cost of homebirth midwives? « Back to Group Discussions

[pastormama]

I'm just curious what others are paying for their homebirths.  I know a lot depends on your area of the country, their level of certification, etc.

I'm in urban Nashville, and my three midwives are CPMs (we have a state certification program).  They charge $3700 for the whole thing (prenatal/birth/postnatal visits), but I have to pay extra for any labs/ultrasounds/supplies for the birth.  They don't require a doula or any assistance.  

Insurance will covers the labs and all, still waiting to see if they will accept the bill for birth . . . fingers crossed!  

How does that stack up to other experiences?

[PhilsBabyMama]

I am seeing a CPM and since she is not licensed, it is much cheaper than I expected. $25 per prenatal visit, $50 birth kit, $900 for the birth and $90 for her birth assistant. (Who is a midwife in training and almost ready to go out on her own.) My insurance obviously will not cover any of it, but I was seen at an OB practice that was covered for the lab work and the anatomy scan for the first half of my pregnancy. In Alaska, I didn't pay out of pocket for anything (the husband and I weren't married at the time so the Army was not paying and I'd been booted from my parents insurance when I had to withdraw from school due to illness. Gotta love that.) because their Medicaid was amazing and covered out of hospital births and midwives. The midwives there were CPM/DEMs and the state laws were much more midwife friendly than they are here in New York.

[Loogiejane]

My MW's global fee is $12,000. She is a CNM with 30 yrs experience combo working in hospital l+d as a nurse, then as a MW in the hospital and now I believe has been a homebirth MW for 15ish yrs. She is one of the top homebirth MW's in NYC and I booked her when I was 7 or 8 weeks for fear of her getting all booked for my EDD. She's a busy woman. She works 5 months, takes off a full month, works 5 months, takes off a full month. Some people like her style, some don't. I do. She was in the movie The Business of Being Born. Not that it matters but I think it did something to spread her name a bit and make her busier. After that movie came out homebirth became more popular in general in NYC.

Anyway, I digress. Her fee is $12,000. Some insurance thingy she has pays $4500 of that so the responsibility on the patient is $7,500 not including any birth kit or tub or doula. I hope our insurance covers a large chunk of the $7,500. Otherwise we're up sh*t's creek. We're looking at about $6,000 of coverage if all goes well so we'll have an out of pocket balance of $1,500. We've been paying our estimated balance off in installments since my MW asks it gets paid before the birth. That rubs me the wrong way a little bit, that we're paying for a birth that hasn't even happened yet but I chose to not make a stink over it. If my insurance "negotiated" I'd like to think they'll pay more but they're strict on no negotiations. My MW does require a doula for first timers so we're looking at $1000-$1200 there. 

So our estimated costs are:

$1500 to MW

$1000/$1200 doula

$300 placenta encapsulation

$500? birthing tub....could be more with delivery? no idea, only briefly looked into it

Birth supplies, no idea how much $$

Given that we live off a single, very modest income by NYC standards, the above costs are definitely a lot for us. I am hoping DH gets a bonus in May otherwise it's just going to come out of our modest savings. 

I just gave you a lot of info 

[pastormama]

We've been paying our estimated balance off in installments since my MW asks it gets paid before the birth. That rubs me the wrong way a little bit, that we're paying for a birth that hasn't even happened yet but I chose to not make a stink over it. 

Ah, yes - good point.  I forgot to mention this too.  My midwives request that the balance be paid by 36 weeks, and then whatever you receive from insurance as a reimbursement.  This makes me less than confident that we will ever see any of that money again!!  I've put down a $500 deposit but have yet to make any more payments because I'm a little wary that something will happen and I will need to switch to OB care later on, and I would only get a pro-rated return on the money.  Feels kind of like I'm jinxing my homebirth, but also feels more practical than just shelling out left and right.  This is totally from savings for us, so I'm being very conservative about it. 

[Trisha Kalous]

Originally Posted by Loogiejane 

So our estimated costs are:

$1500 to MW

$1000/$1200 doula

$300 placenta encapsulation

$500? birthing tub....could be more with delivery? no idea, only briefly looked into it

Birth supplies, no idea how much $$

You don't need to pay that much for a birthing tub!! You can BUY your own for much less. Check out http://www.yourwaterbirth.com/super-deals-2013-new-year-super-deal-p-2410.html

They have complete kits starting at $182, on special now! (cheaper if you don't need all the items that's in the kit) If your midwife has a coupon code for them, you can even save an additional 10%. Alternatively you can buy an inflatable kiddie pool and a $2 sink attachment/adapter and a garden hose and use that for your birth pool. We did that with DD and it worked just fine. Just make sure that the sides are tall enough that you can put enough water in them to cover your belly. An inflatable bottom is wonderful too.

[SteeleTig]

I'm also in NYC, my midwife uses Loogiejane's as her backup midwife (we've privately chatted so I know her midwife). My midwife's global fee is 10k, she "forgives" $2500 if insurance doesn't cover the entire amount, so then the fee is $7500. We're hoping most of it is covered, we'll see. That includes all prenatal visits, the birth and postnatal visits. My best friend is a homebirth midwife here in NYC and will be acting as my doula so she's free. Not sure how much the birth supplies will cost, haven't looked into it yet. I should ask my midwife for her list.

[CoBabyMaker]

I was planning a homebirth last time so I thought I would share, hopefully I am remembering numbers correctly.  Our midwife is a CPM and licensed in our neighboring state- our state does not have licensing and she lives in the neighboring state, just over the border.  I believe she and one other midwife are about the only options in our area.  If I recall correctly her fees were about $3400, I think that was with a discount for paying in full prior to birth.  I also remember that she has a discount for repeat clients ( I think $2800).  This includes everything but a few things for the birth kit that totaled less than $50.  At the time she had an apprentice as well but there was no fee for her.  She did not require a doula and in fact had someone who is not a professional doula that just loves to support where she can.  She came during my labor and I was never charged a fee for that.  I also know that my midwife was willing to work with people if they truly couldn't afford it.  A friend of mine paid part of her fee and did some office type work (organizing some info and typing things up from home) to cover the rest of it. 

[SteeleTig]

Loogiejane, I found a site online that lists both of our midwives birth kits, in case you haven't seen it yet. http://www.birthwithlove.com/categories/birthkit.asp#M

[berrymama]

Wow! Those NYC costs are a bit mindblowing!

Mine is $2900 if you pay out of pocket (I believe it is $3500 for insurance), with a discount to $2400 if you have had a previous birth with her and covers everything except ultrasound and a few births supplies (< $50 worth). She has a tub that is available for use, but the client needs to provide their own hose/liner. She is a CNM, former hospital RN before that. She has an assistant that works with her, either an RN or a midwife student (free to us), so there are at least 2 of them present for the birth. ....Except that they didn't make it to my birth last time because it went so fast.

[SteeleTig]

It is a big difference, but the cost of living here is vastly different from WI too so you have to take that into consideration.

My midwife doesn't want any money before the birth and until after her billing person has dealt with insurance. She also does a payment plan if you have to pay anything out of pocket. 

[Lynann]

I can't believe how expensive NY home birth midwives are. I know that cost of living is expensive there, but I also know that cost of living is pretty expensive down here in South Florida too and the most expensive price I've seen is $5,500.

My first midwife is a LM with 10 years of experience and she charged $4,300 of which we paid $1,700 and insurance paid the rest. All the labs etc were covered by insurance 100%. The birth kit was about $70 and her assistant's fee came out of the money she charged, so was not additional. She also provided child birth education classes too.

My second midwife is a CNM with 15 years of experience. She spent 5 years as a CNM in a hospital, then worked at a birthing center (was on the TV show House of Babies) before going to exclusively home birth. She is also a Physician Assistant and can do more than just midwifery care. She charged $4,500 of which we ended up paying $1900 after fighting with the insurance company for several months. (We decided she deserves her pay and went ahead and paid what was left of the balance rather than make her wait for the insurance company to finally pay up.) She has a birth pool she hires out for $100 and the birth kit cost us about $75.

This time we're planning on a freebirth and I've decided I want to try water birth this time, since nobody else will be here and I won't have to worry about modesty & comfort at the same time. We're planning on buying an Aquaborn birth pool, which will cost us $205, and then whatever fixings we need for the faucet and a drinking water hose pipe.

[alaskanmomma]

I have state insurance, so they are paying everything...but my midwife charges $3200, doesn't require a doula or anything, and can attend homebirths or a birth center birth at all but one of the birth centers around here. On top of her fees, you'd also be paying however much bloodwork and ultrasounds are, plus $100 or so for the birth kit(I have to pay this portion out of pocket). I live in Anchorage, AK.

[PhilsBabyMama]

Man, I miss Alaska! Other states should take notes. Loved their Denali Kid Care and that it made lots of different birthing options available. My son was born in Fairbanks. His birth story is in a book put out by Bali Birthing in Anchorage called Birthing In Alaska: A Modern Woman's Guide. There was such an awesome birth community up there. It's strange going from that to here in New York where your options are so limited.

[adventuregirl]

I am paying $3500 for everything except the birth kit ($60) and will have to get my own tub (haven't started researching this yet, but thanks Trish & Lyn for the links!). Although if we figure out what my insurance will cover, I won't have to pay in full, but just the piece I'd have to pay anyway (deductibles, etc). Insurance is such a freakin hassle! I looked into several mw's around here and $3200-3800 is about the going rate. My mw is a CPM, RM, LM and has 40 yrs experience, with the first few of them being in hospital l&d.

[Loogiejane]

is there another thread about birthing tubs? i have questions....

[Loogiejane]

Originally Posted by Lynann 

I can't believe how expensive NY home birth midwives are. I know that cost of living is expensive there, but I also know that cost of living is pretty expensive down here in South Florida too and the most expensive price I've seen is $5,500.

It's a combination of cost factors. We also have high taxes in NY. A third of DH's salary goes to income tax and it makes a difference. I believe Florida has no income tax right? Maybe that's a contributing factor to the differing costs, who knows. 

[Loogiejane]

Originally Posted by Trisha Kalous 

You don't need to pay that much for a birthing tub!! You can BUY your own for much less. Check out http://www.yourwaterbirth.com/super-deals-2013-new-year-super-deal-p-2410.html

They have complete kits starting at $182, on special now! (cheaper if you don't need all the items that's in the kit) If your midwife has a coupon code for them, you can even save an additional 10%. Alternatively you can buy an inflatable kiddie pool and a $2 sink attachment/adapter and a garden hose and use that for your birth pool. We did that with DD and it worked just fine. Just make sure that the sides are tall enough that you can put enough water in them to cover your belly. An inflatable bottom is wonderful too.

Maybe I had the high cost in my head because I've only looked into the Aqua Doula. For some reason I'm drawn to that style more than the inflatable. It's also the style my sister used at her homebirths so I'm familiar with it. But it surely does seem more expensive. The round trip shipping alone is $120. 

We don't have an ounce of storage space to buy a pool of any kind. We live in a small NYC apartment and I don't want to ask my inlaws to store it for us. My parents will be moving soon and can't store things for me anymore. 

Do those inflatable pools have heaters in them? I feel like the sound of plastic rubbing against things would annoy me in labor :P

[Loogiejane]

Originally Posted by SteeleTig 

Loogiejane, I found a site online that lists both of our midwives birth kits, in case you haven't seen it yet. http://www.birthwithlove.com/categories/birthkit.asp#M

Thanks Steeletig! Oof, I wonder if I really have to get ALL that stuff. 

[aHikaru]

out here in so cal it's $5,500, which is the reason why I can't have a homebirth :( my insurance covers an entire hospital birth and most of a home birth, but we can't afford to pay the midwife first and get reimbursed later, so that's the only reason why. 

[Lynann]

LoogieJane, wow can't believe your DH has to pay so much income tax. That would certainly push things up considerably. Here in Florida we don't have a State income tax, but still pay the Federal one. Its one of the few financial benefits to living here (tourist/resort tax makes up for the state income tax)

One of the advantages I see with the inflatable pool is that the water naturally stays warm/hot for a lot longer than a birth tub that has solid sides and the one we've picked also has an inflatable lid, so it acts like a vacuum flask while the lid is on. That way we can fill it with hot water when labor first starts and then put the lid on, and it'll be ready to go whenever I feel like getting into it. I don't think I ever heard of anyone having issues with the texture of the tub, and I don't think it would be much different from the feel of the disposable liner of a rental tub. The aquadoula does seem very expensive, especially when you can completely purchase other birth tubs for the cost of shipping alone, and then if you go much beyond your EDD there is the possibility of the additional $75 per week for each additional week past the original 3 week rental. Considering that a term baby has a 5 week window around the EDD (37-42) that could easily start to add up to a lot more above the original rental fee. I'd certainly keep an open mind and have a look at other kinds of birth tubs, especially when you are already paying out so much more money than most of us are.

Personally I'd want to make sure my tub was ready to go before I hit 37 weeks just in case the baby comes towards the beginning of that window, and you'd have to figure in keeping it until after 42 weeks just in case the baby is one of those who likes to wait a little longer (my 2 boys both came around the 41 week mark), and then calculate in a few days to get organized enough to repack the rental and make the call to have it picked up. That is potentially a 6 week rental which would entail and extra $225 on top of the rental fee. If you buy a cheaper tub and use a liner you could resell and make a lot of that money back, plus you wouldn't have to worry about how long you had it for or how you are going to store it. Just something to think about.