Homebirth: why is it almost the same cost as a hospital? - Mothering Forums
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#1 of 115 Old 06-25-2011, 04:15 PM - Thread Starter
 
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my wife and i do not have insurance and wanted to have a homebirth.  unfortunately, we found a great midwife but they wanted 4000 dollars for their service!  we are in a small town in binghamton, and i just dont see how people can pay for that.  i also dont think it would be right to charge a lot because there arent enough "customers".  

 

what is going to end up happening is we will do an unassisted homebirth (which we are both completely fine with).  as we are at this junction, ive had one thought: with hospitals charging an expensive rate of 5000-7500 for vaginal birth, why would a midwife charge 4000?  how can the costs compare?  what is the breakdown of cost for a midwife? 

 

it just seems that humanity is in such a wretched position.

 

 

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#2 of 115 Old 06-25-2011, 05:04 PM
 
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Our midwife charged $2500 for our homebirth, plus another $200 for a backup midwife for the birth, and we spent an additional $75 or so on the birth kid and some additional items. Midwives in our area tend to run between $2000 and $4000, with birthing centers in the $4000 range. My daughter's hospital birth with induction and epidural was more than $10,000, and that does not include additional medical fees for our daughter's hospital stay - that was just MY bill, or rather filed under my name with our insurance. One of my cousins had a scheduled c-section almost two years ago, and I think it was $20,000.

 

I find it hard to believe that a hospital is charging $5,000 for a vaginal birth. That seems really low to me.

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#3 of 115 Old 06-25-2011, 05:10 PM
 
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I suppose its *possible* that a hospital might only charge 5000-7500 -- but that's probably just the hospital's cost -- the room, nurses, food, etc.  


Generally you also get a bill from the doctor or doctors, the anesthesiologist (if there is one), the lab, and the pharmacy.

 

8 years ago, my OB/CNM practice charged 2000 for prenatal care and attending the birth.   That was on top of whatever the hospital charged and whatever other professionals who practice at the hospital charge.


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#4 of 115 Old 06-25-2011, 05:21 PM - Thread Starter
 
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i was referring to a hospital birth without an epidural; an epidural shoots up the cost ~$5000.

 

i guess i wanted to find a breakdown of cost.  yes, midwives' cost includes prenatal, but still, a couple of checkups: why would that cost be much?  especially if you aren't getting any tests done and it is a "how are you eating/sleeping/feeling", followed with feeling the belly.  

 

all of the information that the midwives have told us is available free on the internet, and we were just nodding along as they were telling us.  

 

getting back on track, what would be a breakdown of the cost of a midwife, compared to a hospital?  Supplies, gas, time, licence, schooling, staff etc.

 

 

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#5 of 115 Old 06-25-2011, 05:33 PM
 
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Bwahahahaha. I charge what the market bears. Why not? Ford does...

I pay malpractice, my birth assistant, my supplies and medications (not just what I use, but what expires without use), my license, my taxes, my rent for office space, my student loans, my continuing education, IRA, health insurance for me, and more. Don't forget the Latte budget, I live in Seattle, after all.

Homebirth = $3000
Hospital birth = about $12,000 for a natural birth with no epidural, no complications. The doc charges about $4000 and the hospital does the other $8000. Remember to take both into account, there's a hospital fee and a doctor's fee.

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#6 of 115 Old 06-25-2011, 05:37 PM
 
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The MIdwives fee (at least ours) will also cover all the prenatal visits, plus the 6 weeks post partum visits, plus 6 weeks of pediatric care.  NONE of those things are included in the "hospital cost".  The hosptial cost is only what occurs duirng the 2 to 4 days you stay there.

 

(sorry for the typos...sticky keyboard)

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#7 of 115 Old 06-25-2011, 06:56 PM
 
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Quote:
Originally Posted by wzuur View Post

i was referring to a hospital birth without an epidural; an epidural shoots up the cost ~$5000.

 

i guess i wanted to find a breakdown of cost.  yes, midwives' cost includes prenatal, but still, a couple of checkups: why would that cost be much?  especially if you aren't getting any tests done and it is a "how are you eating/sleeping/feeling", followed with feeling the belly.  

 

all of the information that the midwives have told us is available free on the internet, and we were just nodding along as they were telling us.  

 

getting back on track, what would be a breakdown of the cost of a midwife, compared to a hospital?  Supplies, gas, time, licence, schooling, staff etc.

 

 



That doesn't sound right either, becuase when my husband had surgery with a spinal block several years ago,  the meds plus anesthesiologist fee didn't raise it even a fraction of that.   I know because it turned out the anesthesiologist was not a participant in our insurance and his fees were less than our annual deductable.


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#8 of 115 Old 06-25-2011, 08:08 PM
 
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Quote:
Originally Posted by Jane View Post


Homebirth = $3000
Hospital birth = about $12,000 for a natural birth with no epidural, no complications. The doc charges about $4000 and the hospital does the other $8000. Remember to take both into account, there's a hospital fee and a doctor's fee.


Yup. #1 was a hospital birth with an OB. No epidural--I did end up on pitocin for about 3 hours, but otherwise pretty unmedicated. The total (for ME, not counting ds's "hospital stay") was around $12,000; I was fortunate to have an out-of-pocket maximum that capped our expenses at $1,500, plus the deductible ($500, I think?), but then we had to pay separately for ds's 20%. dd's HB was $2,600 total, none of which insurance covered, and it was worth every penny. This was in 2008 in NC, with a CPM, in case that matters.

 

Talk to your MW; if you're uninsured, they'll almost always work with you on the finances. And honestly, I cannot compare the level of care I received from my MW to my OB visits, which were insulting, TBH.

 

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#9 of 115 Old 06-25-2011, 08:27 PM
 
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My midwife charges 3250 total.. I pay for the supplies for the birth which ends up being about 100 bucks.. So 3350 total.

 

That includes all my prenatal, postnatal, and newborn visits for the first month.. WAY cheaper than a hospital birth alone.

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#10 of 115 Old 06-25-2011, 08:29 PM
 
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Mine charges 1500- most of the other one's in my area charge 3000-3500. She lives out of town though.

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#11 of 115 Old 06-26-2011, 01:02 AM
 
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My husband and I had a homebirth with a midwife in November. We have insurance, but don't have maternity coverage. We paid out of pocket for our homebirth ($3500). We also did shadow care with an OB which we also paid out of pocket for, that cost $2500 (included prenatal visits, labs and OB's delivery fee). The hospital fee was a totally separate charge and it applied just to the delivery itself. So, for an uncomplicated vaginal delivery with a 1 night stay, it was $3650. Add $1,200 additional per day for mom after 1st day. That price does not include an epidural ($850 if paid for in full before delivery) or any interventions or augmentations (that price also doesn't include any post partum problems/complications). The baby will be billed separately for any and all care done to them (routine newborn care, nursery stay, Dr. visits, vaccines, tests, etc). If the baby has to go to the NICU, that is another separate bill and another separate Dr.'s (neonatologist and/or other specialist) bill.         

*The reason why I included the above is because most people think the "cash pay" (uninsured patient) price is a flat, all inclusive fee. I'm not trying to insult your intelligence. 

The care we received from our midwife and our entire homebirth experience was worth every single penny and then some. I never felt that our check ups were just a "how are you eating/sleeping/feeling, followed with feeling the belly." Maybe you haven't found the right midwife? The care I received from my midwife versus my OB is night and day (I'll never do shadow care again.). I consider my midwife (a CPM) a medical professional just like myself (I'm a registered nurse). I had full confidence in her when it came to, if something did go wrong, her ability to handle it and guide us. That's really what your paying for: her expertise, knowledge and experience if something (God forbid) does go wrong.

I would look into this further before completely saying no to a homebirth with a midwife. The majority I know really love and believe in what they do and hate when money holds someone back from having the birth they want. Typically, they will work with them anyway they can (payment plans, barter, trade).

Good luck to you! Best wishes.    

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#12 of 115 Old 06-26-2011, 02:08 AM
 
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When we had our first homebirth w/midwife, she had been doing it for a few years and pretty much worked from her house--cash cost $2500.  Second babe planned with her (came quick, so unplanned unassisted), she was still building her practice and working from home--cash cost $3200 (minus a small amount for not actually being at the birth, through no fault of hers).  Between babe 2 and 3 she expanded with a birth center (wonderful option and very pleased it is available for those who want it), so with that the new cash price would have been $5000 (even though we still would have been at home and not using the birth center).  I totally understand the underlying expenses--all the things Jane describes above, plus the extra nice touches that make going to a Midwife special.  We were already on a different journey, but the cost increase did put an extra pause in the process.  Now, with babe 4 the cash price is around $7000!  (I realize that is still usually lower than a hospital, but....).  We have a working relationship and I still see here occasionally for a quick check up and pay on a appointment by appointment scale.  Sigh...we live in an area of the country that accepts that kind of inflation, but it also creates a feeling that it isn't about what it started to out to be...now it seems so business like, red tape, and sign your check before you leave kinda thing.  It really did feel different when she was just caring for mama's and their babes without all the other stuff.

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#13 of 115 Old 06-26-2011, 06:21 AM
 
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I've shopped around for mw's in three different states and the average range appears to be about $1800-$4000 and that includes everything from prenatal visits to the birth to postpartum care.  Birth supplies are a little extra- maybe $50-$200 more depending on if you want a birth pool and if you rent it or buy it.  And a birth assistant might be extra as well if one is required.  DEM and CPM's generally charge less than CNM's.

 

Midwives generally break their prices up into three blocks: prenatal, birth, and postpartum.  The birth portion of the fee is by far the largest.  Many only charge a minimal fee per prenatal and from my experience, roll the price of any necessary medications/tests (bloodwork, Rhogam, GTT, etc.) into the overall cost.  As far as I know, most midwives do not think about their prices in terms of travel time or gas expenses- it's just a global fee.  I have talked to some that charge about $40 a prenatal visit at their home and $50 if I want it at my home.  Really not much different.  Often midwives are willing to travel one hour, but some will travel further and this may increase their price slightly.   With my last baby, I changed mw's at the last minute (38 weeks) and I received almost all of my money back from the first mw and needed to pay the second mw her entire fee.  So this just goes to show that the majority if their fees are in the birth portion of their services.

 

The average hospital birth with no medications is around $10,000 (again, I looked this up in several states to find an average).  Tack on a few medications, an epidural, a c-section, emergency travel, etc. and it jumps to $20K to $50K to $100K and that doesn't include postpartum care past the time you're in the hospital.

 

In Canada, you can get a c-section for closer to $8000 and a vaginal birth for less.  Not here in the USA.


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#14 of 115 Old 06-26-2011, 07:42 AM
 
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I do not understand that either because CPMs , unlike CNMs) do not have 6-7 years of school (BSN plus Master's) worth of student loans to pay. CPMs (unlike OB  or CNMs) do not have malpractice insurance payments either (which mean if something goes wrong , you can't sue them to help you with child medical expenses).

 

So, I do not understand why they charge so much since the overhead should be so much lower.

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#15 of 115 Old 06-26-2011, 07:47 AM
 
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Have you applied for Medicaid or explored you state website? Often special state help is available for pregnant women.

 

You should think about it. Some homebriths end up in transfer (you can read those stories on MDC and other places on internet) and then, if you are not insured , what are you going to do with your hospital bill if you do not qualify for emergency type Medicaid?
 

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Originally Posted by wzuur View Post

my wife and i do not have insurance and wanted to have a homebirth. 

 

 



 

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#16 of 115 Old 06-26-2011, 07:54 AM
 
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OP are you in Binghamton NY ??  All i can say is 'welcome to NY'  I would have paid $5000 for my midwife, in Long Island  (insurance covered it)    In NY - only CNM's can 'legally ' attend a homebirth - like another poster said CNM's have more years in school - have more licensure fees etc... and they do charge more than a CM  a CPM or a lay -midwife.    Seek another midwife ...maybe even one who is NOT a CNM - one who has more lattitude in her service fees.  In a town like Bingahamton (boy do i hope you are talking about NY!)  you will find a good sized HBing community - just ask around.  


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#17 of 115 Old 06-26-2011, 08:01 AM
 
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Originally Posted by MrsShow View Post

The MIdwives fee (at least ours) will also cover all the prenatal visits, plus the 6 weeks post partum visits, plus 6 weeks of pediatric care.  NONE of those things are included in the "hospital cost".  The hosptial cost is only what occurs duirng the 2 to 4 days you stay there.

 

(sorry for the typos...sticky keyboard)


This! Add your costs for prenatal care (and keep in mind it's higher quality care than you'd get at any docs office, with hour long visits and psychological and emotional support). Then think about the value of home-based pediatric and postpartum care, some of which is not even offered by traditional medical establishments.

 

Our homebirth was a very, very fast birth (30 minutes) so it ended up being unattended. But I wouldn't trade our prenatal care for anything. It helped me have the birth I had. And the level of medical support once they arrived was unparalleled to anything I'd had before. My husband and I agree that we'd pay the fee all over again, even knowing that the birth would be that fast and unattended.

 


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#18 of 115 Old 06-26-2011, 08:20 AM
 
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If you have a provider like CPM who had no malpractice insurance and something goes wrong because of their negligence, you can;t do anything  to get $$$ help for the injured party. No attorney will help you.  Malpractice insurance  is required of CNMs, RNs and MD for a reason. Why it is not requirement for CPMs is beyond me. They make mistakes too.

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#19 of 115 Old 06-26-2011, 08:33 AM
 
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If you can get state coverage for the birth it would be substantially cheaper than a HB midwife, and you would also avoid the scenario where you pay the midwife's fee and then also have hospital charges in case of emergency transfer.

 

Have you checked into what state resources might be available to you?

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#20 of 115 Old 06-26-2011, 08:36 AM
 
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If you are going to do a UC, please remember that no matter what your resources and ability to pay, no hospital can legally refuse to take care of your wife if she is in the process of giving birth.  Please keep that in mind if you feel things are not going smoothly.

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#21 of 115 Old 06-26-2011, 08:42 AM
 
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To be honest, it isn't almost the same cost.

 

With a hospital birth you have the cost of the doctor, the facility fees for the mother, AND facility fees for the baby. I would encourage anyone who is comparing the costs to call the local billing dept of the hospital and ask for all those costs. I am paying $3000 for midwifery care right now and what that is equivalent to is my out-of-pocket expenses if I were to birth in the hospital using my current insurance (which I pay about 20%). That is not the same as them actually costing the same.

 

If you are looking at a practice with 2 midwives, then automatically that fee gets split. Add in gas, CEUs, licensing fees, self-employment taxes (OUCH!), rent for an office, supplies, malpractice for those who have it and suddenly you will see that the midwives really aren't making all that much. When I did my taxes last year, I ended up pretty bummed out by the tiny percentage of my income that was left once I covered all my expenses. Also, keep in mind that most people who hire a midwife REALLY want their own midwife to show up at their birth, which means midwives who are doing homebirth cannot take on the same volume of clients as hospital based practices where only the oncall attends the birth.

 

I guess this is something each family has to weigh out for themselves. If you don't feel the service is valuable, then you certainly don't have to spend your money on it. The costs are the costs. I can't walk into a doctor's office and demand that I only pay them $20 for a visit since they only spend 5 minutes with me and I can look up information on WebMD, you know? They charge what they charge and I can choose to utilize their services or not.


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#22 of 115 Old 06-26-2011, 10:00 AM
 
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Midwives of all levels of training need to eat, feed their families and live decently as well. For although we love to hate the high fees doctors pay, they earn that pay for the hard work they do, the training they have, the time from families while on call, the fact that not every shmuck on the street can practice medicine gives them the right to charge more.  Midwives fall in the same boat. They are trained (on some level, CNMs usually the most highly trained), dedicated professionals, taking time from their families - days on end if your wife's labor goes long, and really do have the right to charge a fee that can allow them to live. Many will work with families, use barter systems, etc. but I think folks at times forget that just like doctors and hospitals, midwives need to get paid, it's a business. We forget that sometimes, we think midwives are the friendly kind women down the street willing to help any woman in labor and we forget that for many the fee we pay is that, a fee; it's not a gift to a kind woman, more often than not it's the very money that keeps her lights on.  It's her business and livelihood.

 

What I think is also forgotten is that that hospital fee helps support many folks as well, nurses, janitors, lab techs, etc get paid from that fee. We can be so quick to think it greed and forget that those pretty painted walls and clean bed linens come from that fee we pay for hospital births.

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#23 of 115 Old 06-26-2011, 10:03 AM
 
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For both of our hospitals births we paid 250$  from start to finish, actually this is what we paid for my entire pregnancies AND births. It all depends on your insurance!not including the doula, she charged us 400$  for each birth, in the end we paid more for our doula  than our  CNM  assisted birth with 2 days stay in the hospital.

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#24 of 115 Old 06-26-2011, 06:08 PM - Thread Starter
 
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Well, i make too much for us to qualify for ANY care, and my wife is not on my new work insurance because it was far too expensive each month (about $600 per month to have her on); there was also a large fee to pay to get her on during a time that wasnt "open admission"...  

 

We live about a 3 min local drive from a hospital.  

 

The midwives I was working with weren't "legally" able to be my midwives, so they worked out a deal with a prominent midwife in ithaca who we would only visit once to make the whole process "legal".  However, that midwife said it was up to the other midwives to set a price, so they just used that midwife's normal fee of $4000, which is what everyone charges in ithaca. (on a side note, these midwives refused to barter with our services because they didn't think it was useful [i've worked in the film/tv industry as an editor/camera operator/motion graphics artist for 9 years and my wife is a painter and photographer; we also own our own equipment])  i really find it unfortunate that the midwives chose such an ungenerous approach, even though our bartering was worth far more than their fee.   

 

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OP are you in Binghamton NY ??  All i can say is 'welcome to NY'  I would have paid $5000 for my midwife, in Long Island  (insurance covered it)    In NY - only CNM's can 'legally ' attend a homebirth - like another poster said CNM's have more years in school - have more licensure fees etc... and they do charge more than a CM  a CPM or a lay -midwife.    Seek another midwife ...maybe even one who is NOT a CNM - one who has more lattitude in her service fees.  In a town like Bingahamton (boy do i hope you are talking about NY!)  you will find a good sized HBing community - just ask around.  


 

 

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#25 of 115 Old 06-26-2011, 06:19 PM
 
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For $4000 you can buy several moths of insurance at your work for you wife.  Illegall  MWs? You really want to got this way?

 

Also, talk to your hospital. Hospital have certain amount of money set aside for charity care and you can also arrange for payment plan.

 

 

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#26 of 115 Old 06-26-2011, 06:29 PM - Thread Starter
 
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i think you might have misunderstood some portion of what i wrote.  we cannot afford 4000, that was why we opted out of the midwives we liked.  they were the only ones we could find in the binghamton area, and in order to make it "legal", we had to have the paperwork go through a MW in ithaca.  

 

there is no way we would go to a hospital: that would be worse than having to do it ourselves; they know not of birthing, but of ailments and how to interfere with what is natural.  also, i am sure that you must "qualify" for that charity care with a low income, this is not our problem.  i make 40-50k a year, but that supports both my wife and i.

 

i have no problem with "lay midwives", regardless of their legality.  
 

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For $4000 you can buy several moths of insurance at your work for you wife.  Illegall  MWs? You really want to got this way?

 

Also, talk to your hospital. Hospital have certain amount of money set aside for charity care and you can also arrange for payment plan.

 

 



 

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#27 of 115 Old 06-26-2011, 06:39 PM
 
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Look, you make assumption about hospitals. Go check our you specific hospital. see what their policies are regarding natural childbirth. There are hospitals take the meaning of consent and patients cantered care very seriously. See if you local hospital is designated as "baby friendly"

 

 

You still have time. Explore your options yourself, do not go by what is posted by Internet. Yes, I understand the irony of posting this on the Internet.

 

You have nothing to loose by exploring.

 

 

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#28 of 115 Old 06-26-2011, 06:47 PM
 
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$40K for a family of three (including the baby) would qualify for some assistance where I live.
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#29 of 115 Old 06-26-2011, 06:50 PM
 
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Quote:
Originally Posted by wzuur View Post
    i really find it unfortunate that the midwives chose such an ungenerous approach, even though our bartering was worth far more than their fee.   

 


 

 



To be honest, not every midwife can afford to barter. My kids can't eat graphic designs and the utility company won't accept photographs to keep our power running. I barter often, but sometimes I have to say no because I need to bring in cash too. Imagine for a moment that you went to work and your boss tried to give you a handmade quilt instead of your paycheck..... even if it is a beautiful quilt, you may have bills to pay that you actually need the paycheck for.

 


Erika, mama to three beautiful kids (plus one gestating), and wife to one fantastic man.

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#30 of 115 Old 06-26-2011, 07:08 PM
 
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Quote:
Originally Posted by Jane View Post

$40K for a family of three (including the baby) would qualify for some assistance where I live.


Yep...We qualified for a 90% discount at our hospital.  We make around 35k for a family of 3.  Hospitals (at least our faith based ones, not sure about the county hospita) have quite high income guidelines.  Granted, we are paying for MW care, even though we have to break our long standing rule and take a loan out to do it.

 

 

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