Homebirth: why is it almost the same cost as a hospital? - Page 3

[frogautumn]

With all due respect, you get what you pay for.

You're paying for superior one-on-one prenatal care, someone with experience, knowledge, and training to be there during the birth. Someone who can handle emergencies, can spot potential problems and advise you in a timely manner. Superior one-on-one postnatal care, breastfeeding support...midwives do a heck of a lot and their services are worth. every. penny. for your wife and your unborn child.

Why in the world would you question why they would price their services at fair market value? What about your salary?

You say your wife has insurance available through your work, but it is costly. Isn't your wife's health worth the cost, seriously?? I would suggest you take it. Homebirth is, by law, covered by insurance in NYS. 

What about your child? Will you deny him/her healthcare after he/she is born?

[Bokonon]

If $4000 sounds too costly now, what are you going to do if there are complications?  I was low-risk going into my first pregnancy, and my care and son's NICU stay cost $250,000.  I had excellent insurance and paid $1200 for everything, including prenatal visits.

I can't imagine having tried to barter my husband's software programming skills or my publishing expertise to pay the bills.  Gently, if I were those midwives, I would be incredibly offended.

HTH.

[Honey693]

Originally Posted by wzuur 

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? 

That is insanely cheap for a hospital.  Are you sure that's the entire fee?  With our first it was 10k, one night, no anesthesia.  Then my OB fee which included prenatals and my 6 week check up was another 2750.  So 4k for a midwife around here would be much cheaper than the hospital.  With my second the midwife was 3500 which seems very reasonable for 36 weeks of care, delivery and as many postpartum visits as I needed.

[motherhendoula]

Originally Posted by pers 

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.

The 'legal' MW can accompany mom to the hospital in the event of a transfer - she will have the full chart etc..etc.. whereas the 'illegal' MW can only say she is a best friend or a doula for mom.

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?  Remember, every state decides for themselves who is legally allowed to catch babies at home - in NY that is CNM's only, leaving CPM's, CM's and DER's considered to be 'illegal'  - not undereducated, not dangerous, just not CNM's.

Are their educational requirements lacking?  Can anyone be certain they'd actually know what they were doing if faced with an emergency situation?   Again remember that CM's, CPM's and DER's can catch babies at home in several other states - including a few that border NY.  to say 'illegal' is not to say 'unqualified' here. 

I

[Jane93]

Some people do consider CPMs and DEMs to be under qualified and clearly the State of New York agrees.  

Even assuming they are qualified, certainly one can question whether a practioner's illegal status would negatively impact their care (reluctance to transfer, call for EMS assistance for example) or put the parents under even more stress during an extremely stressful time (if they are expected to lie on the midwife's behalf while their child is in danger or has suffered a major mobidity or mortality).   

[AlexisT]

CMs are legal in NYS. They were the state that originated the qualification.

A CPM is not, on its own, legally recognized (it is possible to meet additional requirements and get certified). The NYS law on education predates the CPM title so I can't go so far as to say they think CPMs are underqualified. There's a single set of requirements that all midwives must meet to practice.

[Jaimee]

Originally Posted by pers 
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?   

Many states do not legalize CPM's and most do not legalize DEM's.  Those that do not recognize the CPM licensure often do not legalize CNM's unless they are overseen by an OB.  Sometimes the state will recognize the CPM license, but to practice in that state they have other restrictions like mw's cannot carry pitocin or even oxygen!   And in some states mw's are required to have cost prohibitive malpractice insurance or they are not legal.  All of these things prevent many skilled and highly qualified mw's from being able to practice legally in their state of residence. 

Here in Maryland many illegal CPM's will file insurance with an out of state billing company in order to get their services covered.  There is literally only ONE legal hb mw in Maryland and she is so overbooked that she frequently misses births (sending a birth assistant instead).  Frankly I am immensely grateful for the illegal mw's that have cared me and even more so that they helped get my insurance to cover it so I didn't have to pay out of pocket.

Anyone considering a hb should interview the mw' and ask the tough questions to determine if she is experienced and competent.  Often it is not hard to find additional and firsthand information from others on parenting groups and forums regarding these mw's statistics, skills, etc.  

Please do not be so quick to jump to conclusions about all illegal mw's as they face many obstacles in this country that are just ridiculous.  They risk fines, jail time, and their careers in the service of women and those they serve are incredibly grateful.
 

[Aleah]

You get what you pay for. Shop around some more- you may end up paying more. A price cannot be placed on the health of mom and babe or the experience of such a divine empowerment.

[AlexisT]

There are 3 CNMs based in the MD suburbs of DC, besides the 1 in Baltimore. Just FYI. I assume that as CNMs they are doing home births legally because the consequences of illegal practice for a CNM can be severe.

[Jaimee]

Originally Posted by AlexisT 

There are 3 CNMs based in the MD suburbs of DC, besides the 1 in Baltimore. Just FYI. I assume that as CNMs they are doing home births legally because the consequences of illegal practice for a CNM can be severe.

The first hb CNM I hired here in MD was not legal as she was not overseen by an OB and it was my understanding at that time that there was only one that actually was.  There are many CNM's that practice legally in hospitals around here, but do not attend hb's. If these CNM's you mention are overseen by OB's and attend homebirths then I stand corrected.  I have not heard of them nor has anyone that I have talked to, but I certainly would never profess to know everything about every midwife especially since I am not intimately connected with the DC hb community as I am with Baltimore's.    However, my point remains the same: illegal midwife does not automatically equal inexperienced or incompetent midwife. 

[CBEmomma]

I paid $2,700 for m homebirth + prenatal care with ds2. With ds1 I had a hospital birth (vaginal) and just the birth itself was around $10,000, that doesn't include prenatal care. Are you sure that price is everything, or is it just the birth without anything? If she has an epidural, vaccuum, etc. then they might start tacking on the price.

[jksmith]

Originally Posted by wzuur  

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.  

That info is also for the midwife, to know if there are any risk factors, and also to learn about you and connect, to be able to help more with labour support. The woman's state of mind is very important to a successful natural birth, so it is really important for midwives to know their clients. 

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.

Here in Ontario, Canada, where midwives are free, the government pays about $2000 per client to the midwife and $600 to the clinic for supplies and operations... which is WAY less than other care providers at about $75, 000 a year... and they are currently fighting for raise because that rate hasn't changed in 11 years

BUT, the government covers the insurance, which I understand can be $30-40,000 a year! So if the midwife you are talking about has to pay her insurance and run her business from that rate... it seems more than fair.

[themaypole]

Can anyone point me in the right direction of how to find a home birth midwife, in my area... southeastern MA.  I've already looked on the Mass Midwives Alliance website, and it just seems like a shot in the dark, going off a website.  i would love any personal recommendations if anyone has any out there :)  thank you!

[littlegreenlady]

Originally Posted by themaypole 

Can anyone point me in the right direction of how to find a home birth midwife, in my area... southeastern MA.  I've already looked on the Mass Midwives Alliance website, and it just seems like a shot in the dark, going off a website.  i would love any personal recommendations if anyone has any out there :)  thank you!

I recommend posting in the find your tribe forum for MA you will probably get more responses and feedback for your area.
 

[Jaimee]

Originally Posted by themaypole 

Can anyone point me in the right direction of how to find a home birth midwife, in my area... southeastern MA.  I've already looked on the Mass Midwives Alliance website, and it just seems like a shot in the dark, going off a website.  i would love any personal recommendations if anyone has any out there :)  thank you!

In addition to the finding your tribe section, locate your local attachment parenting and natural parenting groups.  Often all you have to do is search Yahoo groups, but there are also meetup and google groups and of course chapters of API and LLL.  Join or go to a meeting and just ask around... these people will know about all the options including illegal mw's.

ETA:  I found this GROUP in the southern shore of MA... I'm not sure if that is near you or not, but it's active and pretty big.  I'm sure they'd have some info.  You could also look into neighboring states if you're close to Providence, for example.

[nanasmom]

I did not have time to read thru all the responses but wanted to comment.  I believe the "normal and customary" fee here just for the OB is about $3500!  This is what insurance companies will pay because it is the normal and customary fee.  In addition to that you still have the hospital bill, anesthesiologist, etc so the fee for giving birth in a hospital is no way comparable to that of most midwives.  I had the exact opposite question - it bothered me that my HB midwife would only be paid $3500 when she was doing so much more than an average OB does in the hospital and if I did not have the whole expense of the hospital why couldn't the insurance company pay my midwife more?!?!

[rah0315]

I'm 16 weeks and have hired a HB midwife, I'm in Jacksonville FL. Total cost is $4000 plus $60-70 for the birth kit, and any extras like a birth pool. This includes a primary midwife doing all prenatal care, and postnatal plus postnatal baby care, second MW and back-up midwife if needed.

With my first I had a hospital birth with an epidural and pit which was around $13,000 not including prenatal care (we only paid $30 because of military insurance).

My HB midwife gives exceptional care, worth well beyond the $4000 she charges (she's available 24/7 by text or phone if I need her). We'll most likely be paying almost all of it out of pocket, but it is SO worth it. Also, my midwife had about 4 different payment plans and I'm sure she would have been willing to work with us if none of those had worked.

Honestly, I'd be willing to have my husband and I eat ramen noodles and canned veggies every day for 9 months if it meant getting the birth I wanted. Have you guys tried setting out a budget and maybe couponing or even bartering for other things like fresh veggies or produce from local growers?

Good luck, it just seems like you're being slightly close minded about exploring your options and blaming it on the midwives.

[weemom3]

I"m not trying to be judgmental here but I personally don't believe in the home birth. I have had 2 vaginal births with 2 excellent doctors and am happy that both of my sons are healthy. Had I not been in a hospital I could have lost one of them simply because i didn't have the medical tools necessary to save them. My youngest son came out so quickly that he had fluid in his lungs he was blue and didn't cry right away. Since I was waiting for his cry as my first son did this was a scary moment for us as they had to whisk him away to get him breathing. I don't believe that any should suffer the loss of a healthy infant due to a home birth. i would have been devastated had I lost either of my children. They are now 18 and 13 year old's. If money is an issue there are so many programs available for mom's and unborn children. Statewide programs to help individuals in need/ Medicaid. Never be too proud for help we all need each other and that is what those programs are for "those in need." If you make too much money to qualify then I say put it on the credit card,make payments or get a second job for the time being. Don't risk losing a perfectly full term or premature baby due to "the lack of tools available" in a home birth. Just saying...

[BubbleMa]

Originally Posted by weemom3 

I"m not trying to be judgmental here but I personally don't believe in the home birth. I have had 2 vaginal births with 2 excellent doctors and am happy that both of my sons are healthy. Had I not been in a hospital I could have lost one of them simply because i didn't have the medical tools necessary to save them. My youngest son came out so quickly that he had fluid in his lungs he was blue and didn't cry right away. Since I was waiting for his cry as my first son did this was a scary moment for us as they had to whisk him away to get him breathing. I don't believe that any should suffer the loss of a healthy infant due to a home birth. i would have been devastated had I lost either of my children. They are now 18 and 13 year old's. If money is an issue there are so many programs available for mom's and unborn children. Statewide programs to help individuals in need/ Medicaid. Never be too proud for help we all need each other and that is what those programs are for "those in need." If you make too much money to qualify then I say put it on the credit card,make payments or get a second job for the time being. Don't risk losing a perfectly full term or premature baby due to "the lack of tools available" in a home birth. Just saying...

I'm not sure why you're here if you don't "believe" in home birth.  How do you suppose the human species managed to avoid extinction before hospitals and doctors came along? 

[lunarlady]

If money is tIght you could try to find a student MW to assist you. With our first, we had a student MW and we just paid what we could as we went along. I think it ended up being about $1800 all told. The student did all but one of the prenatals, came to the birth right away and called her supervisor in when I was close, and did the postnatals. She was cheaper because it was part of her training, but I was fine because the supervising, experienced MW was there for the birth.

You can do the same for a doula. Find someone who is interested in becoming a doula, and in training to be one, and you may find one who will do it for free of cheaply just to gain experience.

As for the "usual cost" of MW, you have to know that many take only a few births each month (like 2-3). So if there is two per month, she is making $8000 a month, or $96000 a year. Take away taxes, overhead costs, liscencing fees, etc. And you will see that it is actually a fair salary for someone who works 24/7/365.