Home birth in San Fran/San Fran Bay Area

[dynnyrne]

Hi everyone :)

My husband and I are considering moving to San Francisco or the San Francisco Bay area next year and I wanted to find out more about the home birth scene there.

We're currently living in Seattle but we're from Australia and had our last baby at home in Australia so we don't know the "system" very well in the US... and I know it varies a lot by state anyway.  We would like to have another baby in about 18 months-2 years so we need to know if we'd be able to birth the way we want to in the San Fran area, or if we should just move back to Australia instead.

I want a midwife who would be prepared to support us if baby is a bit "high risk" such a breech birth, and I would be about 38 at the time.  I also want home visits for my antenatal and postnatal care and I don't want much testing (such as GBS, gestational diabetes, doppler checks).

We would have a group health plan with maternity cover but I'd be prepared to have a "freebirth" with an unregistered midwife if it helped us get the care we want.  Does anyone know if there are midwives giving this type of care in the area?  How much would it roughly cost out of pocket?  If we need to transfer, how would we expect to be received at the hospital?  If we have a freebirth with an unregistered midwife, would we run into problems using our insurance for hospital care if we need to transfer?

Thanks!!

[cristeen]

Lots of MWs in the area.  Lots.  Finding one to do breech is tougher, but still possible.  If this is a big concern, it's a question I would ask on the phone.  The one I have this pg does not do them, but the one I used with my DS does.  Finding health insurance that will pay for it can be tougher, but is still possible. 

No testing, home visits, and the like is actually the norm here.  Tests are offered, but it's up to mama to choose which ones she wants to do - there are a few MWs who do require some tests, but most do not - you might have to sign a waiver stating you declined the test, but that's pretty standard.  Very few HB MWs have offices (rent is too $$).  I haven't had a single VE until I was in advanced labor, and no doppler until active labor... pushing stage, actually.  Most use fetascopes so long as you can hold still for it. 

Out of pocket, costs run in the $4-5K range.  Most hospitals are fine with HB transfers because it is so prevalent here. 

And I doubt you'd find an "unregistered (unlicensed)" MW around here, there's just too much competition.  The state of CA does license MWs (LM), which is additional on top of the NARM (CPM) standard.  So you might occasionally find a CPM who has not finished the LM yet, but they're usually working with an LM in the interim for legal purposes.  And we even have a few CNMs that do HB. 

Between 3 pregnancies, I have interviewed well over a dozen MWs (3 with the first pg, 8 with the 2nd and 8 with the 3rd), and that's just the ones that service my part of this area.  This is a list of Bay Area midwives - each one should have a note as to which part of the bay she covers.  It's definitely not a comprehensive list, but it's a great place to start. 

HTH

[dynnyrne]

Thank you so much!  That helps heaps!!  And all great news.

Can I ask why you changed MWs for each birth?  Just wondering if there is an issue with the MWs in the area.

We would most likely just decide on our insurance by the one my husband's work offers, so I guess then we're locked into MWs who accept that type of insurance?  Is the $4-5K cost based on what it costs after insurance, or without insurance?

Thanks for your help.  I'll look at that list now :)

[cristeen]

My first wound up being a hospital birth, and I discovered I have some issues with authority figures during labor with my 2nd, so I picked someone less matronly, and more contemporary (my own age) this time around. 

Around here, there are very few midwives who "accept" insurance.  It's more whether your insurance is willing to pay for a MW (OOH birth, hospital birth with MW is usually covered).  And then how much they're willing to pay.  With the insurance I have at the moment, HBMWs are out of network, and they only pay 50% over my deductible amount.  I have a $3K deductible, so I might see 50% of the last $1K, if I'm lucky.  I do have an HSA though, and I can pay for it out of there, so it's not entirely out of pocket.  You just have to remember, and this is the really important thing, that regardless of your insurance, you have to pay the full amount out of pocket before the birth (usually by 36 weeks).  If insurance is going to pay, it will be after the fact, and they'll reimburse you for whatever piece they feel like. 

[dynnyrne]

Thank you so much.  You've been such a huge help.  It sounds sort of similar to Australia in that there you pretty much can't get any insurance coverage for a homebirth.  Our homebirth there cost about $5K, but that was for two midwives attending.

I had heard birth in the US cost about $20K so I was kind of freaking out about what you do if insurance doesn't cover it!  I really should work out how the HSA thingo works.  The american health care system confuses the heck out of me!!

[cristeen]

Originally Posted by dynnyrne 

Thank you so much.  You've been such a huge help.  It sounds sort of similar to Australia in that there you pretty much can't get any insurance coverage for a homebirth.  Our homebirth there cost about $5K, but that was for two midwives attending.

I had heard birth in the US cost about $20K so I was kind of freaking out about what you do if insurance doesn't cover it!  I really should work out how the HSA thingo works.  The american health care system confuses the heck out of me!!

Most MWs will work in teams or have a backup available.  At the minimum they will have an apprentice or assistant at the birth.  My MW last time had an apprentice at my birth, and this time my MW hires a "secondary" MW for the birth.  So there's usually at least 2 people there. 

And $20K is pretty accurate for a hospital birth.  Thankfully I didn't have to pay for our hospital birth, since it was fully covered, but I expect it would have been in that neighborhood. 

[Thyme Mama]

I have lived in California my entire life, and northern Cali for the past 19 years. I have had 3 homebirths. Most midwives charge somewhere around $3000 in Northern California, with the Bay area being a bit higher, around $3500-4000.
 

The bad news is, it is illegal for a midwife to attend a breech birth or twin birth in California :( Typically in California, only "low-risk" women are seen by homebirth midwives. You would have to find an underground midwife to attend a "high-risk" birth, and one with breech birth/twin birth experience can be very hard to find. It is a weird homebirth climate here.

[dovemama]

I had no idea it was illegal to breech birth!!! Wow, I am sort of shocked. The midwives and I haven't even touched on this yet!

We live smack dab in the bay and our midwives are charging 5k. 

[pokeyAC]

I am not sure that it is illegal for a midwife to attend a twin or breech birth at home.  I found that there was some type of proposal to change the law in 2005, but I don't see if it was passed. In the standards & practices for licensed midwives in CA, it lists multiples and breech as reasons to refer the client to a physician.  On MDC I found a posting that said midwifes would have to refer clients to physicians but that they could refuse kind of like informed consent or informed refusal.  It seems that there are midwives who will deliver twins, but you may have to look around as not all of them do.  I would talk to some midwives first to find out.

[thegoodearth]

Originally Posted by Thyme Mama 

I have lived in California my entire life, and northern Cali for the past 19 years. I have had 3 homebirths. Most midwives charge somewhere around $3000 in Northern California, with the Bay area being a bit higher, around $3500-4000.
 

The bad news is, it is illegal for a midwife to attend a breech birth or twin birth in California :( Typically in California, only "low-risk" women are seen by homebirth midwives. You would have to find an underground midwife to attend a "high-risk" birth, and one with breech birth/twin birth experience can be very hard to find. It is a weird homebirth climate here.

I second the bolded. I had a baby with a midwife in Santa Cruz in 2010 and the midwives I interviewed all made it clear that it was illegal for them to attend breech or twin births in California. They all were either CPMs or CNMs and we interviewed 6. I believe ours cost $4200. 

As a side note -- we are pregnant again and planning a homebirth in Portland, OR. Here licensed mw's can attend breech and twin births. I was shocked by this at first b/c of what I learned the first time around in California.

[Thyme Mama]

Originally Posted by pokeycip 

I am not sure that it is illegal for a midwife to attend a twin or breech birth at home.  I found that there was some type of proposal to change the law in 2005, but I don't see if it was passed. In the standards & practices for licensed midwives in CA, it lists multiples and breech as reasons to refer the client to a physician.  On MDC I found a posting that said midwifes would have to refer clients to physicians but that they could refuse kind of like informed consent or informed refusal.  It seems that there are midwives who will deliver twins, but you may have to look around as not all of them do.  I would talk to some midwives first to find out.

If the midwives diagnose twins, or you go into labor and they know you have a breech baby, by law they must transfer your care. They will lose their license if they knowingly deliver twins or a breech birth. Surprise twins or breech = okay. Prior knowledge of twins or breech = loss of license.

Originally Posted by thegoodearth 

I second the bolded. I had a baby with a midwife in Santa Cruz in 2010 and the midwives I interviewed all made it clear that it was illegal for them to attend breech or twin births in California. They all were either CPMs or CNMs and we interviewed 6. I believe ours cost $4200. 

As a side note -- we are pregnant again and planning a homebirth in Portland, OR. Here licensed mw's can attend breech and twin births. I was shocked by this at first b/c of what I learned the first time around in California.

Exactly. Glad to hear it's not illegal in Oregon!

[dynnyrne]

Thanks so much for everyone's replies!  Sorry it's taken me a long time to come back and post.  I've been pondering it all and I still can't decide if th illegal births is a deal breaker for the move.  There are so many benefits to us moving, and we're still unsure we'll have another so it's hard to know how much importance to place on a type of birth that may not even happen.

I think I'm nervous about birthing in the states full stop.  I saw someone's home birth photos and the midwife was wearing gloves and suctioning the baby after birth.  It looked so medicalized.  And I'm plan terrified of going to hospital here.  The amount of mother/baby separation I see on TV births, and all the poking and prodding for the little newborn baby.  Is it always like that?  Is it a real fight to get everyone to leave the baby alone?  How about delayed cord clamping for example?