Frustrated at high cost of childbirth

[Cekimon]

So since my first child we moved to a different county. I have the same exact insurance and even though I knew I'd have a different doctor and deliver at a different hospital, I budgeted for roughly the same cost. It's only been two years difference so if prices increased, I wouldn't think by that much. Turns out because of the "area" in which we live, the cost of all of this is going to be DOUBLE

I had considered homebirth in the past but knew that DH would not go for it. He's been so good about everything else... supportive of breastfeeding, cosleeping, when i worked, he prepared all the breastmilk bottles... he's a champ, really. So I knew the thought of homebirth was a little much for him so even though I was open to the idea of it and learning more about it, I put it aside to "pick my battles" so to speak.

however, this budget issue puts a major kink in our budget. The worst part is that during this pregnancy, I've visited the ER twice and so far I've received one of the bills and it's almost $500 - not to mention who knows what the second bill will be (probably close to the same.) So with that expense, PLUS the double increase I had anticipated .... I'm seriously thinking of homebirth now.

I feel silly for considering this just over money but I think it could be a good thing - my son has never spent one night away from me since birth and I think it will be really traumatic for him to have me away for two nights and then for me to arrive with a new baby. SO... that would be one good aspect in terms of family.

I am honestly a bit scared... I don't handle pain well at all and I did have a epidural with my first birth. I held on until the very end but ended up caving in. However, I was induced for that labor and understand that contractions are worse with induced labor.

Anyway... I'm curious to hear from moms who chose homebirth in the middle of their pregnancies, left doctors, and went to midwives. Did the midwife prorate the price b/c the prenatal care part was only for half or less of the pregnancy?

Any thoughts from anyone would actually be appreciated...
I am totally freaking out about money and it's really causing me to feel very depressed.

[alegna]

Homebirth is a good choice for so many reasons.

Many women feel that their labors are significantly LESS painful *because* they are at home.

I would have had a LOT more trouble staying on top of things with dd's birth if I'd been in the hospital. Don't get me wrong, it wasn't *fun* at home, but no one was messing with me or getting in my space so I could easily zone out and make myself as comfortable as possible.

Homebirth with a normal pregnancy is safer for mom and baby. Hospitals are cess-pools of infection.

Try reading anything by Henci Goer. She has great information.

-Angela

[nashvillemidwife]

Have you talked with any midwives in your area about fees? Fees and policies about prorating vary so widely that all anyone here can really give you is anecdotes. Not that there's anything wrong with that, but my best advice is going to be to consult some local midwives.

[Peony]

I switched MW's towards the end of DD2's pg, one HB MW for another. Her fee was not pro-rated, and I've honestly never ran into a MW IRL who does that. The fee is always the same regardless of how many times they see you.

One thing though, HB MW's are usually much more willing to work out a payment plan.

[wednesday]

I don't think most midwives pro-rate much, if at all, for taking someone later in pregnancy. There's also the risk of not being able to find a midwife who is not all booked up around your due date already.

Where I live most homebirths are attended by lay midwives and NO insurance in my state covers it as it is not technically legal. So, I would most likely spend more out of pocket for a homebirth as our health insurance coverage for a hospital birth is fairly good. I'm trying to keep it in perspective, what if a hospital birth turned into a c-section, my co-insurance amount could become substantial.

It's frustrating though, we had a lot of money set aside for a homebirth and my maternity leave, then had a very large and unexpected expense and now have very little in savings. Whatever amount I spend paying a midwife out of pocket -- is that much less time I can afford to stay off of work with the baby. Whereas the co-pay to a hospital bill wouldn't be due until after birth and we could work out a payment plan. Heck my son's birth center birth wasn't paid off until he was 2!

My worst case scenario is we scrape up a few thousand to a midwife for a homebirth, then end up a hospital transfer with a c-section and have to work out a payment plan to the hospital as well...I try not to think about this though.

Good luck with figuring something out...I'm 13 weeks and still totally scratching my head on this.

[doctormom]

Originally Posted by wednesday

I don't think most midwives pro-rate much, if at all, for taking someone later in pregnancy.

Agreed. This question comes up here periodically, and while I understand the logic that less visits = less cost, from the midwife perspective it may actually be assuming MORE risk to take over care late in pregnancy. Prenatal visits provide an opportunity for education and building a relationship...and trying to do that in a much shorter period of time would be more challenging.

Like Wednesday, I live in NC where insurance does not cover homebirth, so I appreciate that cost can be a significant factor. (I'm going to respectfully disagree with her though, and add that many homebirths here are attended by CPMs, not just by lay midwives) It would definitely have been less expensive for me to have a routine hospital birth...except that I couldn't find an OB who was really supportive of VBAC...and my deductible and co-insurance for another $*%&@ c-section (not to mention the physical and emotional trauma) would be greater than the cost of my homebirth.

To help defray the cost, we are using pre-tax dollars from a flex spending account; if that option is available, it may be helpful to you. Also, to some extent I had to just suck it up - it IS a lot of money, but on the other hand, it's for one of the most important events of my life, and I'm willing to make a lot of financial sacrifices in order to have the peaceful birth that my newborn and I deserve.

I hope you will be able to find a solution that works for your family. I don't know that homebirth will necessarily be the cheapest option, but if it feels right for you, please don't rule it out just because of cost. There are midwives who offer sliding fee scales, bartering, or extended repayment plans.

[Sheekara]

Midwifery is illegal here too, unless you are a CNM. The lay midwife I had originally chosen to use before I knew of the stupid legal stuff only charged $1000. The CNM I have charges nearly 4 times that much. But I will tell you... It is so absolutely 100% undoubtedly worth every red cent!!!! And my husband agrees. The amount of personal attention I get coupled with having access to my care provider 24/7 is so much better than the cold impersonal 15 min appointments with a Dr.

My sister in another state paid her primary midwife $800 and the back up midwife $200. That compared to her two hospital births that cost them out of pocket $5000 and $6000 AFTER insurance covered it's part.

I would suggest finding midwifes in your area and talk to them. The bonus is unlike making an office visit with a Dr. a midwife won't charge you for a phone conversation or for a first time meeting to see if she's really what you are looking for.

Good luck!

[wednesday]

Originally Posted by doctormom

(I'm going to respectfully disagree with her though, and add that many homebirths here are attended by CPMs, not just by lay midwives)

It's a big state... in western NC I've been able to turn up one CNM practice that attends homebirth and takes insurance, but they were not a good fit for me. I'm glad to hear you have more choices where you are.

[RubyOrganique]

I agree with doctormom. The costs can be high, often depending on where you are. I comfort myself this way. It's the most important thing I've ever done in my life. Many in the US spend more time, energy and money planning their weddings than planning their births (excluding many of us on this forum!). I'm sort of having the opposite anxiety-I chose homebirth from the beginning, but am concerned that if I experience any problems along the way, I may be forced into hospital care. Then my insurance will only cover the hospital care, and I will need to pick up the cost of care I've already received from my CNM. So while I'm imagining that my insurance is going to cover everything, we're planning for the worst case scenario and hoping for the best. (Supposedly there is a law in my state that if an insurance company doesn't offer a service in-network, they are required to cover that service even when provided by an out-of-network provider. There are no hmws in network, so we're hoping for what's called an exemption.)

And then I keep the health care issue at the front of my mind when assessing my local representation and of course the presidential candidates. Something has to change so that all of us have the opportunity to focus on the comfort, health and meaning of our baby's first moments; not how far it's going to set us back financially.

This is my first birth so I can relate to your concern about handling pain. I have no idea how it will be, but I'm certain that I can relax more easily at home than in a hospital setting. It's no guarantee, but it can't hurt (no pun intended!)

I'll imagine good things for you as you sort this through. Trust your heart and it will work out.

ruby

[SaraGriffin]

The cost was prorated for me, because I decided to have a homebirth at 34 weeks. I continued to see my doctor though because I'm military and it was free, but also the midwife.

[barefootpoetry]

I am not sure if our homebirth will be covered by our insurance yet, but even if we have to pay the entire cost out-of-pocket, it will still be roughly the same amount we'd have to pay for traditional prenatal care and hospital birth even AFTER our insurance.

I would rather go into debt paying for a homebirth than have a totally free hospital birth. There are some things in life that are just worth paying for (and amusingly enough, they're usually the things "you can't put a price tag on.") And this is coming from someone who is terrified of debt (we've never even owned a credit card!) so rest assured that a homebirth is worth the price.

I was looking up homebirth info for DH to read back when we started TTCing, and I came across a website that said something along the lines of, "A homebirth costs about as much as your average engagement ring. If you spent that much money on a chunk of rock, isn't a good birth worth just as much, if not more? How much is that special woman in your life worth to you?"

[doctormom]

Originally Posted by wednesday

It's a big state... in western NC I've been able to turn up one CNM practice that attends homebirth and takes insurance, but they were not a good fit for me. I'm glad to hear you have more choices where you are.

OT Clarification: a CPM is neither a CNM nor a lay midwife...CPMs undergo formal training and licensure (in states that recognize them, which NC does not) but their emphasis is on homebirth...CNMs have a nursing background that emphasizes hospital practice, and they are less likely (in my experience) to participate in homebirths.

I believe that in NC as a whole, there are quite a few more CPMs doing homebirth than CNMs. I think lay midwives are less common.

And now, we return to your regularly scheduled post...

[JessicaS]

Check with your insurance plan and see if midwives are covered. My midwife is in my PPO network.

[mousebandit]

As to the pain in homebirth question, I would recommend the book by Sarah Buckley - "Gentle Birth, Gentle Mothering" (I think that's the title!). She explains VERY well the "hormone cocktail" that comes with natural birth. Basically, when you are not given synthetic hormones (like Pitocin, which they use to induce or augment contractions), your body produces the natural versions, which have many more functions. Natural oxytocin not only produces your contractions (in a natural, do-able strength and rhythm), but it also triggers the production of pain-reducing hormones (were they opiates? I'd have to go look at the book again.). The pain-reducing hormones ARE NOT triggered nor produced when you're given synthetic hormones. THUS, in the hospital (where some dreadfully high rate of labors are "stimulated" with Pit), not only are you suffering from unnaturally hard, strong, fast, and long contractions, but you are NOT getting your natural pain-killers.

There's TONS more to the story, and I would REALLY recommend you read that book - she explains it all very clearly. In a completely non-medicated childbirth, you get the same hormone combinations that you get during orgasm, but at MASSIVELY higher doses.

And all this doesn't even begin to discuss or take into account the natural relaxation (and thus pain relief) of being at home and being in control of your body position and situation / people around you.

There's LOTS of advantages to homebirth, besides the financial ones!

Good luck!

Tracey Mouse

[Mina]

Originally Posted by SaraGriffin

The cost was prorated for me, because I decided to have a homebirth at 34 weeks. I continued to see my doctor though because I'm military and it was free, but also the midwife.

Was your fee prorated for you because you started care at 34 weeks, or because she wasn't present for the birth? Didn't you post wondering if you should consider your birth UC, because you did it yourself and only had a doula for support present?

[3cuties]

Originally Posted by abimommy

Check with your insurance plan and see if midwives are covered. My midwife is in my PPO network.

And even if they are excluded, ask the midwife how she bills, if she bills under an OB's name and the OB is in your network, then you are good.

[DoulaJulian]

:Sorry, a little personal rant here about $$

Cost of birth is one of those bizarre things in our culture! Many couples spend (literally) tens of thousands of dollars on the ideal engagement ring, engraved invites, the perfect color-coordinated floral arrangements, dresses, tuxes, tent rental, food, booze, a romantic honeymoon...all for their wedding. But those same couples will hem and haw over a few thousand (in my case, $2000 if insurance didn't cover) for the birth of their baby.

I'm not throwing insults around if you or someone you know decided to have an elaborate wedding ceremony (DH and i eloped, had a fantastic, private honeymoon,and it cost us a total of $800, and no hassles with IL's!) but what i am trying to point out is that this is another way that our culture/society has relegated the mother/child role into the background...made it less vital...less important...less sacred than a wedding ceremony (that ends in divorce within 5 years at least 40%-50% of the time if my stats are accurate). It's more important for girls to dream of their perfect fashion model weddings than it is for them to dream about the kind of world they want to welcome a baby into!

Other countries acknowledge the sacredness of childbirth and plan to pay for it within their taxation/government system because they recognize that those vital mother/child relationships shape their entire nation...create the citizens who will pay taxes, run businesses, educate their nations children. The fact that we have to scrimp and save to cover something so important is indicative of our cultures backwards values...I'm not saying that midwives should give away their services, but until the nation catches up and realizes the error of it's ways, we all need to find creative and empowering ways to have the births we want, welcome our children into the world gently, and let our legislature know that the problem with our country isn't drugs, or crime, or poverty...but our lack of respect for human life and dignity.

Okay, done with my rant! And OP, i share your frustrations!