payment schedule question

[ajohns1]

We are planning a homebirth for our second baby (but first homebirth), due in August, and we just had our first appointment with the midwife. She gave us a sheet detailing her fees and how she expects the payments to be done, and she expects that we will have paid her in full by 37 weeks. I have no problem paying for the prenatal care as we go along, but she is essentially asking us to prepay for the birth. Is this common for midwives to ask for payment to be done this way? What happens if she misses the birth or something like that, we would have no financial recourse (and I don't think it would be unreasonable to expect some sort of discount in that situation). Any thoughts or comments on this? are we being unreasonable or is that a valid concern?

[dogmom327]

Yes, it's very common. Essentially you are paying a spot on their calendar. Good midwives take a limited number of clients each month so you are paying for that spot--for her to be available to you and not take on a different client. Also, I have a feeling that some midwives haven't been paid in the past (baby comes, mom and dad get busy, etc.) and I'm sure it's harder for them to collect than it would be a hospital, etc.

It's quite uncommon for a MW to miss a birth. Usually it's because the baby comes too fast but they would still be there to check you and the baby out afterward. If you're concerned, ask how they handle situations where they have two mama's in labor at the same time, etc.

[LittleBirdy]

Yes, my midwives are the same way. Basically it's up to you to figure out a plan that works but payment must be made in full by 37 weeks.

They do have a written policy on how they handle the $ situation if you leave their care prior to giving birth, which was comforting to me. As far as the midwife missing the birth, I think virtually all of them have a backup they can call if two women are in labor at once. Obviously your midwife would need to compensate the backup midwife and thus you would still need to pay her, which I think is fair. (Stinks that you didn't get "your" midwife but you still got a trained professional attending your birth vs. an unexpected UC delivery.)

For the record, I have even heard of OB practices requiring/encouraging prepayment of the birth.

[Right of Passage]

Adding to what others have said. Most midwives charge a global fee, if you had her break down what she'd charge per prenatal, birth, extra time spent on the phone for questions, homevisits after the birth, etc it would end up being a LOT more than the global fee being asked for.

Like my first homebirth midwife stated that her fee was $1800, if I chose to transfer out of her care it would be $175 per prenatal visit. There are roughly 13 visits including a 40 week visit, so that would have meant I would pay $2275 just for prenatals, no lab work or anything. $1800 was one heck of a bargain, for labs, pre/postnatal care, birth, plus unlimited e-mail and phone support.

[ajohns1]

Thanks everyone. I guess I feel a bit better about this, knowing that it's pretty standard. Our midwife is charging $4100, not including lab work or any extra supplies (oxygen, etc.) that might be required at the birth. They do take insurance, but we have a high deductible plan, so it all comes out of pocket. And they did give us info on pro-rating their fees if we do transfer out for some reason during the pregnancy.

I guess my concern about them missing the birth comes from the fact that I need them to take it seriously when I call them at the first signs of labor. We live an hour away, and my first labor was only 4.5 hours. I actually have met someone who birthed with them and this midwife didn't get there in time, and hers was a ~6 hour labor. So, I'll have this discussion with them and make my concerns clear to them as we go along, and maybe they'll also have some flexibility about leaving part of the fee to be paid at the time of the birth, or something like that.

[smpayne]

Originally Posted by ajohns1

Thanks everyone. I guess I feel a bit better about this, knowing that it's pretty standard. Our midwife is charging $4100, not including lab work or any extra supplies (oxygen, etc.) that might be required at the birth. They do take insurance, but we have a high deductible plan, so it all comes out of pocket. And they did give us info on pro-rating their fees if we do transfer out for some reason during the pregnancy.

Make sure they turn it into the insurance company anyway, you should at least get credit toward your deductible.

[bclare]

Same with mine-- if I pay by 32 weeks in full we get a $400 discount.

[jenfl]

Originally Posted by ajohns1

What happens if she misses the birth or something like that, we would have no financial recourse (and I don't think it would be unreasonable to expect some sort of discount in that situation).

Our primary midwife missed our birth, but the backup midwife that we'd chosen lived closer and made it while I was pushing. My primary midwife compensated the backup midwife a certain amount, larger than she would have if the backup had remained a backup.

This pregnancy, we made clear our first labor experience (3-4 hour labor). When we were with a midwife who lived and worked an hour away, everyone at the practice was made aware of our previous experience. They were prepared to come our way at the very first signs of labor and even just hang out in the area, shopping or something, until we were sure it was time. They even entertained using a midwife they had never used as a backup before, simply because she lives very close to us. But then we switched our care to the close midwife, anyway, so now she's only 5-10 minutes away.

[xixstar]

Most midwives will take the timing concern seriously. Mine made it very clear that I needed to let her know when things started because she is almost an hour away and my first birth was fairly quick -- how funny it was when labor ended up being 26 hours long the second time around and the urgency wasn't actually needed.

But with any midwife or birth, I think you need to realize that you could still be pushing baby out before someone shows up, even if you call right away and they head there right away. Sometimes babies just decide they're not waiting around. But your midwife will still be showing up (or sending a backup if she's caught up elsewhere -- though that is pretty odd) to assess you and baby right afterwards.

I personally wouldn't spend so much time worrying about the financial aspect of a very swift labor, midwives still deserved to be paid in full even if you end up with an 1 hour labor. I love how my doula puts it for her services, she can't charge you less for a fast labor anymore than she can charge someone more for a long labor. Midwives are there to support you in either situation.

[mamakori]

Requiring payment in full by 37 weeks is very common in my experience. From teh midwife's perspective, she doesn't want to be left in the position of having provided full prenatal and labor care, only to be unable to collect payment after the birth. The midwife should have a contract that covers contingencies such as transfer of care, etc.

[Talula Fairie]

Most midwives do this. They want you to have paid them off before the birth happens. My midwife told me one of the main reasons is, once the baby is born, there is really no incentive to keep paying. Midwives are not like a big business hospital that can just write off the debt or send you to collections, if they don't get paid, they're out of luck.

[mbhf]

Originally Posted by ajohns1

Thanks everyone. I guess I feel a bit better about this, knowing that it's pretty standard. Our midwife is charging $4100, not including lab work or any extra supplies (oxygen, etc.) that might be required at the birth. They do take insurance, but we have a high deductible plan, so it all comes out of pocket. And they did give us info on pro-rating their fees if we do transfer out for some reason during the pregnancy.

I guess my concern about them missing the birth comes from the fact that I need them to take it seriously when I call them at the first signs of labor. We live an hour away, and my first labor was only 4.5 hours. I actually have met someone who birthed with them and this midwife didn't get there in time, and hers was a ~6 hour labor. So, I'll have this discussion with them and make my concerns clear to them as we go along, and maybe they'll also have some flexibility about leaving part of the fee to be paid at the time of the birth, or something like that.

Yes, this is very standard. Every homebirth midwife I have spoken with has asked to be paid in full by 37 weeks, though the midwives I have actually given birth with have offered to be flexible if necessary.

I wouldn't ask your midwife to let you reserve partial payment until after the birth, though. Occasionally, a midwife will miss a birth, but it doesn't happen often and it's not because they don't take their clients seriously. Perhaps the woman you met didn't call her soon enough or made a very rapid progression after an original call to give the midwife a "hey maybe I'm in labor I'll keep you posted" heads up. Obviously if you hear that your particular midwife is known for missing births or you feel that she is not taking you seriously in general you might examine your choice of midwife, but I think it would be insulting and damaging to your relationship with your midwife if you withheld partial payment to make sure she doesn't miss the birth. You pay your midwife for her prenatal care and expertise, but also for her on call time. Generally midwives only take on a few clients a month, so by taking you on as a client she may have had to turn someone else away. She also plans her life around her on call schedule, perhaps her grandson has a play at his school an hour away from her that she would love to go to but she can't because that would put her too far away from you around your due date. That is part of her job, yes, and it is part of what you are paying her for.

[Talula Fairie]

It is possible to find a flexible midwife. We had intended to pay by the time the baby was born, but then the furloughs happened and DH's pay ended up being cut 15% We are paying them off this month (baby is 5 months old).

[wannathird]

payment

For my first home birth yes i had to prepay prepayment. with this one i am giving depsoit and she will bill my ins for the rest of it.

[LittleBlackBug]

Our midwifes missed our birth, but was a few minutes away, so they arrived shortly after and were able to take care of pretty much anything. Because of the crazy birth, they both spent the night with us, something they said they don't normally do, which we were extremely grateful for. I appreciated all of their care over the course of my pregnancy and even though they missed the birth, I still believe we got an extremely great deal!

[velveeta]

These have all been great replies. Our experience is the same. I just wanted to add that my midwife is on call for me 24/7, and I feel that paying her by 36 weeks for that is more than fair. Honestly, I wish we could pay her more -- she certainly deserves it. She is not getting rich being a homebirth midwife! And the care is beyond compare!

edited to add that we also pay out of pocket, and we are not rich. I would sell my car or something similar to insure we had $$$ for homebirth. Super high priority for me and my family.