Delivery Dilemma! « Back to Group Discussions

[kitteh]

So, I would absolutely love to have a home birth, or to deliver in a Birth Center. Unfortunately those things are cost prohibitive in SoCal. Homebirth alone would wipe out at least half of our savings, and it has taken us ages to save it all up! So that is pretty much not an option.

My insurance sucks and almost none of the hospitals around here accept it. When I had my daughter 3 years ago I was bale to see the UCLA nurse-midwives and had my baby at Ronald Regan Medical Center up at UCLA, and my insurance covered the whole thing. I just assumed that would be the case this time around too, but I was WRONG.

The midwife I am seeing now is great, but she only delivers out of a ghetto hospital that I have never heard of in Downtown LA. I looked it up online and it has absolutely horrendous reviews on yelp. Actually, there is one among 17 that was glowing, but I think that lady even admitted that she was really lucky that the right people were on staff the night she went into labor. Other reviewers have commented that when they arrived there were no midwives to be found, one even labored for 22 hours and never saw a midwife! Even the reviewer with the positive experience said that the majority of the hospital staff were rude and disinterested.

Even if it weren't for the negative reviews, I wouldn't want to drive all the way to downtown Los Angeles--at least a 20 minute drive without traffic--to have this baby. With my last I was maybe a 5-10 minute drive from the hospital and I still ended up going in too early (only 3-4 cm dilated) because I was anxious about getting there. And even that short of a drive was not pleasant while in labor. I can't imagine doubling it!

I had originally thought that the UCLA birth center right across the street from me would be where I have this baby, but they don't take my insurance either. I really had my heart set on laboring mostly at home and then going across the street to push my baby out. I'm having a really hard time letting go of that plan.

So, I've been throwing a great big preggo temper tantrum and crying on and off since I found all of this out. I really have no idea what to do or where I am going to be able to have this baby. I'm feeling really depressed and devastated right now :(

[veggieviola]

Kitteh, I hate that you are in this position.  It really sucks when women are forced to choose a birth they can afford rather than the birth they desire.  

I wonder if any of the Birth Centers or homebirth midwives offer any kind of sliding scale, payment plan, or ability to charge you only at the allowable rate dictated by insurance?  I am fuzzy on this, but I also seem to recall someone once explaining to me a way to find a loophole in their insurance which allowed them to get some level of reimbursement from their insurance for their homebirth.  They still had to pay a bit out of pocket, but maybe something like that would be financially feasible?

Are there any OB's covered by your insurance who deliver at your hospital of preference?  Since you've done this before, maybe you could switch to their practice late in the game and deliver where you want to with a doula who would be there to help you advocate for yourself should need be?

I'm just racking my brain and throwing ideas out there. I hope you're able to find a birth option that feels right to you!  Hugs x

[womenswisdom]

If you're not 100% committed to having a midwife-attended births, maybe try and find out if there are any OBs who would deliver somewhere you would prefer. Maybe contact you local homebirth community for an OB who provides backup for homebirthing families and contact ICAN for recommendations.

[kitteh]

Thanks for responding veggieviola and womenswisdom :)

I just spent the past hour calling various birth centers and homebirth midwives, feeling like a tool sitting there on the phone just calmly "uh-huh-ing" while they threw out six, seven, and eight thousand dollar figures for their services. I felt like I was wasting everyone's time even making the calls, knowing before I even got on the phone with them that we probably couldn't afford most of those places.

The very last place I called told me that it is difficult to just throw out a figure because every situation varies, and that they actually have a non-profit on site and do work with lower-income families on a sliding scale. She also said that they have payment plans and financing options available. So I have an appointment to go meet with them on Monday afternoon.

I looked them up on Yelp and they do have some mixed reviews. They have a rotating midwife model of care (which I am familiar with because the UCLA nurse midwives do the same) so any of their midwives my be on call the night that you happen to go in labor. I am ok with that model, but I know some aren't. Also, some found their pricing to be confusing and not straightforward, so I guess for that I can only wait and see what happens at our meeting on Monday. The woman with whom I spoke did tell me that she warns clients who are unprepared to pay anything out of pocket that they will not be able to accommodate them at this birthing center. DH and I talked about it last night and decided that we would be comfortable paying $2-3k maximum for this birth, hopefully near the lower end of that range. So now I am just crossing my fingers that we get good news and find this place to be a good fit when we go in on Monday.

[Sweet Huck]

Dont panic, kitteh! call your insurance company and learn about how to apply for out of network services. My friends wanted a homebirth and they had to go this route....they might have paid out of pocket, but were reimbursed. Took a lot of phone calls and paperwork, but they swung it.

And if another setting truly isnt an option, have faith that you can still build a kickbutt support team and have a great labor...in spite of the hospital reviews and set backs!!! Prepare, set your mind to it, consider a doula and/or writing a birth plan that covers multiple scenarios. Be as determined as you are with your running!!! I have faith in you!

Keep us posted!

[FarmerMomma]

Hugs kitteh. 2-3 k seems plenty to pay out of pocket. That's about what I'm paying my midwife for a home birth and pre and post visits. Ouch those big city prices.

[SweetMama34]

I don't have any better advice to offer, but wanted to say that you aren't alone. We can't afford the home birth that we wanted, but insurance pays nearly all of our hospital birth costs. It's total BS. Ridiculous. I don't even understand.

[kitteh]

I'm on Medi-Cal for this pregnancy, so my options through insurance are extremely limited. I am pretty committed to having either a home birth, laboring at a birth center (probably far too expensive for us!) or using CNMs in a hospital setting. I actually love the midwife who is currently providing my care (under Medi-Cal) but I HATE HATE HATE the hospital where she would have to deliver my baby, and I am trying to do everything in my power to avoid having to drive all the way to downtown LA for this birth. Also, although I have only ever met the one midwife during prenatals, I do believe that the hospital has a rotating system of midwives who are on-call at any given time, and I have read reviews of others on Medi-Cal who received their care with a midwife but then when they went into labor no midwives were to be seen at the hospital, and apparently one was never called. I suppose if I am backed into a corner and have absolutely no choice but to deliver at the dreaded downtown hospital, I might be able to have my own direct contact number with the midwife so that I can contact her when I am planning to head down to the hospital? I will have to ask her about that as an option. I also do plan to tour the hospital so that I can see for myself what I would be in for if I decided to deliver there. It is quite likely that my entire family--DH, 3 yr old DD, mom and step-dad--would be heading to the hospital together and I'd like to be sure that there is an acceptable, clean, welcoming space for my step-dad and DD to wait if they choose not to be present in the delivery room.

Other than that, I have continued to do a lot of research online and have emailed a few different local homebirth midwives, explaining my situation and asking if they offer reduced rates for late care transfers. One of the women I found specifically addressed Medi-Cal and its failure to cover homebirths, and she stated that she does everything in her power to work with Medi-Cal recipients to come up with a fee that works for them. So I am excited to hear back from her.

My hopes are high and my fingers are crossed that we will be able to have the birth that we want this summer.

[dayiscoming2006]

Sounds good Kitteh. You'll get something worked out. I know how frustrating it can be. I'm thankful I had a sizable tax return(that will be completely drained after paying midwife and credit cards) and a reasonable rate for a midwife where I'm at. ($3200) But, if there was no other options that seemed suitable and safe and I had some money saved like you, then I'd try to figure out something even if that meant paying a little more. A comfortable, safe birth environment is important for you and baby. 

[veggieviola]

Originally Posted by Sweet Huck 

Dont panic, kitteh! call your insurance company and learn about how to apply for out of network services. My friends wanted a homebirth and they had to go this route....they might have paid out of pocket, but were reimbursed. Took a lot of phone calls and paperwork, but they swung it.

And if another setting truly isnt an option, have faith that you can still build a kickbutt support team and have a great labor...in spite of the hospital reviews and set backs!!! Prepare, set your mind to it, consider a doula and/or writing a birth plan that covers multiple scenarios. Be as determined as you are with your running!!! I have faith in you!

Keep us posted!

Yes, this is what I was thinking of - a good friend of mine had a homebirth this way.  They still had to pay some out of pocket, but they did get some reimbursement from their insurance in the end.  Our insurance does not "cover" homebirth either, and the midwives I spoke with here mentioned they do the same  - work with your insurance to get out-of-network reimbursement after the fact.  We did not decide to go this route, but the option is there.  Of course things may be completely different dealing with Medi-Cal.  

Kitteh, I'm glad you found some options to pursue.  Rooting for you that one works out that you feel good about!

[kitteh]

OK, so I need to do some processing and decision-making, and I figured I would do it here so that if anyone has some perspective/advice I can benefit from that as well.

.

We met with a group of midwives this afternoon, and they are willing to cut their usual base rate by a little more than half for us, but that still means paying $3k for their services. We can do 3k, but that is the absolute high end of our range of possibility and it would be very tight. I would feel much more comfortable with 2k, but I highly doubt that anyone in LA would be willing to be my midwife for that amount. The other reduced-fee quotes we have received have been $4k and above. And that is their REDUCED fee! Crazy.I can't help thinking about what we could do with that 3k if we didn't have to spend it on the birth. We could finish all of the little projects around the house. I could sign up for some prenatal yoga classes and get a prenatal massage or two. I also wan. t to get an Ergo or Boba for the new baby. I don't think we could afford any of that stuff if we spend so much on the birth. But at the same time, I have been dreaming of having a home birth since I was pregnant with DD1, and I really believe that not having to think about all of the STUFF involved in a hospital birth--how soon or how long to wait before heading out, whether or not we'll get stuck in traffic en route, whether or not one of the nurses or staff members will be rude or difficult, where DD will be during the labor, etc etc--not having any of that factor in will give me the ability to get into the right head space and hopefully have the birth that I have been envisioning.

However, I also just found out that the hospital downtown offers water births, and that the midwife I have been seeing for all of my prenatals is the one who kind of runs the waterbirth show, so I would get her direct number and she would be there for the birth, even if she wasn't on call that night. So that resolves one of my major strikes against the hospital (not knowing which midwife would show up for my birth--or if I would be like one of the women who said that no midwife ever showed up at all!) I'm still not stoked about having to drive across town while in labor. If I'm lucky and go into labor on a weekend or in the middle of the night then we should be able to get there within 15-20 minutes. But if it happens during rush hour (and rush hour in LA lasts HOURS) then it will take 1.5-2 hours to get to the hospital. That possibility makes me very nervous and anxious. I feel like it would be a dark cloud hanging over my labor, and would detract from my ability to really focus on the task at hand. Also, I don't love that I am going to have to stay at the hospital for at least 24 hours after the birth. What about DD? She has never slept apart from either DH or me, and I don't like the idea of having DH at home with DD1 and me and DD2 all the way down at the hospital, alone.

Luckily DH is on board with either option and sees it as primarily my choice. Which is nice, I guess, but also makes me feel like there is a lot of pressure for me to make the "right" decision.

[dayiscoming2006]

I'm paying 3200 for my home birth. We have no savings right now. Sure we could use the money for many other things. But, I have had some really bad hospital experiences and would not choose to birth at a hospital unless it was absolutely necessary. I wouldn't want to risk being in traffic in labor for that long, if that wasn't a possibility, I think I'd have considered sticking it out with the midwife you liked at that hospital, but 2 hours in a car in labor... Yikes! And who knows if you wouldn't start pushing while in the car or something! Ack!

 If I were you, 100% home birth. 3000 isn't much in the grand scheme of things. Having a bad birth experience would stick with you. And just having to stress about all the things you'd have to do once you were in labor would suck.

[Sweet Huck]

Man. All this concern about car labor ... is it really that horrendous?  I'm 1 hr from our birth center as it is, but I'm scheduled to attend an archaeology dig when I'm 8 1/2 months. No way in heck I'm missing the dig (unless I've already had the baby).... but I do have some worries about going into labor while in the field.  If I do, I'll only be 3 ish hours away from the birth center.....  that's not too bad, right?   

[womenswisdom]

SweetHuck - if you are riding in the car when you *think* you're in labor rather than laboring at home as long as possible and doing transition in the car - whole different story. You'll likely be just fine, especially with a first baby.

[amlikam]

Considering labor for most woman can be at least a few hours I imagine you could make it over in time. I drove an hour for my DD but wasn't in active labor (PROM).

That being said we are paying $3400 for our homebirth and considering extras like a pool (I <3 water). While we have some money that my father left us, I still feel strongly we would have made if work even without it. Sometimes Midwives are willing to do a payment plan when the bulk of the fee is paid on or before delivery. It sucks you are in this place. I know so many moms who despite having nothing found a way to make it work and none of them tell me it was a waste (part of my initiative to really have a HB this time.)

I hope you find a solution and team that will work for the best birth possible, I am sory you are stuck with such a choice.

[dayiscoming2006]

Originally Posted by Sweet Huck 

Man. All this concern about car labor ... is it really that horrendous?  I'm 1 hr from our birth center as it is, but I'm scheduled to attend an archaeology dig when I'm 8 1/2 months. No way in heck I'm missing the dig (unless I've already had the baby).... but I do have some worries about going into labor while in the field.  If I do, I'll only be 3 ish hours away from the birth center.....  that's not too bad, right?   

Let's just say it can be pretty uncomfortable. It depends how bad the contractions are for you. I had to catch a bus and walk to the hospital in labor in Romania. Then I had to be transferred by ambulance to another hospital (because the only Doc at that hospital didn't like my "attitude" and said comply or transfer) while in labor and that took about a half hour or so. All of it was very uncomfortable, but particularly the ambulance ride. I would avoid it if possible. It was a much nicer experience to just be able to stay home and not worry about any of it for me. Especially since the last time, I don't even think I would have thought to go to the hospital (not painful enough contraction/not long enough) until about 3 contractions before pushing. Could have risked a car birth since I was a half hour from the hospital there. 

With the archeological dig, I'd probably go to it. Chances are slim you'd go into labor right then and if you did, it will take a while, so, you'd know to boogie out of there. It'd be more of a potential problem if you were waiting to go to the hospital until you had a certain length, time period between contractions. And since you are a first time mom, you're far more likely to go into labor after 40 weeks than before and for the labor to take longer.

[shanna-cat]

In my opinion laboring in the car will be exactly what YOU make of it, just like everything else. With my first we were at the coast 3.5 hours away when labor began. We called mom and our midwives, picked up the house, went for a lovely walk along the beach and then headed home for the long drive. I found it nice. The motion of the car felt good and we were able to put on soothing music and through every contraction I focused on keeping my body relaxed, breathing, and visualized myself opening up. I never even thought about laboring in a car as being uncomfortable so for me it wasn't. When I got home I was 5 cm.

With my second he was almost born in the car. We lived in an apartment and were delivering at my moms house - which was 15 blocks away. My water broke in the car (yes, that was icky) and I was pushing when I got to my moms door. I stepped in the house, made it to the bedroom, and out he came. Delivered by my mom about 2 min after I got out of the car.

So my point in all this is that you can still have the labor you want even if the conditions aren't ideal. Often times its a mindset. I hope things work out for you Kitteh and that you find peace in whatever decision you make.

[Sweet Huck]

Originally Posted by shanna-cat 

.....laboring in the car will be exactly what YOU make of it, just like everything else....

Thanks Shanna-Cat!

[kitteh]

Still trying to decide over here on homebirth vs hospital (agonizing, more accurately.) We have the hospital tour this Tuesday and I'm really hoping that seeing the space will help sway us strongly one way or the other.

I've also been toying with the idea of financing the home birth--one of our credit cards keeps sending us balance-transfer offers with checks for one year of 0% interest. There is a 4% fee, of course. So if we financed the entire $3,000 we'd pay around $120 for the ability to pay the whole shebang off over the course of a year (which would come down to $260/month, I think)

This is appealing to me because having cash in savings really makes me feel secure, and the thought of wiping out a good chunk of our hard-earned, hard-saved money practically in one fell swoop makes me jittery.

On the other hand, we just barely finished paying off the last bit of $25,000 worth of credit card debt that I had amassed before DH and I met, and being totally debt-free feels amazing. So I'm not terribly keen to go right back into thousands of dollars worth of debt again.

Decisions, decisions. I hate this.

[amlikam]

Just wondering if the midwife will let you pay most (or good chunk) before birth and then spread out the balance after birth. Or you could use your savings and then commit to placing $260 a month back into it. Those credit card checks will incur all the finance charges over the year if you don't have it paid off by the day I believe. (make sure to read the terms). We carry credit card debt but I try to be careful with it because it is so easy. If I didn't have the creative means to budget the fee for my midwives I might put it on a credit card myself. Fortunately we have a savings account through work and my employer is paying $500 toward the fee (Yes I realize how incredibly lucky I am.)
If it were me I would go to the hospital open minded. I know we talked about doulas being expensive in your area (I believe) but I would keep that route in the maybe world too?
This is such a hard decision and while I believe in homebirth and a normal option for families I also think families need to be comfortable emotionally with their choice. Finances contribute to that significantly.