A question of money

[Riverbeauty]

I would go to whatever lengths necessary to achieve a VBAC... but to be honest, money is a major concern!

• I am not willing to do an unassisted VBAC because of all my personal health issues.
  
• I cannot afford to pay out of pocket for a Midwife assisted homebirth.
  
• In Washington State out of hospital VBAC is not covered under Medicaid, and it is illegal to VBAC in a freestanding birth center...

So that leaves me with hospital birth.

I know that my insurance doesn't cover medical costs out of state unless it's an emergency... But what would happen if I went on vacation at, say, 40 weeks or so... and just happened to go into labor near a very VBAC friendly hospital? Would my insurance cover that?

ETA: I should add that my provider seems to be very supportive... provisionally. I was reading on http://vbacfacts.com and saw that when a doc sets provisions they are actually not very supportive. I don't want to be baited and switched again. I plan to use the Interview questions listed on that site to find out just how supportive my doc ACTUALLY is...

[cairomama]

I don't believe that there are such things as VBAC-Friendly Hospitals, only VBAC Friendly Providers. There are definitely VBAC Un-friendly Hospitals that have VBAC Bans and other hospitals that allow VBAC, but there can be great variation in the providers.

I think you are better off to try to find a VBAC friendly provider in your area, than take your chances going to another hospital and getting whoever happens to be there. The list of interview questions is a good place to start to find out if someone is truly supportive. However, since money is a factor you may not get someone who answers all the questions perfectly to your satisfaction. Ask for recommendations and try to interview as many as possible. Prioritize what is important to you and let the other stuff go. You can still have a great experience and successful VBAC.

I had a great hospital VBAC with heplock in the forearm and continuous EFM (except for bathroom breaks). However, I stayed home until I was really far along and had freedom of position. I labored on my hands and knees and the birth ball and pushed on my hands and knees. I was only in the hospital for 2.5 hours before my baby was born. I think that freedom of position is extremely important.

I would not agree to an epidural in place or to a 40-week deadline or laying on my back. Find out your dealbreakers and try to find the most supportive provider possible. You can always refuse to be induced or have a repeat c-section because you pass the doctor's deadline, but it is better and less stressful to have someone support you rather than fight you.

Good luck!

[SalmonBayDoula]

Originally Posted by Riverbeauty

So that leaves me with hospital birth.
.

Could you try and find a provider over at Group Health Central in Seattle? Many of their midwife groups are very supportive of VBACs and so is the hospital. Also some of the family practice docs might be another option. I know it is a FAIR distance from where you are located, but maybe you could have collaborative care where you see the seattle based provider every OTHER visit and someone close to home the rest (even an out of hospital midiwfe near you, as the prenatal care would be covered, just not the birth!)

Good luck! The lack of options is frustrating and discouraging!

Sharon

[Riverbeauty]

Originally Posted by SalmonBayDoula

Could you try and find a provider over at Group Health Central in Seattle? Many of their midwife groups are very supportive of VBACs and so is the hospital. Also some of the family practice docs might be another option. I know it is a FAIR distance from where you are located, but maybe you could have collaborative care where you see the seattle based provider every OTHER visit and someone close to home the rest (even an out of hospital midiwfe near you, as the prenatal care would be covered, just not the birth!)

Good luck! The lack of options is frustrating and discouraging!

Sharon

We originally saw a provider at the UW in Seattle because my local ob wasn't wanting to take me for anything but a repeat cesarean... and it was horrible commuting for visits. I also attempted to get care at Group Health Central in Seattle, but they wanted to refer me to the UW because of my health concerns...

Because of my Diabetes, Hypertension, Non-Epileptic Seizures, and other health problems... I couldn't find a out of hospital midwife locally who was willing to take me on. I did find a traveling midwife who was willing, but she didn't take my insurance AT ALL as she was from out of state...

We have ended up at Tacoma General. The doc has agreed to take me on for a VBAC but there are quite a few restrictions, as you can imagine.

[GoestoShow]

I think on the insurance question, you need to check with your company what the policy is. I've heard of some insurances denying coverage for a birth if the person was two or more hours away from their --- I don't know how it would have been defined, even, practitioner? Hospital? I don't know, but whatever that was and had the baby in a hospital nearby. The OB I saw for my pregnancy said she encountered this a couple of times with people who gave birth at 36 weeks on. But I don't know what insurance they have and if it was an in-network, out-of-network issue.

Personally, I can't see my insurance denying coverage completely because I have the out-of-network option. And then there's always the emergency option. If you give birth in an ER, I believe it's looked at differently than giving birth in a labor and delivery ward.....it'd be covered under your emergency room visits. Again, check with *your* insurance about this. Every insurance is different.

[AlexisT]

I believe it's Medicaid (since she mentioned it in her OP), and they tend to be very difficult about going out of state. If you "just happened" to be elsewhere at 40 weeks, Medicaid might well say it wasn't a real emergency and refuse to pay.

[sandcastle]

I understand the money concern (I am trying to figure out how to pay for another homebirth myself). With the insurance we have now, it would cost me $150 to have my baby in the hospital, but I'd have to pay upfront for a homebirth midwife and then submit it to insurance and hope they'd reimburse. However, there's a good chance our insurance will change at the end of Nov and it's not known how the benefits will be afterwards yet.

In your case, I would find a good doula and stay home as long as you feel comfortable. That is my plan if I cannot find a way to raise the funds for a homebirth. My best birth overall was my hospital VBAC about three years ago. It is possible to have a wonderful hospital birth if you have a supportive provider and hospital. I would think about the restrictions your dr wants to place on you and whether they are reasonable or not. It's not reasonable to expect a woman to go into labor by her due date, but that's a common restriction.

[Riverbeauty]

Originally Posted by ferrum97

In your case, I would find a good doula and stay home as long as you feel comfortable.

Luckily, my local ICAN leader is my Doula