Homebirth: why is it almost the same cost as a hospital?

[wzuur]

my wife and i do not have insurance and wanted to have a homebirth.  unfortunately, we found a great midwife but they wanted 4000 dollars for their service!  we are in a small town in binghamton, and i just dont see how people can pay for that.  i also dont think it would be right to charge a lot because there arent enough "customers".  

what is going to end up happening is we will do an unassisted homebirth (which we are both completely fine with).  as we are at this junction, ive had one thought: with hospitals charging an expensive rate of 5000-7500 for vaginal birth, why would a midwife charge 4000?  how can the costs compare?  what is the breakdown of cost for a midwife? 

it just seems that humanity is in such a wretched position.

[mcgee]

Our midwife charged $2500 for our homebirth, plus another $200 for a backup midwife for the birth, and we spent an additional $75 or so on the birth kid and some additional items. Midwives in our area tend to run between $2000 and $4000, with birthing centers in the $4000 range. My daughter's hospital birth with induction and epidural was more than $10,000, and that does not include additional medical fees for our daughter's hospital stay - that was just MY bill, or rather filed under my name with our insurance. One of my cousins had a scheduled c-section almost two years ago, and I think it was $20,000.

I find it hard to believe that a hospital is charging $5,000 for a vaginal birth. That seems really low to me.

[savithny]

I suppose its *possible* that a hospital might only charge 5000-7500 -- but that's probably just the hospital's cost -- the room, nurses, food, etc.  

Generally you also get a bill from the doctor or doctors, the anesthesiologist (if there is one), the lab, and the pharmacy.

8 years ago, my OB/CNM practice charged 2000 for prenatal care and attending the birth.   That was on top of whatever the hospital charged and whatever other professionals who practice at the hospital charge.

[wzuur]

i was referring to a hospital birth without an epidural; an epidural shoots up the cost ~$5000.

i guess i wanted to find a breakdown of cost.  yes, midwives' cost includes prenatal, but still, a couple of checkups: why would that cost be much?  especially if you aren't getting any tests done and it is a "how are you eating/sleeping/feeling", followed with feeling the belly.  

all of the information that the midwives have told us is available free on the internet, and we were just nodding along as they were telling us.  

getting back on track, what would be a breakdown of the cost of a midwife, compared to a hospital?  Supplies, gas, time, licence, schooling, staff etc.

[Jane]

Bwahahahaha. I charge what the market bears. Why not? Ford does...

I pay malpractice, my birth assistant, my supplies and medications (not just what I use, but what expires without use), my license, my taxes, my rent for office space, my student loans, my continuing education, IRA, health insurance for me, and more. Don't forget the Latte budget, I live in Seattle, after all.

Homebirth = $3000
Hospital birth = about $12,000 for a natural birth with no epidural, no complications. The doc charges about $4000 and the hospital does the other $8000. Remember to take both into account, there's a hospital fee and a doctor's fee.

[MrsShow]

The MIdwives fee (at least ours) will also cover all the prenatal visits, plus the 6 weeks post partum visits, plus 6 weeks of pediatric care.  NONE of those things are included in the "hospital cost".  The hosptial cost is only what occurs duirng the 2 to 4 days you stay there.

(sorry for the typos...sticky keyboard)

[savithny]

Originally Posted by wzuur 

i was referring to a hospital birth without an epidural; an epidural shoots up the cost ~$5000.

i guess i wanted to find a breakdown of cost.  yes, midwives' cost includes prenatal, but still, a couple of checkups: why would that cost be much?  especially if you aren't getting any tests done and it is a "how are you eating/sleeping/feeling", followed with feeling the belly.  

all of the information that the midwives have told us is available free on the internet, and we were just nodding along as they were telling us.  

getting back on track, what would be a breakdown of the cost of a midwife, compared to a hospital?  Supplies, gas, time, licence, schooling, staff etc.

That doesn't sound right either, becuase when my husband had surgery with a spinal block several years ago,  the meds plus anesthesiologist fee didn't raise it even a fraction of that.   I know because it turned out the anesthesiologist was not a participant in our insurance and his fees were less than our annual deductable.

[XanaduMama]

Originally Posted by Jane 


Homebirth = $3000
Hospital birth = about $12,000 for a natural birth with no epidural, no complications. The doc charges about $4000 and the hospital does the other $8000. Remember to take both into account, there's a hospital fee and a doctor's fee.

Yup. #1 was a hospital birth with an OB. No epidural--I did end up on pitocin for about 3 hours, but otherwise pretty unmedicated. The total (for ME, not counting ds's "hospital stay") was around $12,000; I was fortunate to have an out-of-pocket maximum that capped our expenses at $1,500, plus the deductible ($500, I think?), but then we had to pay separately for ds's 20%. dd's HB was $2,600 total, none of which insurance covered, and it was worth every penny. This was in 2008 in NC, with a CPM, in case that matters.

Talk to your MW; if you're uninsured, they'll almost always work with you on the finances. And honestly, I cannot compare the level of care I received from my MW to my OB visits, which were insulting, TBH.

[Apmama210]

My midwife charges 3250 total.. I pay for the supplies for the birth which ends up being about 100 bucks.. So 3350 total.

That includes all my prenatal, postnatal, and newborn visits for the first month.. WAY cheaper than a hospital birth alone.

[greenmama66]

Mine charges 1500- most of the other one's in my area charge 3000-3500. She lives out of town though.

[Salem Lily]

My husband and I had a homebirth with a midwife in November. We have insurance, but don't have maternity coverage. We paid out of pocket for our homebirth ($3500). We also did shadow care with an OB which we also paid out of pocket for, that cost $2500 (included prenatal visits, labs and OB's delivery fee). The hospital fee was a totally separate charge and it applied just to the delivery itself. So, for an uncomplicated vaginal delivery with a 1 night stay, it was $3650. Add $1,200 additional per day for mom after 1st day. That price does not include an epidural ($850 if paid for in full before delivery) or any interventions or augmentations (that price also doesn't include any post partum problems/complications). The baby will be billed separately for any and all care done to them (routine newborn care, nursery stay, Dr. visits, vaccines, tests, etc). If the baby has to go to the NICU, that is another separate bill and another separate Dr.'s (neonatologist and/or other specialist) bill.         

*The reason why I included the above is because most people think the "cash pay" (uninsured patient) price is a flat, all inclusive fee. I'm not trying to insult your intelligence. 

The care we received from our midwife and our entire homebirth experience was worth every single penny and then some. I never felt that our check ups were just a "how are you eating/sleeping/feeling, followed with feeling the belly." Maybe you haven't found the right midwife? The care I received from my midwife versus my OB is night and day (I'll never do shadow care again.). I consider my midwife (a CPM) a medical professional just like myself (I'm a registered nurse). I had full confidence in her when it came to, if something did go wrong, her ability to handle it and guide us. That's really what your paying for: her expertise, knowledge and experience if something (God forbid) does go wrong.

I would look into this further before completely saying no to a homebirth with a midwife. The majority I know really love and believe in what they do and hate when money holds someone back from having the birth they want. Typically, they will work with them anyway they can (payment plans, barter, trade).

Good luck to you! Best wishes.    

[Munchkingirl]

When we had our first homebirth w/midwife, she had been doing it for a few years and pretty much worked from her house--cash cost $2500.  Second babe planned with her (came quick, so unplanned unassisted), she was still building her practice and working from home--cash cost $3200 (minus a small amount for not actually being at the birth, through no fault of hers).  Between babe 2 and 3 she expanded with a birth center (wonderful option and very pleased it is available for those who want it), so with that the new cash price would have been $5000 (even though we still would have been at home and not using the birth center).  I totally understand the underlying expenses--all the things Jane describes above, plus the extra nice touches that make going to a Midwife special.  We were already on a different journey, but the cost increase did put an extra pause in the process.  Now, with babe 4 the cash price is around $7000!  (I realize that is still usually lower than a hospital, but....).  We have a working relationship and I still see here occasionally for a quick check up and pay on a appointment by appointment scale.  Sigh...we live in an area of the country that accepts that kind of inflation, but it also creates a feeling that it isn't about what it started to out to be...now it seems so business like, red tape, and sign your check before you leave kinda thing.  It really did feel different when she was just caring for mama's and their babes without all the other stuff.

[Jaimee]

I've shopped around for mw's in three different states and the average range appears to be about $1800-$4000 and that includes everything from prenatal visits to the birth to postpartum care.  Birth supplies are a little extra- maybe $50-$200 more depending on if you want a birth pool and if you rent it or buy it.  And a birth assistant might be extra as well if one is required.  DEM and CPM's generally charge less than CNM's.

Midwives generally break their prices up into three blocks: prenatal, birth, and postpartum.  The birth portion of the fee is by far the largest.  Many only charge a minimal fee per prenatal and from my experience, roll the price of any necessary medications/tests (bloodwork, Rhogam, GTT, etc.) into the overall cost.  As far as I know, most midwives do not think about their prices in terms of travel time or gas expenses- it's just a global fee.  I have talked to some that charge about $40 a prenatal visit at their home and $50 if I want it at my home.  Really not much different.  Often midwives are willing to travel one hour, but some will travel further and this may increase their price slightly.   With my last baby, I changed mw's at the last minute (38 weeks) and I received almost all of my money back from the first mw and needed to pay the second mw her entire fee.  So this just goes to show that the majority if their fees are in the birth portion of their services.

The average hospital birth with no medications is around $10,000 (again, I looked this up in several states to find an average).  Tack on a few medications, an epidural, a c-section, emergency travel, etc. and it jumps to $20K to $50K to $100K and that doesn't include postpartum care past the time you're in the hospital.

In Canada, you can get a c-section for closer to $8000 and a vaginal birth for less.  Not here in the USA.

Edited by Jaimee - 6/26/11 at 6:33am

[Alenushka]

I do not understand that either because CPMs , unlike CNMs) do not have 6-7 years of school (BSN plus Master's) worth of student loans to pay. CPMs (unlike OB  or CNMs) do not have malpractice insurance payments either (which mean if something goes wrong , you can't sue them to help you with child medical expenses).

So, I do not understand why they charge so much since the overhead should be so much lower.

[Alenushka]

Have you applied for Medicaid or explored you state website? Often special state help is available for pregnant women.

You should think about it. Some homebriths end up in transfer (you can read those stories on MDC and other places on internet) and then, if you are not insured , what are you going to do with your hospital bill if you do not qualify for emergency type Medicaid?
 

Originally Posted by wzuur 

my wife and i do not have insurance and wanted to have a homebirth. 

[motherhendoula]

OP are you in Binghamton NY ??  All i can say is 'welcome to NY'  I would have paid $5000 for my midwife, in Long Island  (insurance covered it)    In NY - only CNM's can 'legally ' attend a homebirth - like another poster said CNM's have more years in school - have more licensure fees etc... and they do charge more than a CM  a CPM or a lay -midwife.    Seek another midwife ...maybe even one who is NOT a CNM - one who has more lattitude in her service fees.  In a town like Bingahamton (boy do i hope you are talking about NY!)  you will find a good sized HBing community - just ask around.  

[mbravebird]

Originally Posted by MrsShow 

The MIdwives fee (at least ours) will also cover all the prenatal visits, plus the 6 weeks post partum visits, plus 6 weeks of pediatric care.  NONE of those things are included in the "hospital cost".  The hosptial cost is only what occurs duirng the 2 to 4 days you stay there.

(sorry for the typos...sticky keyboard)

This! Add your costs for prenatal care (and keep in mind it's higher quality care than you'd get at any docs office, with hour long visits and psychological and emotional support). Then think about the value of home-based pediatric and postpartum care, some of which is not even offered by traditional medical establishments.

Our homebirth was a very, very fast birth (30 minutes) so it ended up being unattended. But I wouldn't trade our prenatal care for anything. It helped me have the birth I had. And the level of medical support once they arrived was unparalleled to anything I'd had before. My husband and I agree that we'd pay the fee all over again, even knowing that the birth would be that fast and unattended.

[Alenushka]

If you have a provider like CPM who had no malpractice insurance and something goes wrong because of their negligence, you can;t do anything  to get $$$ help for the injured party. No attorney will help you.  Malpractice insurance  is required of CNMs, RNs and MD for a reason. Why it is not requirement for CPMs is beyond me. They make mistakes too.

[Jane93]

If you can get state coverage for the birth it would be substantially cheaper than a HB midwife, and you would also avoid the scenario where you pay the midwife's fee and then also have hospital charges in case of emergency transfer.

Have you checked into what state resources might be available to you?

[Jane93]

If you are going to do a UC, please remember that no matter what your resources and ability to pay, no hospital can legally refuse to take care of your wife if she is in the process of giving birth.  Please keep that in mind if you feel things are not going smoothly.