Want a homebirth but....

[Salem Lily]

I am terrified of having to transfer! It's not because I'm afraid of the hospital. I know that it's completely necessary in some situations and I would have no problems going if I needed to. My main reason is (please don't judge), it's going to cost a fortune if I do. If we didn't want a homebirth and went with a planned hospital birth instead, it would be significantly less (we are paying for everything out of pocket, no maternity coverage). But I really want a homebirth! It's just so much more "like it's supposed to be" in my mind. I know cost shouldn't be a deciding factor, but we do have to be somewhat practical because of our particular situation.

My question is, what are the main reasons for having to be transferred? This is my first baby, does that increase my chances?

I know hospital vs homebirth is a "hot topic" on Mothering, but please be thoughtful and kind. I'm actually nervous just posting this!

[Annoia]

I'm assuming you mean transfers during labor. You can also transfer care during pregnancy for a number of reasons.

From what I understand, most transfers during labor are for long labors / maternal exhaustion. Generally occurring with first time births.

You can also transfer during the third stage of labor for a retained placenta, but I'm not sure how common that is.

Emergency transfers are pretty rare (again, just from what I understand).

This is just off the top of my head - no hard numbers to back it up (other HB moms - is the average transfer rate about 20%? Or was it closer to 10%? )

[Salem Lily]

Yes, I mean transfer during labor.

[lotus.blossom]

I had a homebirth transfer. I already had one c/s under my belt for failure to progress. This time I did progress beautifully but after 5 hours of pushing we decided to go to the hospital. He just wasn't coming down no matter what we did. While it wasn't an emergency, I certainly did not enjoy the transfer process. I wouldn't trade my labor at home for anything though. It was so much more calm and manageable than my first.

[evjolin]

yes, as a first timer you have a greater risk of transfer. most transfers as previously mentioned are for exhaustion or dehydration. some midwives, depending on your state and their licensing, can do IV's at home (for dehydration). if that is the case for you, that's one less "reason" you would have to transfer. i too am in your boat--i have insurance, but will have to pay for both the hb mw and the hospital if i transfer. i'm risking the transfer, but my mw can do IVs.....

[Arianwen1174]

Both my births were transfers. The first was an emergency, the second was not. Both turned out fine with no c/s--I give the first doc a lot of credit because he could have rushed me straight to the OR. I'm TTC and definitely hope to have a home birth!

[lotus.blossom]

I just wanted to mention that if finances are a concern, its always a possibility for you to hire a really knowledgable doula and spend a lot of your labor at home. Travelling only to the hospital for your birth. That way you will get the best of both worlds. Your doula should be able to recognise the signs of labor and when its a good time for you to head over. You could be one of those lucky mamas with a seamless labor and easy birth, or you could have a long tough road ahead of you. If you plan on having more children you could opt for a homebirth for your second (and of course everyone knows that no two labors are alike, but you'll at least have a better idea of what you are in for)

[micah_mae_]

Not the same but at the birth center where I had my son they said their transfer rate was like...6%? And about 4% of that was maternal choice for drugs either for pain or exhaustion. Only about 2% were really necessary for medical reasons.
I'm planning a home birth this time around.

[Defenestrator]

I don't understand how a planned hospital birth could be less than a planned homebirth without transfer. The hospital fees themselves shouldn't be more if you transfer, you just have the difference between what your prenatal costs would be with a homebirth midwife and what they would be with a hospital-based midwife. Here's a couple of scenarios from the high end of fees in our area.

Have a homebirth, no transfer $3800
Have a homebirth, transfer $3800-$15000 (hospital fee)= $18800
Have a hospital birth $2500(prenatal fee) +$15000(hospital fee)+$17,500


I think that the chance of transfer for a first-time mom is about 25%. A lot of those will be non-emergency transfers for pain relief or exhaustion. Taking good care of yourself in early labor and getting good support around you (supportive partner, friend, family member, or doula, as well as a midwife who does good labor support) will help cut that down.

You might also be eligible for medicaid -- in our state you can get coverage just for pregnancy at a lot of different income levels.

Good luck!

[Salem Lily]

My homebirth would be around $2800 (prenatal visits and birth included). The birth kit, doula and tub would be more obviously. In our state we don't have birth centers and midwives don't deliver at hospitals.
Since we are "cash pay" the hospital fee is $2000 for an uncomplicated vaginal delivery with 1 day stay. I believe a c-section is $5700 with 2 day stay. This is only valid if you set this up before labor. I do not want an epidural but you can pay for one ahead of time ($800). It's a lot more if you wait and ask for it during labor. My OB charges $2000 for all prenatals, an ultrasound and delivery. Since we do have insurance (just not maternity coverage) the baby is covered.
I'd imagine in the event I needed to be transferred, all of thoses prices (and interventions) are going to sky rocket since we don't have a "contract" with the hospital.
I have thought about getting a doula and laboring at home for as long as possible. That way, I can have my birth plan signed by my OB ahead of time and be in some sort of control.
Medicaid isn't an option for us, we make too much. We are very fortunate because we both do well financially, but if we can avoid numbers like this:"have a homebirth, transfer $3800-$15000 (hospital fee)= $18800 or have a hospital birth $2500(prenatal fee) +$15000(hospital fee)+$17,500" than we'll do it.
We've been saving for over a year and a half because maternity coverage for independant contractors (like ourselves) is a joke. You have to wait a year to get pregnant, but during that time you have to pay the monthly premium for maternity coverage ($600, husband's premium not included) and the deductable that has to be met is ridiculously high. We figured out, before we got pregnant, it's more cost efficient to just pay out of pocket and save up. We were completely shocked too.
Ugh..I have a lot to think about! If it wasn't for this fear I have of being transferred, it wouldn't be that difficult of a decision.

[CoBabyMaker]

Another thing you may want to consider is looking at the intervention rates as well as policies for things like rooming in at your hospital.
You may also want to check with your insurance about what the coverage is like if you transfer in the event of an emergency. I have a friend that has a similar insurance situation to you but if they transfer for emergency care it is covered. (Weird but whatever.)

We have insurance but the maternity coverage is not great so it costs about the same to homebirth (out of pocket) as what our portion of the hospital birth would be. If I transfer we have to pay for both but for us the homebirth was more important. Part of our choice was based on a horrible hospital experience with DD and that I am VBACing (in an area where the medical community is NOT pro-VBAC). We wanted a homebirth with DD but didn't for financial reasons and I think we both regret it. I don't say that to say that hospitals are bad. Just that if you really want a homebirth I would recommend making that a priority.

[PiesandAbrosmama]

I think It's Real important to consider other factors when considering where to birth and with whom. Sure Fear is a significant hurtle to over come, but with the proper care and focus during prenatel care that should not be a deciding factor IMO. I think it's really important to interview potential care providers in both settings. I think once you establish an interview where you and partner can voice your concerns including transfers and payment, you can then begin to put the pieces of the puzzle together to decide who is going to provide the best care for you. This is a birth of your child, the cost (though I realize is a factor and let me just say I paid cash for all of my 4 births over the entire pregnancy. Then in one of the births continued after the birth to pay the balance) shouldn't prevent you from having the birth you desire.
I think a great book to read and work out fears such as transphers and what type of birth experiance you are looking for is Mother's Intention: How belief Shapes Birth by Kim Wildner. This book will help you work out all fears about the birth process and put into perspective what type of birth experiance you are after and how to mentally achieve it. I am a huge supporter of home birth but realize if you do not feel safe, have under lying fears, and are worried about cost those things will contribute to your birth experiance.
Blessings mama as you find your way

[soso-lynn]

I would encourage you to get all the exact information on costs before making a decision. You cite a price for an uncomplicated vaginal birth but the chances of that happening (depending on how they define uncomplicated) can be pretty low depeding on the hospital.

What you need to compare is the cost of a transfer for the possible real medical issues that warrant a transfer versus the cost of the same complications occuring in the hospital. You then need to look at the statistics for those complications occuring in an intended homebirth vs an intended hospital birth.

You need to talk to your midwife about her transfer rate, what can warrant a transfer and how to avoid transfers for things like exhaustion, dehydration or too long labour. Your choice of midwife can make a huge difference there.

I had a homebirth with my first and I think it would have been really sad if I had had to go to the hospital for financial reasons, especially hypothetical financial senarios.

[LittleLu'sMom]

Originally Posted by Salem Lily

My homebirth would be around $2800 (prenatal visits and birth included). The birth kit, doula and tub would be more obviously. In our state we don't have birth centers and midwives don't deliver at hospitals.
Since we are "cash pay" the hospital fee is $2000 for an uncomplicated vaginal delivery with 1 day stay. I believe a c-section is $5700 with 2 day stay. This is only valid if you set this up before labor. I do not want an epidural but you can pay for one ahead of time ($800). It's a lot more if you wait and ask for it during labor. My OB charges $2000 for all prenatals, an ultrasound and delivery. Since we do have insurance (just not maternity coverage) the baby is covered.
I'd imagine in the event I needed to be transferred, all of thoses prices (and interventions) are going to sky rocket since we don't have a "contract" with the hospital.
I have thought about getting a doula and laboring at home for as long as possible. That way, I can have my birth plan signed by my OB ahead of time and be in some sort of control.
Medicaid isn't an option for us, we make too much. We are very fortunate because we both do well financially, but if we can avoid numbers like this:"have a homebirth, transfer $3800-$15000 (hospital fee)= $18800 or have a hospital birth $2500(prenatal fee) +$15000(hospital fee)+$17,500" than we'll do it.
We've been saving for over a year and a half because maternity coverage for independant contractors (like ourselves) is a joke. You have to wait a year to get pregnant, but during that time you have to pay the monthly premium for maternity coverage ($600, husband's premium not included) and the deductable that has to be met is ridiculously high. We figured out, before we got pregnant, it's more cost efficient to just pay out of pocket and save up. We were completely shocked too.
Ugh..I have a lot to think about! If it wasn't for this fear I have of being transferred, it wouldn't be that difficult of a decision.

We were in a similar spot. We had individual coverage for me, with no maternity included. By state law (I think state?) pregnancy-related emergencies are covered, but not a healthy pregnancy and normal delivery. We opted for a planned homebirth but before deciding we did some research and realized the cost of that was less than the cost even of the planned hospital birth with no epidural, and actually cheaper than what we'd paid WITH maternity coverage when we had our first, b/c of copays and deductibles for both her and me.

Anyhow, we took the chance and did a lot of saving, budgeting, and planning to get the birth we wanted. No transfer for us, thankfully, so it worked out perfectly.

FWIW, our hospital told us the price would be the same for cash pay no matter whether you paid in advance or after the fact. The difference might be what we would have to pay the OB, since we didn't have care under one and would therefore be subject to their billing for the birth as well. Our midwife worked with 2 OBs as back up, though, so I felt confident they wouldn't be running me through the wrigner should I need to transfer.

GL with your decision!

[AustinMom]

I've read your posts here, but not the responses, so bear with me if I repeat anything...

Is it an option to 'sign to contract' with the hospital and not use it? Will they still hold you accountable for paying it even if you HB? I'm asking because I know a lot of women do dual care with HB MW and OB for the 'just in case I do transfer' aspect. You could easily just tell them you labored fast and had the baby at home, or if you transfer, tell them you wanted to labor at home as long as possible.

I know someone has probably said that the reasons for emergency transfer are small, I would guess around 1% of all births are emergency transfers. Depending on the MW you choose and what routes you are willing to go at home to not transfer, it can be lower. For instance, for hemorrhage, you can try eating a piece of placenta, or just holding it in your mouth to stop bleeding, usually works, also MWs carry Pitocin for this reason too. (there is a whole other few threads on this, I know it's pretty out there...)

Typically, most MWs in my area (birthing center and HB) have a transfer rate of around 10% on the high side. The majority of those are for 'failure to progress' or exhaustion, and usually more with first time moms, as nature has designed them to have longer labors to be gentler on the body as it opens up for the first time. I'd be prepared and make sure your MW is prepared to wait a little longer for dilation. Ask her her rates. Also, things she does to speed up labor. Hire a Doula to help as well to get another head thinking for you.

I understand the crappy side of insurance. They don't cover any HB MWs here, and we will end up paying about $5K out of pocket if we were to go through a hospital with their coverage. A HB is about $3K, and if we transfer, we will pay both the MW and the hospital fees. To us, it was WAY worth the 'risk' of HBing with the chance of transfer. The kind of stuff that goes on with typical OB prenatal care, and the stuff that goes on in a hospital during birth, and postpartum, is well worth avoiding by paying an extra 5K.