Why are Nurse-Midwive's so expensive? It is really frustrating to me to want a home childbirth...

[elliottyellow]

After having a less then peaceful natural childbirth at the hospital, I am now convinced that for my next I want to have a home birth. When I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money.... I asked one of the ladies how many she has a year and she said 24.. 24x $4,000 equals sitting pretty. I need to just breath about it, but right now I am so turned off. Does anyone have any suggestions for me?

[jsh7809]

No suggestions, unfortunately, but commiseration. My guess is that they have to charge a lot to cover their own insurance costs, and most areas/ health insurance plans don't cover home births so they don't get benefits that hospitals do. But I too find it very frustrating... we spent a long time trying to figure out a way to afford a home or birth center birth, but are ultimately going to go for the hospital. I think it's going to be $500 through our HMO instead of $4000-5000 .
We're having a doula and working to make the best of the birth situation we can afford, but it still sometimes frustrates and disappoints me. I heard over and over again that midwives try to be flexible and that there are payment plans available - but if you don't have the money, and won't later, a payment plan can't do much. One area doula actually told me that we should really NOT have a hospital birth, we should have a home birth unless we wanted to end up with a C section. One grouchy old woman's opinion but it still made me really mad and turned me off.
I think it's the tricky situation home birth midwives are in because of our country's crappy health care situation and the fear people have around home births, but it is so frustrating! I know in our area there are very few home birth midwives available because they are restricted from having hospital transfer privileges - so most of the area midwives are associated with a hospital and forbidden to attend home births. We need new laws!!

[CorasMama]

That actually isn't a lot of money. They have huge overhead, and work a ton of hours for that money. And it's way, way, way less than an OB and hospital birth costs. It feels like more because insurance doesn't always cover it. But that midwife isn't taking home nearly what you think, and she's not just working a 9-5 office job to get it, either.

[GreenTeaGinger61]

It's not a lot when compared to how much a Dr charges added to hospital costs but for most of us insurance will cover those costs whereas they won't cover a homebirth midwife.

It is a business but most of the midwifes I interviewed were willing to work with me. One told me she would never deny someone a homebirth because they couldn't pay. We didn't end up with her because she ended up being pregnant and due around the same time as me And the midwife I have now at a birth center, is going to work me in terms of money because my insurance is being a PITA. Not many drs. around here would be willing to do this.

[rootzdawta]

My hospital birth, insurance paid $12,000. My homebirth, they paid less than a third of the $5000 my midwife was asking. I paid the rest out of pocket. $4000 isn't a lot when you consider the overhead and insurance and all that. Ask about a payment plan or see how the midwives can work with you. Most midwives are willing to help.

[rootzdawta]

Moved from I'm Pregnant.

[WaitingForKiddos]

To me, a net of 96k isn't much considering she's a business owner. With that money she's working long unpredictable hours, often overnight, and even when she's not actually with a client she must answer their calls/emals promptly. She must provide her own healthcare ,must pay for updating her skill set with classes and such, must keep medical equipment up to date and dependable. She must deal with babies who die. There's ton more too.... Oh and taxes!!! That takes out a nice chunk right away.

IMO midwives are underpaid but they aren't in a position to charge more because for most people, like me, the current rate of about 4k is as much as a family can spend.

[emnic77]

As a previous poster said, that midwife isn't taking home as much as you think. $4,000 x 24 = $96,000. Figure 40% of that gone for taxes and another big chunk if she needs to pay for her own health insurance...don't know about Sacramento's cost of living but I can tell you that here in the Boston area, that's a fairly modest take home amount.
Be frustrated with insurance companies that won't cover out of hospital options. THEY are the problems, not the midwives that are merely trying to do what we all want out life - to put food on the table for our families while doing what we love to do.

ETA: there's something to be said for the risk that they take, too. To me, paying my midwife $3500 is nothing compared to the political and social risk she takes to even PRACTICE homebirth in an environment that is fairly hostile towards homebirthing. If I could afford it, I'd give her a big fat tip on top of what I'm paying her. She does not NEED to do what she does, she could make more money elsewhere, she does what she does because she is driven to make a difference and because she believes that *I* should have choice as to where and how I give birth, and IMO, that's priceless.
/soapbox

[lunita1]

Originally Posted by elliottyellow

After having a less then peaceful natural childbirth at the hospital, I am now convinced that for my next I want to have a home birth. When I started researching midwives in the Sacramento area I was really disturbed by the prices I was being quoted. I know what they do and how important they are and all their qualifications, but it just feels like a business to me. A serious one where they are making serious money.... I asked one of the ladies how many she has a year and she said 24.. 24x $4,000 equals sitting pretty. I need to just breath about it, but right now I am so turned off. Does anyone have any suggestions for me?

I'm in your area and I'll agree with others that say that a gross income of $96,000 before expenses is not unreasonable AT ALL. They work hard, long hours, take big risks, have valuable skills and they deserve to be paid for what they do. Also, for context here are the costs of unmedicated, uncomplicated hospital births in our area http://www.betterbirthsacramento.com...omparison.html

Also, it probably won't save you any money, but the most experienced midwives in the area aren't CNM's. If I were planning a homebirth, I'd hire Tosi Marceline http://www.birthstream.com/index.html. For reasons I won't get into here, I'm driving across the causeway to the cheapest hospital on the list above (even after carefully considering the Birth Center, which is pretty close to me.) Birth tubs, volunteer doulas, reasonable c/s rate, policy of delayed cord clamping, staff that didn't blink an eye when I said I wanted to go home a few hours after the birth, etc.

[SamGroom]

I know nothing about CA law but CNM's generally charge a little more than CPM's. So you may want to check out midwives in your area that are not nurse's.

[ciga]

You can add into those lists of why they deserve what little they make the incredible personalized care you get with a midwife versus a hospital OB. I have had many friends complain that they don't feel like they have time to ask questions in appointments because they only see their doc for ~10 minutes. Every appointment I've had with my midwife has been 45min-1hr most of which is just us talking through my questions.
When I go into labor I am going to feel so much more at ease because I actually have a relationship with the person who is there to support me. Fortunately my insurance does pay half the midwifery/birthingcenter fees but I still had to shell out $2k, which I did gladly (even though it was a stretch) to avoid a hospital birth and to assure that labor support relationship would exist.
Mainly, I just agree with previous posters who pointed out that this is something to be pissed at the insurance companies for, not the midwives.

[Peony]

It can frustrating for some but they really don't make that much at the end of the day. I am friends with 2 MWs in my town, one really struggles to make ends meet, the other does "ok" but still qualifies for low cost health care for herself because despite doing many, many births a month, it isn't enough with all the overhead.

[kittywitty]

I agree that's not much money for what they do and the overhead. But I also completely commiserate on the price to the family. I wish insurance would cover it. It's completely too much for most families.

[MsBlack]

Just want to say--this mw's heart has been thoroughly warmed by all the affirmative commentary here about the work, risks and committment of midwifery, and how little we do actually take home after our costs

I do know some mw's who make a fairly pretty penny (taking home way more than the mw the OP mentioned), and feel they should make as much as anyone else and be as comfortable as the 'American Ideal' promises. I don't judge them for it...but I will say that more of us DO live on pretty darn little take home pay. And we do so because what with the hostility of the med profession against hb, and the insurance companies therefore being so stingy about paying us, we mws try to keep it affordable for as many fams as possible. We work mainly for love of this work and the families we serve. But we do live wherever we live, with the associated cost of living and all--and can't work if we can't pay for groceries.

OP, keep looking, and keep working on it! You may just find the perfect mw for you, with a pricetag and terms you can meet along with the kind of personality and practice approach that you most desire.

good luck!

[MidwifeErika]

She probably only brings home about 50% (or less) of that as income, which makes it a much lower income. Keep in mind that she has a master's degree and to make about 40K with that much education really isn't very much at all! Midwives deserve to make an income. there are long hours and a whole lot of responsibility that comes with the job. It isn't just some expensive hobby, it is work. I just did my taxes and for last year I brought home only 6% of my gross due to the costs of getting a practice going, paying assistants, miles put on my car, overhead expenses (rent, utilities, phone), and advertising. goodness, I barely broke even!

Generally, a vaginal birth in the hospital with all the prenatal care and such will end up being about 20K, so 4-5K is a really reasonable bill. However, I totally understand where 4,000 is hard to come up with as well (I would have a hard time trying to find that in our budget... ok, an impossible time). I think rather than being upset at midwives for their fees, we should take issue with not having insurance better cover midwifery services. Write and complain to your insurance company or start working for action for midwives to be covered by any universal healthcare that may go through in the future. It takes consumers taking action to make things change!

[dannic]

Originally Posted by SamGroom

I know nothing about CA law but CNM's generally charge a little more than CPM's. So you may want to check out midwives in your area that are not nurse's.

I know this certainly isn't true in all cases, but my cnm was MUCH more medical minded than my cpm. Like night and day. I agree with pp to shop around.

Are there things that you can cut from your budget? Things have been tight for us each time I got pregnant and we don't have insurance and yet have been able to (barely!) cough up the 3,000$ for our midwife each time. In fact, the first two were 3800$. We've cut eating out, texting, and other wants.
DS has sacrificed Legos, lol. "Mom, I really want the new Atlantis legos"
"Well, honey, legos are expensive and we're saving for the baby. Wouldn't you rather have a brother than more legos?"
He thinks..., "I'd rather have both, but I can wait til after the baby's born".

Keep trying!

[MidwifeErika]

Originally Posted by dannic

DS has sacrificed Legos, lol. "Mom, I really want the new Atlantis legos"
"Well, honey, legos are expensive and we're saving for the baby. Wouldn't you rather have a brother than more legos?"
He thinks..., "I'd rather have both, but I can wait til after the baby's born".

Keep trying!

Oh my goodness, that is ADORABLE!

[Nicole730]

I agree with PP. Try and find a midwife that would be willing to work with your budget or a payment plan. Most of them are willing to. Also, does your insurance have any flex-spending (or something like that?) money you could use towards the bill?

[FireWithin]

We are also struggling with the choice. I am in my first trimester and DH and I are talking about a homebirth. Sometimes it is hard for me to justify. I briefly talked about this with my very crunchy hospital midwife (last breech preg she highly encouraged me to travel to The Farm for my birth). She sees this as a political issue that we all need to get involved with.

We don't always have enough money for the right or best kind of food. We are in the red many months. Our hospital birth could cost us $0 (we pay a lot monthly on insurance). We are still leaning towards a homebirth. DH said it was our last chance to do it the way we want.

We still don't know and I feel so angry at the insurance companies for putting us into this situation.

[nia82]

CPMs are cheaper, but e.g. my insurance only covers CNMs, I guess that is the case with you too. Is there a birthing center and is it covered by insurance? I lucked out that my insurance covers a birthing center with CNMs just 2 hours South of us. Otherwise, it's everything out of pocket. I hope it works out for you.