Picking a provider.....cost vs. 'dream birth'

[WaitingForKiddos]

I'm needing some support I think...

I'm in search of a VBAC. I have a 'heart-shaped' uterus making it more likley that I'll have a term breech baby (as was my DS). I'm in a very unfriendly place when it comes to VBACs.

I have a few choices...

-OB who does home/birthcenter births. He's very skilled. Passionate about birthing choices. He's knowledgable about breech births. Great with VBACs. Uses a MW assistant. Cost  for all prenatal care and birth about $7000 to be paid for 100% by us. I feel like this could be a dream birth. Heck, it's like I'd hardly need a birth plan this OB and I are so on the same page.

-OB who does hospital VBACs. Not at all breech friendly. Hospital has so/so reviews by other VBAC moms. Is supportative of a very monitored VBAC. Due to insurance insanity it will be a fight to get him covered as 'in network'. However, if approved, cost of birth about $200 + $10 per prenatal exam.

-OB who ins't VBAC friendly but will refer me to UCLA for birth. Unknown if UCLA is BreechVBAC friendly. Prenatal care would be with VBAC unfriendly OB who is defeating at visits. ("You'll keep having breech babies and never VBAC anyways.") Cost about $100 + $10 per prenatal exam.

-MW who is VBAC friendly. Not breech friendly. Homebirth only. Cost for prenatals & birth about $3000. Additional costs of $100-500 for u/s, labs, etc.



So, at what point do you let price dictate your birth. In this case it seems like I'm going to be paying a premium for the ability to not be easily risked-out due to presentation. It really shook me to be risked out with DS so I'm thinking that this is important to me. The whole VBAC thing makes it beyond a laboring mama simply making her birth as she wants it. I don't want to walk in to a hospital as a combative patient and I'm not sure if DH or I could handle that in the midst of labor.

Financially, we are able but man, it's going to be really tough. We dont have the money laying around so it will be on a credit card or we'll be really scrimping every month.

WWYD? Mamas who got a dream birth and those who wish they did.....what price would you put on it?

Someone tell me that homebirths really are the empowering amazing thing I know they are.

[SimpleLove]

Just have to mention that putting it on credit card means you're not financially able.

I'm in a somewhat similar position as you and went with cheapest option, will be at a hospital, and using an OB who is atleast open to VBAC (though not exactly pro-VBAC!). I'm sure you have a good amount of in-network OBs to choose from, one of them has to be somewhat open to it.

[WaitingForKiddos]

Sadly, there is only one hospital within an hour of our home that allows VBACs, and at that hospital there are two docs who allow them. Both only take PPO insurance and we have a HMO. Attempts to have one of these OBs be considered as 'in network' got my insurance to refuse any payout for any VBAC anywhere. I know I can fight this, I'm just not sure I'm up for fighting a big insurance company while pregnant and being a mom to a toddler.

I figure with the credit card it would be paid off in a year. So, no, we can't afford it right now, but I think we could pay towards it in a decent amount of time.

[Plummeting]

I'm sorry you're in this position! I would find out if UCLA is VBAC friendly before making a decision. If it doesn't sound like what you want and it was likely you'd get the VBAC at the birth center, I, personally, would be willing to pay for the care at the birth center, and I think it's FINE to use a credit card to pay for it and it does NOT mean that you're not financially able. That's what credit cards are for. I say that as someone who has zero debt and plenty of money in the bank to survive a few months with no pay, so it's not like I'm in debt up to my eyeballs. It's just that I've been through times in my life in which I used credit and I don't feel bad about it at all, and it didn't stop me from being a responsible adult, saving money, etc., etc. The only problem is that I don't know how likely you'd be to end up with a repeat cesarean anyway. If there was a high likelihood of that, I wouldn't spend the money. If the risk was low, I'd go for it. I don't know enough about your situation to know how likely you'd be to get another c-sec anyway, kwim? I hope you're able to come to a decision that you are satisfied with. Good luck!
 

Originally Posted by SimpleLove 

Just have to mention that putting it on credit card means you're not financially able.

That's your opinion of credit and the definition of 'financially able', not everyone's. Some people believe credit is fine, and the OP did not ask for us to judge whether or not we thought she was able to afford something. The fact that you are so quick to state that you went with "the cheapest option" suggests that you have certain values about money and how it should be spent that not everyone else shares. Some people would not make a decision like this based on the price, if they felt they could afford it. Additionally, there does not "have" to be an OB open to what the OP is wanting. Perhaps they're easy to find where you are, but that is NOT the case everywhere. In some places, a woman who wants to VBAC will drive HOURS to find an OB or hospital willing to do it. You're just wrong to state that there has to be someone who will do it.

[Just1More]

I'd probably pay, too.  But, what if you have a csection?  Will you have to pay for that out of pocket, too?  Or will your insurance cover it even if you go with the OB you have to pay 7000 for?

[parsley]

I wouldn't choose to go with a provider where I would have to pay the whole cost out of pocket.  Especially not $7000!

I also had a c-section for breech baby with my DD.  And, plan on a VBAC with this baby.  So, I am coming from a similar position as you.  I also hated having a c-section and don't want to have it happen again. 

That said, I don't think I could stand to spend that much money for what amounts to a few weeks of my life (birth + recovery time)...  (and before anyone starts hounding me with arguments of just how bad a c-section is... I know.)  I just feel like I would want to save the money to be able to enjoy and/or provide for my child during it's whole life not just for it's birth. 

And, I'm in a position where I could take the money from savings (I wouldn't have much left but I could take it out) and I still wouldn't spend it. 

That said, I wouldn't go with the VBAC unfriendly doctor with whom everything is going to be a fight and a struggle.  Interventions start happening way before those last few weeks and, for me anyway, that negative attitude really contributed toward my first c-section and my lousy recovery. 

Good luck. 

[LiLStar]

I'm wondering if there was an option as good as the $7000 one... but perhaps a couple grand less?! 7000 is pretty high for OOP for a home birth. There are traveling midwives.. and you have to pay their travel expenses in addition to the birth fee, but i think it would still cost much less.

[rebirth]

I would hire a traveling midwife.

[AbbieB]

Out of your options, and given that you are very likely to have a term breech birth, the only real option I see that gives you a shot at a VBAC is paying the $7000. There is no way I would be comfortable birthing a breech baby with someone that was not comfortable, confident, and trained at breech birth.

We are in a very similar boat financially. We are scraping every spare cent to pay to safely birth where we want and with who we want. There are other options, right down to free, but my birth experience does matter, to me and to my babe. There is no way I will birth with someone who I did not feel was safe, who I did not trust, or who did not respect my right to informed consent (meaning I can say NO.)

[Just1More]

I have no idea what their fees are, or if it would be at all feasible...but, what about the "Farm" in Tennessee?

[WaitingForKiddos]

I thought of The Farm too. We have a 1 year old who would need to travel with us and Dh's job isn't great a long vacations so it would mean me going alon until I had the baby...then flying all of us home. Sounds kinda' daunting.




Thanks for the replies!! We've decided on the OB who does homebirths. I think this will be a great experience!!!! I have to admit, after really thinking I'd be delivering in a hospital, the idea of a big ol' birthing tub in my living room makes me giddy with excitment!!!

[SBradbury]

Glad you have come to peace with a decision. Working on good positioning early on (much earlier than what would even be considered for most) might lessen your chance of a breech birth. While it is obviously no guarantee, if you can get baby head down before he or she grows big enough to be confined by septum, he/she might be 'stuck' in a head down position. For women who don't know that the heart shape is an issue (often first baby with no reason to consider) positioning isn't considered an issue until too late (for this situation). Sounds like you have a provider who is supportive either way, just thought I would throw that information out there. :) 

[MarineWife]

i paid completely out-of-pocket for my homebirth MW twice even though i could have gotten 100% coverage with an OB in a hospital. I was doing VBACs #2 and #3. I had VBAC #1 in a hospital. It was definitely worth it to me to pay to get the support and birth I needed. It only cost me $2800 for the first homebirth and $3250 for the second, so nowhere near the $7000 you are talking about if your baby is breech.

Although having to use credit cards does mean that, technically, you are not financially able to pay for it, I would probably do that, too, because it's that important to me. (Assuming it wouldn't make you homeless or something extreme like that.) I'm pretty good at paying off CCs. I pay way over the minimum if i don't pay it in full every month and i stop using them if i'm carrying a balance that i can't pay off all at once.

i'd check into all the options more. would UCLA be supportive of a VBAC/breech VBAC. could you start with the MW assuming your baby won't be breech with the option to switch to the breech VBAC supportive OB at a reduced cost if needed? depending on why that OB isn't covered, is there any possibility with your insurance that you could file your own claims and get partial reimbursement? or switch to the more supportive hospital OB if needed.

i'm very big on planning for emergency but assuming everything will be fine. I don't see how anyone can 100% guarantee that all of your babies would definitely be breech. With that in mind, I'd at least start out with the most positive and supportive of a homebirth VBAC, if that's your ideal, with contingency plans if that becomes unavailable.

[Kedrosami]

What MarineWife said! And if it comes down to it, yes, to ME it would be totally worth it to pay out of pocket, even if it means being in debt for a year or years. To me, it is so important that if there was any way to make it work, I'd do it.

I've had 2 dream homebirths and yes, it is everything you imagine it to be and then some! I had to pay a lot of money for both of my births (no $7000 but still a lot!) and I have no regrets. I feel that both of my babies got the gentle entrance into the world that they deserved, and I started off motherhood (and repeat motherhood) on the right foot from the beginning. I can't even tell you how amazing and empowering and gratifying it is. I would have paid $7000 if I had to.

It's not as important to most people, which I don't get because it's SO important to me, but IMO, a peaceful birth with competent, respectful caregivers is worth whatever it costs.

[L'lee]

I wouldn't give up and assume that you won't be able to get any insurance coverage, whether it's before or as a reimbursement afterwards. Some states protect your right to choose a provider, or to have a homebirth or attempt a VBAC (and get an in-network exception for someone who provides services not provided by anyone in your network). I don't know enough about CA law or your specific situation/HMO, but I think it's worth looking into. Even if you've gotten a no so far from the insurance company, that doesn't necessarily have to be a no, especially when you're working with a licensed professional - a DR at that! You can make a good argument that you're saving them a lot of money even if they pay the full fee for the DR. Make sure to write down the date/time/name of anyone you talk to and details about what they say. There are companies that work to get reimbursement for midwives that might be able to help, one I talked to was Larsen billing service - they had tons of advice (for free) when I was asking about their service for parents trying to get reimbursed.