Homebirth: why is it almost the same cost as a hospital? - Page 2

[MidwifeErika]

To be honest, it isn't almost the same cost.

With a hospital birth you have the cost of the doctor, the facility fees for the mother, AND facility fees for the baby. I would encourage anyone who is comparing the costs to call the local billing dept of the hospital and ask for all those costs. I am paying $3000 for midwifery care right now and what that is equivalent to is my out-of-pocket expenses if I were to birth in the hospital using my current insurance (which I pay about 20%). That is not the same as them actually costing the same.

If you are looking at a practice with 2 midwives, then automatically that fee gets split. Add in gas, CEUs, licensing fees, self-employment taxes (OUCH!), rent for an office, supplies, malpractice for those who have it and suddenly you will see that the midwives really aren't making all that much. When I did my taxes last year, I ended up pretty bummed out by the tiny percentage of my income that was left once I covered all my expenses. Also, keep in mind that most people who hire a midwife REALLY want their own midwife to show up at their birth, which means midwives who are doing homebirth cannot take on the same volume of clients as hospital based practices where only the oncall attends the birth.

I guess this is something each family has to weigh out for themselves. If you don't feel the service is valuable, then you certainly don't have to spend your money on it. The costs are the costs. I can't walk into a doctor's office and demand that I only pay them $20 for a visit since they only spend 5 minutes with me and I can look up information on WebMD, you know? They charge what they charge and I can choose to utilize their services or not.

[EngineeringMama]

Midwives of all levels of training need to eat, feed their families and live decently as well. For although we love to hate the high fees doctors pay, they earn that pay for the hard work they do, the training they have, the time from families while on call, the fact that not every shmuck on the street can practice medicine gives them the right to charge more.  Midwives fall in the same boat. They are trained (on some level, CNMs usually the most highly trained), dedicated professionals, taking time from their families - days on end if your wife's labor goes long, and really do have the right to charge a fee that can allow them to live. Many will work with families, use barter systems, etc. but I think folks at times forget that just like doctors and hospitals, midwives need to get paid, it's a business. We forget that sometimes, we think midwives are the friendly kind women down the street willing to help any woman in labor and we forget that for many the fee we pay is that, a fee; it's not a gift to a kind woman, more often than not it's the very money that keeps her lights on.  It's her business and livelihood.

What I think is also forgotten is that that hospital fee helps support many folks as well, nurses, janitors, lab techs, etc get paid from that fee. We can be so quick to think it greed and forget that those pretty painted walls and clean bed linens come from that fee we pay for hospital births.

[flox8]

For both of our hospitals births we paid 250$  from start to finish, actually this is what we paid for my entire pregnancies AND births. It all depends on your insurance!not including the doula, she charged us 400$  for each birth, in the end we paid more for our doula  than our  CNM  assisted birth with 2 days stay in the hospital.

Edited by flox8 - 6/26/11 at 10:18am

[wzuur]

Well, i make too much for us to qualify for ANY care, and my wife is not on my new work insurance because it was far too expensive each month (about $600 per month to have her on); there was also a large fee to pay to get her on during a time that wasnt "open admission"...  

We live about a 3 min local drive from a hospital.  

The midwives I was working with weren't "legally" able to be my midwives, so they worked out a deal with a prominent midwife in ithaca who we would only visit once to make the whole process "legal".  However, that midwife said it was up to the other midwives to set a price, so they just used that midwife's normal fee of $4000, which is what everyone charges in ithaca. (on a side note, these midwives refused to barter with our services because they didn't think it was useful [i've worked in the film/tv industry as an editor/camera operator/motion graphics artist for 9 years and my wife is a painter and photographer; we also own our own equipment])  i really find it unfortunate that the midwives chose such an ungenerous approach, even though our bartering was worth far more than their fee.   

Originally Posted by 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.  

[Alenushka]

For $4000 you can buy several moths of insurance at your work for you wife.  Illegall  MWs? You really want to got this way?

Also, talk to your hospital. Hospital have certain amount of money set aside for charity care and you can also arrange for payment plan.

[wzuur]

i think you might have misunderstood some portion of what i wrote.  we cannot afford 4000, that was why we opted out of the midwives we liked.  they were the only ones we could find in the binghamton area, and in order to make it "legal", we had to have the paperwork go through a MW in ithaca.  

there is no way we would go to a hospital: that would be worse than having to do it ourselves; they know not of birthing, but of ailments and how to interfere with what is natural.  also, i am sure that you must "qualify" for that charity care with a low income, this is not our problem.  i make 40-50k a year, but that supports both my wife and i.

i have no problem with "lay midwives", regardless of their legality.  
 

Originally Posted by Alenushka 

For $4000 you can buy several moths of insurance at your work for you wife.  Illegall  MWs? You really want to got this way?

Also, talk to your hospital. Hospital have certain amount of money set aside for charity care and you can also arrange for payment plan.

[Alenushka]

Look, you make assumption about hospitals. Go check our you specific hospital. see what their policies are regarding natural childbirth. There are hospitals take the meaning of consent and patients cantered care very seriously. See if you local hospital is designated as "baby friendly"

You still have time. Explore your options yourself, do not go by what is posted by Internet. Yes, I understand the irony of posting this on the Internet.

You have nothing to loose by exploring.

[Jane]

$40K for a family of three (including the baby) would qualify for some assistance where I live.

[MidwifeErika]

Originally Posted by wzuur 
    i really find it unfortunate that the midwives chose such an ungenerous approach, even though our bartering was worth far more than their fee.   

To be honest, not every midwife can afford to barter. My kids can't eat graphic designs and the utility company won't accept photographs to keep our power running. I barter often, but sometimes I have to say no because I need to bring in cash too. Imagine for a moment that you went to work and your boss tried to give you a handmade quilt instead of your paycheck..... even if it is a beautiful quilt, you may have bills to pay that you actually need the paycheck for.

[MrsShow]

Originally Posted by Jane 

$40K for a family of three (including the baby) would qualify for some assistance where I live.

Yep...We qualified for a 90% discount at our hospital.  We make around 35k for a family of 3.  Hospitals (at least our faith based ones, not sure about the county hospita) have quite high income guidelines.  Granted, we are paying for MW care, even though we have to break our long standing rule and take a loan out to do it.

[savithny]

Originally Posted by wzuur 
The midwives I was working with weren't "legally" able to be my midwives, so they worked out a deal with a prominent midwife in ithaca who we would only visit once to make the whole process "legal".  However, that midwife said it was up to the other midwives to set a price, so they just used that midwife's normal fee of $4000, which is what everyone charges in ithaca. (on a side note, these midwives refused to barter with our services because they didn't think it was useful [i've worked in the film/tv industry as an editor/camera operator/motion graphics artist for 9 years and my wife is a painter and photographer; we also own our own equipment])  i really find it unfortunate that the midwives chose such an ungenerous approach, even though our bartering was worth far more than their fee.   

Of course, the thing about barter is that the person with whom you are bartering with has to have some need for the item or service you are offering.   You need their service; they may need cash to cover their expenses more than they need moviemaking, painting, or photography.  Or they may need some other good or service.  

If they weren't planning on spending business money on film, painting, or photography, why should they suddenly develop a need for it just because that's all you have to offer?   Perhaps you could find out what good or service they might actually need, figure out who provides *that* good or service, and then try bartering with *that* person?   If they need professional laundry service, for example -- perhaps a local laundry would like publicity photos taken in exchange for credits, which you could then sign over to the midwives?

[wzuur]

well now, i was going to be offering up to one thousand with our bartering because i understand people need to pay for things, but bartering was completely turned down.

lets not get into the subject of "does a business need marketing", because then it really is an issue of education about how to grow or get more business; lack of education or knowledge in such a field would render the subject to take on a stance of ignorance to video/pictures/branding etc.

[stik]

Skilled care in pregnancy and childbirth is an investment in your child - a skilled attendant can spot and treat a number of problems while they are still small, in some cases preventing costly long-term health problems for mother and child.  Wzuur, I hate to sound harsh, but you make $2-3K/month after taxes.  Pregnancy is 40 weeks, which is 10 months, financially speaking.  Sit down and make yourself a budget that allows you to pay the midwife (the one you like), and then stick to it like it's the most important thing in the world, because it's for your child, and it's that important.  

[Jaimee]

OP, have you tried posting in the "Finding Your Tribe" section of MDC?  There are likely other mw's in your area that are not easy to find b/c they are illegal. Here in MD CPM's and DEM's are illegal as are CNM's that are not overseen by an OB.  I had to dig a bit to find them all and their prices definitely varied.   Likewise, I'm moving to IL in a month and finding the underground mw's there is much, much more difficult, but by putting out feelers in the parenting community (meetup groups, Yahoo groups, etc.) I have located three- all with varying prices. 

I have to agree with pp's and say that you simply cannot compare the level of care you will get with a mw to that of an OB and a hospital birth.  Working with a mw is completely worth the money and taking a good look at your budget and finding a way to make it work is a great idea.   Is there something you can cut out or cut back on for the next few months?  Or an extra job you can take on?  Many mw's are happy to make a payment plan for you- sometimes even extending past the 36 week mark by which most mw's require full payment.   Perhaps you could borrow some money from a friend or family member and make a payment plan with them.  You and your wife will only birth a finite number of times and how you birth your baby does matter.  It is such a magical, life changing, transcendent time.  If you want a homebirth find a way to make it work.

[motherhendoula]

"The midwives I was working with weren't "legally" able to be my midwives, so they worked out a deal with a prominent midwife in ithaca who we would only visit once to make the whole process "legal".  However, that midwife said it was up to the other midwives to set a price, so they just used that midwife's normal fee of $4000, which is what everyone charges in ithaca"

OP - i get what your saying here ...but i still have to say that $4000.00 for the full 9 months, delivery, and PP doesnt sound like a lot to me.  I know the area and i think you need to look just a little harder and you will find MORE midwives.  You can really look as far as Syracuse - PA.  Most people in that area are accustomed to having to travel for things!

- Barring that, i agree with the other poster who pointed out that MW often will take a payment plan, and that option would be worth exploring!  

"Illegall  MWs? You really want to got this way?"  these women only became illegal in NY state in 1996.  They are legal in many other states - including bordering state of VT.  Not an uncommon choice here.

[Bekka]

I think that comparing a HB midwife to a hospital birth with a dr. isn't a fair comparison at all.  She/he is going to drive their car to your house, maybe multiple times, spend several 45 to 1 hour appointments with you, assessing, educating, in depth, looking at your whole picture.  Whether your birth is 3 hrs start to finish or 3 days start to finish, she will be at your house for as long as is needed.  She will skip hours of sleep, meals, and even adjust her voiding patterns to make sure the bathroom is available for the laboring mother.

Most hospital care providers spend 10 min or less in a prenatal visit, even when you ask lots of questions and come in to "catch the baby."

And $4000 is very comparable to the cost of HB midwives in my area--all of them.

[Alenushka]

I have a friend who did a fundraiser on Facebook and Livejournal for his wife HB. Their insurance would not cover it.

They raised $4K from their friends.

I have other friends who did same thing collecting money for moving costs when they were evicted.

To be honest, I was irked by the first one because my friend had an insurance that would cover hospital or birth center. To me i twas like "I have Ford, but I want Prius".

As far as barter. I have bartered my own service but for things I actually needed. If you are hiring an illegal MW....why would she want any marketing services. Exposure on the Internet and open marketing would lead to legal consequences. If anything, a person practicing illegally would rather barter for legal service than anything else, I imagine

[Jane93]

Hmmmm... I wonder why providers of an illegal service may not have a great interest in marketing opportunities!!  I'm guessing the local pot dealer isn't interested in bartering with you either.

[GooeyRN]

I am sorry things aren't working out for you as planned.  I am also from the Binghamton area.  I birthed at Lourdes Hospital and had a 100% natural child birth.  The midwives there were fantastic.  I went to Elaine Rosenwach and she really was fantastic.  The midwives there will support pretty much any kind of birth you want. If you want it, you got it, if you don't, you won't.   Katie (who happened to be the only midwife able to make it in during the snowstorm!  She came in just so I wouldn't have to birth with an OB) the CNM just sat there and let me deliver, very hands off.  They really are flexible as long as there are no health complications going on.  They aren't supposed to let you do water births, but they will let you if you ask.  I am posting just to say things aren't horrible at Lourdes... Not at all.  They are quite baby friendly, too.  The birthing suites are very home like with a full bed for your partner, tv/movies/music, tubs/showers, free snacks/allowed to eat and drink during labor, etc.. The kitchen will bring you whatever kind of food you want pretty much.  It isn't a standard "here is your lunch, the same as everyone else" you call the kitchen and tell them what you want and they bring it!  No one said anything about co-sleeping and baby never left my side, all was done at the bedside.  No one ever suggested formula, either.  The nurses were very friendly and smart.  No one questioned my choices, they just went along with what I wanted.  I really couldn't have asked for a better experience.  (this was my third birth)  My choice to go "overdue" was fully supported.  (no I didn't go past 42 weeks)

I also birthed at Wilson in the past.  I really liked the CNM's, but I do not recommend birthing there at Wilson.  They aren't as baby friendly as Lourdes, they are short staffed, and the rooms are not private for your stay.  (you do birth in a private room, but then you have to move once settled/after you nurse, and you have a room mate if they are full)

I just thought I would share that birthing at Lourdes is far from doom and gloom, and you can have a natural child birth there if you wanted instead of UCing.

[pers]

Originally Posted by wzuur 

well now, i was going to be offering up to one thousand with our bartering because i understand people need to pay for things, but bartering was completely turned down.

lets not get into the subject of "does a business need marketing", because then it really is an issue of education about how to grow or get more business; lack of education or knowledge in such a field would render the subject to take on a stance of ignorance to video/pictures/branding etc.

Not all businesses wish to grow.  A midwife can only handle so many births in a month.  I'm not sure how busy the midwives you were talking to are, but the ones here have waiting lists and unfortunately far too often have to turn away women who want there services because they already are at their limit.  They certainly don't need to advertise. 

I do not understand how visiting a legal midwife once could somehow legalize midwives practicing without a license or whatever.  Sounds very shady to me.  Perhaps its just so they can pretend the legal midwife is the one actually providing care for purposes of fraudulently billing the insurance of those who have it?  I can't imagine any other reason, but someone please set me at ease by filling me in if you know any more innocent reason why this could be.

In any case, if these midwives are practicing illegally and possibly stealing from insurance companies, I can certainly see why they wouldn't to draw undue attention to themselves by doing anything flashy.  I'd also stay far, far away from the myself.  Why aren't they practicing legally?  Are their educational requirements lacking?  Can anyone be certain they'd actually know what they were doing if faced with an emergency situation?