born and I delivered the placenta, I got up and took a nice hot shower in my own bathroom. Then I put on my nightgown and went out to my kitchen and made us all coffee.

DS has spent every single night of his life in our bed. He was never taken away from us for anything. We were able to choose which procedures we wanted done (yes, vit K shot; no eye ointment, no circ). Everything was about US -- not about some hospital's policies or some doctor's schedule.

It felt normal to me and that's why we're planning another homebirth for January. SO, who was not quite sure about it the last time, is now a firm believer in homebirth. He didn't even hesitate about doing it again.

Since we both believe this is the best choice for us, we don't think of this as an "optional" expense. It just is what it is.

[dydy]

DD1 & 2 were born in hospitals. DD2 cost me $45.45 total from prenatal care to the traumatic c-section I had. DH understands that it's worth way way more than $3,000 to not go through that again. We've decided to give up some travel, bday and anniversary gifts to make up the cost of the homebirth. I guess it's all about priorities and what you're willing to sacrafice. If you don't really want a homebirth, out of pocket cost is just one more item in the minus column.

ETA: I totally know what you mean about people in your circle "just not doing" this sort of thing. I was really concerned about that when we were deciding but DH basically said "Why do we have to tell any of them?" He's so right. No one is going to ask what our plans are and we can tell them afterwards if we feel like seeing the weird look on their faces.

[emnic77]

Haven't read the responses yet...but I recently told my dh that I felt a little guilty spending all this money on our homebirth when we could have a hospital birth, which really wasn't all that bad, for essentially a $20 copay.
His response was "the cost of the homebirth is peanuts compared to the cost of stress for having to deal with crap at the hospital, having to wade through a hospital full of germs for each prenatal appointment, and having to rely on the luck of the draw for a good nurse on duty that night that won't annoy or hassle us."

That pretty much sums it up for us.

[Belle]

I had a hospital birth the first time around. It wasn't bad as hospital births go. But there were several things that really irked me. They were very pushy about me getting an IV. I had the nurses on my side and they weren't so pushy and even looked pleased when I politely refused one. The OB was not so pleased. I didn't have an open portal to add pitocin at her will so she pushed me hard for one. I signed an AMA and she seemed satisfyed. But they she wouldn't permit me to breathe when I needed to while pushing. I was turning purple and seeing stars. I took a breath before their inane counting was done and was yelled at, told to be a good girl and hold it to ten. I told them I was seeing stars and they put oxygen on me between pushes. (Not during when I needed it) So, of course, because I wasn't getting enough oxygen Dd1 wasn't either. Her heartrate started dropping. This scared me. They pushed for the IV again. I consented this time. They got it in super fast. (They lie when they say they can't get it in fast) I was really scared. As soon as it was in Dd's heartrate was normal. I remember the nurse saying "Both mom and baby are 140 BPM" I got a rush of adreneline and my heart was racing. After the IV was in Dd was out in two pushes. Then the OB tried yanking out my placenta. She put her whole weight into pulling on the cord. I thought she was going to pull my uterus out.

After her birth I vowed I would do things different the next time around. I planned a homebirth with midwives that I trusted. This pregnancy ended in m/c at 13 weeks. I ended up transfering to a hospital for a D&C and a transfusion. I'll spare you gory details, but I'll tell you. If I ever had a fear of needles and immobility before this it was nothing to what its like now. Being strapped down to a bed/table and being unable to move while somebody tried unsuccesfully to stick needles in to both arms is my personal version of hell. I can't even give blood anymore because I freak out when I lie down and they come at me with a needle.

All this affirmed my decision to not give birth in a hospital if I could help it. My third pregnancy was a successful homebirth. I didn't have to go anywhere. The people that I chose to be at my birth were guests in my home. Not me going to the hospital to birth under their stupid rules. One of those stupid rules is that once the water breaks the baby must be born in 24 hours. Well, my water broke and I didn't go into labor until 36 hours later. In a hospital I'd have been given pit or sectioned. As it was I had an easy four hour labor. Also they'd probably have freaked about the double nuchal cord. At home it wasn't that big a deal, just unwrap it and birth the baby. I could push how I damn well felt like with nobody telling me I was doing it wrong. No needles were pushed on my and I ate and drank what I wanted. My baby was never taken from me and her sister got to see her born. Siblings being present are not possible in a hospital these days with H1N1. The cord was not cut until the placenta was born and nobody pulled on it. I lost a quarter of the amount of blood I lost in the hospital.

Giving birth at home was no luxury item. For me and my dh it has become a no brainer. Myself and my baby are at more risk in the hospital. Their stupid policies interfere with normal birthing. If needed (as in pregnancy #2) I'll go there again, but nothing less than life or death will get me through those doors to give birth.

[sunfish21]

The only justification that I have is that is safest and best for me and the baby. It is a huge financial burden for us, and we will pay the midwife our entire our tax return (our insurance would cover 80% at the hospital). I can't put a price on the peace of mind of knowing I call the shots and there is no pressure to do anything because it is "policy".

[callieollie]

For me, I see a hospital birth and a homebirth as 2 completely different things. So it's not like i'm paying $3000 for something at one place and nothign for something at another - they aren't the same "something" i'm getting, if that makes sense. That said, I do struggle with choosing a homebirth over a birth center birth. A birth center birth would be covered by insurance but a hb would not and that for me is a little harder to justify since they are much more similar to me than a hospital and homebirth would be.