Thanks Steeletig! Oof, I wonder if I really have to get ALL that stuff.
The top portion that doesn't list individual prices but is all grouped together for one price is the things she wants for sure, the bottom stuff is stuff she thinks are good but are optional.
I'm in MA, and the CPM we were going to go with charged $3400 (not including labs/ultrasounds/birth kit, but did include her assistant, and she did not require a doula) if paid by 28 weeks, and $3600 if paid by 36 weeks. She required payment before birth, and if insurance covered we would have to pay her anything that went above what we paid (billing for things individually would add up to more $ than her global fee, so we would get our 34/3600 back, or whatever was covered, but if insurance reimbursed 4000, we would have to give her the difference). But our insurance won't cover CPM's, only CNM's, who can't do homebirths here, so we won't be able to go with the HB :(
I'm in MA, and the CPM we were going to go with charged $3400 (not including labs/ultrasounds/birth kit, but did include her assistant, and she did not require a doula) if paid by 28 weeks, and $3600 if paid by 36 weeks. She required payment before birth, and if insurance covered we would have to pay her anything that went above what we paid (billing for things individually would add up to more $ than her global fee, so we would get our 34/3600 back, or whatever was covered, but if insurance reimbursed 4000, we would have to give her the difference). But our insurance won't cover CPM's, only CNM's, who can't do homebirths here, so we won't be able to go with the HB :(
I'm in MA too, and ran into the same problem, which broke my heart a little since I've always wanted a homebirth. My husband is out of work at the moment, though, and the financial gamble was just too great, so we're going with a birthing center instead. Were you able to find somewhere to birth that you feel good about?
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)
I'm pretty sure everyone pays the same % of taxes. It kind of sucks but I'm so used to it.
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)
I'm pretty sure everyone pays the same % of taxes. It kind of sucks but I'm so used to it.
I'm in MA too, and ran into the same problem, which broke my heart a little since I've always wanted a homebirth. My husband is out of work at the moment, though, and the financial gamble was just too great, so we're going with a birthing center instead. Were you able to find somewhere to birth that you feel good about?
The community hospital nearest me actually recently had an overhaul and is very natural birth friendly now, so I feel pretty good about it as far as hospital births go. I'm most worried about feeling out of my element, and then dealing with the pediatricians there than I am worried about them pushing induction/other interventions on me. They also have a tub there so I can do a water birth as well. I was nervous about going to the birth center because my MW said that because of regulations they have to be more liability based than evidence based and it would be better to find a practice/hospital that i was comfortable with than having to deal with a premature transfer to an unknown hospital with an unknown staff "just in case".
I have also heard really good things about the MW who works out of Tobey Hospital (I can't remember the rules about mentioning names, etc)...but it's just too far of a drive for me to be comfortable going there. I'm happy so far with my care...are you?? I would love to hear about your experience there!
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.
you can buy one and then re sell it to avoid paying a weekly charge for renting it too long, I'm sure there's a market for it....
The community hospital nearest me actually recently had an overhaul and is very natural birth friendly now, so I feel pretty good about it as far as hospital births go. I'm most worried about feeling out of my element, and then dealing with the pediatricians there than I am worried about them pushing induction/other interventions on me. They also have a tub there so I can do a water birth as well. I was nervous about going to the birth center because my MW said that because of regulations they have to be more liability based than evidence based and it would be better to find a practice/hospital that i was comfortable with than having to deal with a premature transfer to an unknown hospital with an unknown staff "just in case".
I have also heard really good things about the MW who works out of Tobey Hospital (I can't remember the rules about mentioning names, etc)...but it's just too far of a drive for me to be comfortable going there. I'm happy so far with my care...are you?? I would love to hear about your experience there!
So far, I am quite happy! The birthing center is affiliated with Cambridge Hospital, so there's always that backup (which is mainly for the peace of mind of my naysayers - I'm not concerned). The midwife I've been seeing for my prenatal visits has been great, but since I'm not guaranteed to have her for labor, I've been looking for a doula as well. The birth center has a staff of doulas, but they tend to work first with women who don't have as much of a support system (and again - you don't know who you're going to get). I have heard things about the transfer rate being high, but I'm hoping for the best. I've talked to a lot of women who birthed there are loved it.
I know what you mean about feeling out of your element, though - even though the birth center is set up like a home (I think it's actually in a converted old house), it still won't be MY home, so it still won't be perfectly ideal.
So far, I am quite happy! The birthing center is affiliated with Cambridge Hospital, so there's always that backup (which is mainly for the peace of mind of my naysayers - I'm not concerned). The midwife I've been seeing for my prenatal visits has been great, but since I'm not guaranteed to have her for labor, I've been looking for a doula as well. The birth center has a staff of doulas, but they tend to work first with women who don't have as much of a support system (and again - you don't know who you're going to get). I have heard things about the transfer rate being high, but I'm hoping for the best. I've talked to a lot of women who birthed there are loved it.
I know what you mean about feeling out of your element, though - even though the birth center is set up like a home (I think it's actually in a converted old house), it still won't be MY home, so it still won't be perfectly ideal.
I'm sure things will go smoothly! I think most places have staff that are on rotation, so that's definitely not unique to the birth center. I'm torn between trying to labor as much as possible at home before going in, or just going in right away (in active labor) and bringing things to make me more comfortable...one of the things that was really hard for me the first time was knowing that we had to leave for the hospital - I just couldn't relax knowing that we had to travel at some point - my labor went much smoother once we got settled in. Meh. I guess we will see what the timing is.
Our midwives in Portland, OR charged $4200 for the package, minus labs, u/s, birth kit. Our insurance paid for more than half (I can't recall the specifics now).
Here in our teeny tiny town, my midwife charges $2000 for the same thing. Last time, our insurance didn't cover any & we had to pay out of pocket (although we paid less than her full charge because we moved to the state late in my pregnancy).
This time I am on medicaid. As far as I understand so far, they cover $1400 of the bill (plus the labs, u/s), we will have to pay the rest.
I 
my midwife.
For my previous birth in WI with my CPM I paid her $1300 out of pocket for the birth (but that was the lowest part of her sliding scale that went up to $2000 I think. She was new so she let her customers choose what they could pay based on the sliding scale) and I think $25 per prenatal visit also out of pocket. So that probably added a couple hundred dollars onto that final price. Insurance didn't cover one red cent of my mw costs, but because I also so an OB concurrently I did not pay anything for labs, ultrasounds, etc. because it billed through my OB office which insurance covers.
I live in GA now. The CNM I have chosen charges $3400, but this does not include lab fees, ultrasounds etc. But she works with a back-up OB who takes care of my ultrasound needs so those are covered with insurance. My insurance should also cover my lab fees. I get a $500 discount because I have had at least one uncomplicated, unmedicated birth. And if I pay by 36 weeks I get an additional $250. She is bringing her own Aqua Doula tub and the "birth kit" and an assistant, all built into her flat fee. I do not anticipate that insurance will cover any of this BUT I am planning on using my medical flex account at work to get "paid back" for a portion of the costs. Since I am using my medical flex for a couple of other things this year I will not be able to get the full fee at the pre-tax rate but I should be able to finagle at least half.
Insurance sucks man....
I'm in northern VT and the fee for my first birth was $4,100 due before the birth. I'm seeing the same midwife though her co-midwife has changed. Her rates have not changed but because I ended up with a C-section after a transfer this birth is higher risk and the state requires that two midwives attend this birth so the fee is $4,600. I think labs are included, birth tub is extra ($100), and I'm not sure about the birth kit. I'm pretty sure the ultrasound will get charged to insurance.
Due to the transfer last time we didn't even fight insurance to try to get any of it covered since they covered the hospital birth. This time the state's passed a law that insurance has to cover midwives so we'll have a better leg to stand on. We've already been warned that because our midwife is out-of-network they'll try not to pay any of it. 
FWIW - I just found this article on one woman's process to get her homebirth reimbursed by insurance in 2004. Took her a LONG time and a LOT of headache, but she got her money back!
Ours will cost about $6K. We are responsible for $1K out-of-network deductible, and then 20% of the remaining balance. I'm in New England.
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