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Hi all--I'm new here, three months pregnant for the first time, and starting to look into my options for birth.<br><br>
Turns out they're pretty limited. I'm an MIT grad student on fellowship, which includes MIT student insurance (a Blue Cross plan). My insurance ONLY covers birth at Mount Auburn Hospital--in fact, if you travel in your ninth month and end up unexpectedly giving birth out of town, they won't cover you. I've been told by several people that they won't cover home birth at all.<br><br>
I very much want a natural birth, and am nervous about unnecessary interventions. I'm not committed to having a home birth, but I'd like to consider it. I met with Marcia Snyder the other day, one of the Mount Auburn midwives who also does care at MIT Medical, to talk over my options. Basically, she told me that if I decide to have a home birth, I shouldn't tell her about it, and if I had to be transferred to the hospital for complications, I couldn't have a Mount Auburn midwife attend the birth, because they don't support home birth.<br><br>
It was a very frustrating conversation, and there were lots of long silences where I got the sense that she wasn't allowed to say whatever it was that was on her mind. Apparently it's a question she doesn't get asked very often--which was surprising as well.<br><br>
I am leaning toward having the birth at Mount Auburn and also hiring a doula (which I'll have to pay for out of pocket as well). Mount Auburn seems like a decent hospital to be stuck with, if you're going to go that route. But I'm extremely disturbed by MAMAH's attitude--and also by the fact that if I go with the hospital, I'll get whatever midwife happens to be on duty that day.<br><br>
Any of you folks have things to say about MAMAH, good or bad? Is it unreasonable to want to know which midwife will be attending your birth? Do other hospitals have different policies? If I try for a home birth and get transferred to a hospital, could my insurance refuse to cover me altogether? Are there private insurers that might cover a home birth or birthing center?<br><br>
And if anyone has any recommendations for doulas, hit me. I am feeling really at sea here and could use a knowledgeable advocate on my side.<br><br>
Sorry for the million questions. Your advice is most appreciated.
 

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Welcome to the board whiptail and congratulations on your pregnancy!<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>whiptail</strong> <a href="/community/forum/post/10291248"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I am leaning toward having the birth at Mount Auburn and also hiring a doula (which I'll have to pay for out of pocket as well).</div>
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This is pretty standard, some insurances make it very difficult for doula fees to be reimbursed to the client. If you're totally strapped and won't be able to save up for a doula consider hiring a newly trained doula that is working for travel fees or very low fees to gain experience. You'll find a lot of doulas in the Boston area run between $500 and $1,200 (approximately), if that helps you to plan your budget or whether you'll want to start looking for someone that is just getting started and can charge a lower rate.<br><br>
Best wishes on your journey!
 

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I have heard nothing but good things about Mt. Auburn. I think it is probably the best hospital in Boston if you want to go natural. I know several people who delivered there and they all had great experiences.<br><br>
I think you can meet several of the midwives during your pregnancy so you have a better chance of knowing the one who actually delivers you. After all, even with a homebirth there is always a chance that your primary provider won't be there.<br><br>
I also know a good doula who is on the less expensive end of the scale and comes with high recommendations from people in the area. This doula has attended births at Mt. Auburn. PM me if you want her info.
 

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I'm on the South Shore and can't speak personally about MAMAH, though PLENTY of other moms here can! I will tell you that had I not found a good all-midwife group here on the South Shore, I would have gone with them.<br><br>
All of the following is said ASSUMING you're (or one is) going with a hospital birth. You can then make comparisons to a homebirth.<br><br>
It's not a hospital policy about who attends your birth. The way it works is, an individual practitioner (rarely) or group (the norm) has an arrangement with a hospital-- what you've heard of as "hospital privileges." The hospital agrees to allow certain people to deliver babies or perform surgery or do diagnostic tests on their premises, the practitioner agrees to abide by the hospital's policies, the practitioner's group handles their charges and the hospital handles supplies and charges for nursing and other hospital-related services. And in ANY group practice, you get whom you get and that's it. The practitioners rotate call and office hours, but anyone who sees a group for prenatal care should realize that you're getting the group, not the individual. The only three ways to ensure that you get one particular person to attend your baby's birth are:<br><br>
1) Schedule an elective cesarean (definitely not what you want!!!!) with an OB you like<br><br>
2) Schedule an induction when the midwife you like is on<br><br>
3) Hire someone who practices solo<br><br>
Even under those circumstances, you're still not guaranteed the attendant you want. I won't even go into the fact that the first two of the three options are the antithesis of a midwife-attended natural homebirth. Think of all the things that could get in the way, though. You could schedule an elective section and end up going into labor during another doctor or midwife's shift. You could schedule the induction and it could either fail (in which case you could go home and wait until the baby comes on its own, or consent to a cesarean for "failure to progress" aka failure to be patient) or take longer than the chosen midwife's shift. Even hiring a solo practitioner (and Dr. Hardiman at MA is one of two hospital-based solo providers I know of in the entire state) could fail, because SHE could have an emergency....though if you want the best bet of knowing who'll attend your birth, AND want a natural birth, this is really the only option.<br><br>
As I said, very, very few OBs or midwives work solo. If you think about it, it's almost impossible to do from a scheduling standpoint. I started out this pregnancy seeing a solo provider (she's since been banned from doing VBACs by her hospital or I'd still be with her), and had my first appointment with her canceled TWICE because someone else went into labor.<br><br><br>
Now, about home birth.....<br><br>
CNMs in Massachusetts are not allowed to attend home births, or they risk losing their licenses. Home births are attended by CPMs, and there are many good ones available! However, you will pay out of pocket 100% for the CPM. I can't speak to whether or not your insurance would pay for a homebirth transfer if the only prenatal care you've been receiving if from the CPM, but what a lot of women do is both. They see a CNM or OB (or combined group practice) for what some people call "shadow care" and get on record with the insurance company as having their prenatal care through the hospital-based provider. Then when they go into labor, they stay home and call the CPM. If something goes wrong or they decide they really do want that epidural (or whatever else!), they transfer to the hospital where the providers were expecting them in the first place.<br><br>
The big issues here are, of course, trust and money. If your insurance doesn't cover a CPM and you can't afford it (that was the case with me!), well, you go with a hospital birth or you have an unassisted birth at home. And only you can decide if you want to build a relationship with a hospital-based group or provider where you're lying to them the whole time about where you're having the baby. Some people are fine with this, some people aren't-- everyone has her own comfort level.<br><br>
I really like my doula. If you PM me, I can give you her info and if you have any other questions, let me know <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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If you are not interested in the midwives at Mt Auburn, Beth Hardiman is a midwife minded OB, whose backup is a midwife. Either she or the midwife attend all of the births. She is phenomenal, and will at least give you an alternative should you want one.<br><br>
eta: she is at mt auburn, and keeps her practice small, so tends to fill up quickly.
 

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<div>Originally Posted by <strong>jbmill2</strong> <a href="/community/forum/post/10293825"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">If you are not interested in the midwives at Mt Auburn, Beth Hardiman is a midwife minded OB, whose backup is a midwife. Either she or the midwife attend all of the births. She is phenomenal, and will at least give you an alternative should you want one.<br><br>
eta: she is at mt auburn, and keeps her practice small, so tends to fill up quickly.</div>
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Not to be a wet blanket but she isn't taking patients right now as far out as August and September. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Always worth trying just in case but people shouldn't get their hopes up.
 

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<div>Originally Posted by <strong>whiptail</strong> <a href="/community/forum/post/10291248"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">But I'm extremely disturbed by MAMAH's attitude--and also by the fact that if I go with the hospital, I'll get whatever midwife happens to be on duty that day.</div>
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I say...listen to your gut! It's telling you something!<br><br>
Personally, I'd do whatever I had to do to come up with the money to pay for the birth I wanted (for me, definitely a home birth) rather than be at the mercy of hospital policies and restrictions. In fact, even if the hospital was paying me, there's no way I'd give birth in one. But that's just me <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/winky.gif" style="border:0px solid;" title="Wink"><br><br>
There was a recent link about insurance companies paying for home birth. You may want to check out some of the resources listed there. Our insurance company ended up paying for about 1/3 of our home birth. Insurance companies NEED to hear from women to know that women WANT home birth to be covered, to know that home birth is LESS expensive than hospital birth and AT LEAST as safe (if not safer) than hospital births. If they don't hear from us, they won't know.<br><br>
I'd definitely recommend reading <a href="http://pushedbirth.com/" target="_blank">Jennifer Block's book</a> Pushed: The Painful Truth About Childbirth and Modern Maternity Care. A very eye-opening read about what's happening to women in the maternity system today.<br><br>
I'd also recommend at least interviewing a couple home birth midwives and making a comparison about how they practice and the type of care would receive vs. MAMAH as part of your decision-making process.<br><br><span><span style="font-family:'Comic Sans MS';">=================<br>
Mama to DS 5/03 & DD 2/06 (HBAC!) <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/nocirc.gif" style="border:0px solid;" title="nocirc"><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/winner.jpg" style="border:0px solid;" title="BFSymbol"><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/familybed2.gif" style="border:0px solid;" title="Familybed2"><br><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/ribboncesarean.gif" style="border:0px solid;" title="cesarean">: <a href="http://ican-online.net/" target="_blank">ICAN</a> "Birth is the epicenter of women’s power." ~Ani DiFranco</span></span>
 

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Whiptail, it's pretty standard to have a random midwife/OB deliver you. That's what I didn't like about my birth at the Cambridge birth center -- I really love my midwife there but didn't much care for the woman who ended up delivering my son.<br><br>
I doubt so much that it's because Mt.A "doesn't believe in homebirth" that you wouldn't get a midwife for your care if you had to transfer. My hunch is more that you would come in through the ER system and would be assigned to whatever OB was on call. Since your HB midwife would already be with you, a MtA midwife would be unlikely to join since she'd be redundant. If it were something within the scope of the Mt.A midwife, then your HB midwife wouldn't transfer you to hospital, KWIM?<br><br>
FWIW, my CBC midwife is very supportive of the idea of a homebirth even though it means more or less transferring out of her care (I'm still in the planning stages but I think I'll try to do some sort of tandem care). I'm sure you could find a supportive midwife at Mt. A.<br><br>
As for a doula, I'd suggest contacting ALACE. I know that many newly trained doulas will take on a client for free or almost free to get experience, as long as you don't mind being the first or almost first client.<br><br>
Good luck finding the birth professional that meets your needs!
 

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<div>Originally Posted by <strong>Cathieq</strong> <a href="/community/forum/post/10295129"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Since your HB midwife would already be with you, a MtA midwife would be unlikely to join since she'd be redundant.</div>
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My understanding is that this would not be true...maybe Paige can comment if she sees this thread. Home birth midwives in MA do not have hospital privileges and I think it would be unlikely that a hospital would allow them to attend to you (and in some (many?) cases to even stay with you) in the case of a HB transfer to a hospital.<br><br><div style="margin:20px;margin-top:5px;">
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<div>Originally Posted by <strong>Cathieq</strong> <a href="/community/forum/post/10295129"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">If it were something within the scope of the Mt.A midwife, then your HB midwife wouldn't transfer you to hospital, KWIM</div>
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In many instances, this is not necessarily accurate. Most of my HB midwife's HB to hospital transfers have been for non-emergency situations, most often an exhausted Mom or a Mom who decided she wanted pain relief and where the family simply drove over to the hospital. These would definitely be in the scope of a CNM's care, but I think you hit the nail on the head that in the case of a transfer, a women would go though the ER and the hospital wouldn't really care if she preferred a CNM or an OB.<br><br><span><span style="font-family:'Comic Sans MS';">=================<br>
Mama to DS 5/03 & DD 2/06 (HBAC!) <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/nocirc.gif" style="border:0px solid;" title="nocirc"><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/winner.jpg" style="border:0px solid;" title="BFSymbol"><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/familybed2.gif" style="border:0px solid;" title="Familybed2"><br><img alt="" class="inlineimg" src="/img/vbsmilies/smilies/ribboncesarean.gif" style="border:0px solid;" title="cesarean">: <a href="http://ican-online.net/" target="_blank">ICAN</a> "Birth is the epicenter of women’s power." ~Ani DiFranco</span></span>
 

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<div>Originally Posted by <strong>MAMom</strong> <a href="/community/forum/post/10297726"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">but I think you hit the nail on the head that in the case of a transfer, a women would go though the ER and the hospital wouldn't really care if she preferred a CNM or an OB.<br></div>
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Which is a reason to do concurrent care - that way you can just go to the hospital as if you were planning to do it all along right? Skip the emergency room.
 

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<div>Originally Posted by <strong>MAMom</strong> <a href="/community/forum/post/10297726"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Most of my HB midwife's HB to hospital transfers have been for non-emergency situations, most often an exhausted Mom or a Mom who decided she wanted pain relief and where the family simply drove over to the hospital.</div>
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Interesting. It was my understanding at Cambridge that as soon as you choose pain relief or augmentation the oversight of your care transfers to an OB -- your midwife stays with you, of course, but the OB calls the shots (if he/she can be bothered, lol!). I'll have to check with my midwife.<br><br>
That's what I meant by two midwifes being redundant... for support, since your care has transfered to an OB. But if the midwives at Mt A. do medical interventions then obviously I have no idea what I'm talking about!<br><br>
Oh, and every homebirth midwife I've talked to has said that they would come with us in the event of a hospital transfer as a support person. I can't imagine being ditched at the door, yikes.
 

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<div>Originally Posted by <strong>LolaK</strong> <a href="/community/forum/post/10297890"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Which is a reason to do concurrent care - that way you can just go to the hospital as if you were planning to do it all along right? Skip the emergency room.</div>
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That's what I'd recommend to anyone who could afford it.
 

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<div>Originally Posted by <strong>grumpyshoegirl</strong> <a href="/community/forum/post/10303134"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">That's what I'd recommend to anyone who could afford it.</div>
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Well for me my insurance will cover no part, not one cent of a homebirth, but every single penny of every single OB visit, test, ultrasound, and hospital stay I might have. So, for me if I can afford the homebirth I can do concurrent care since it doesn't cost anything more.
 

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<div>Originally Posted by <strong>LolaK</strong> <a href="/community/forum/post/10303663"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Well for me my insurance will cover no part, not one cent of a homebirth, but every single penny of every single OB visit, test, ultrasound, and hospital stay I might have. So, for me if I can afford the homebirth I can do concurrent care since it doesn't cost anything more.</div>
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That's what I was talking about <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
My insurance covers everything of a hospital birth whether it's an OB or a CNM, but not one penny of home birth. We can't afford a homebirth, period, so we went with an all-CNM group and hired a doula. I'm doing some free tutoring for her kid in exchange for a discount; everyone wins!
 

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I was really pleased with the care I received with mamah - between the pre-natal, birth and post-partum I probably met almost all of them. They may have different personalities but it appears that they are committed to the most "natural" way. Their web-site really shows that they are proud of their low c-section rate and high vbac rate.
 

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fyi, i hear women's health assoc in wellesley (deliver at newton wellesley) back up home birth. i just had my baby with them in december at NW and was very pleased w/my care.
 

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One year ago tomorrow, I had a VBAC with the Mt. Auburn Midwives.<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/orngbiggrin.gif" style="border:0px solid;" title="orange big grin"><br><br>
There were a couple there who maybe didn't have the best bedside manner ever, but at the end of the day they were ALL extremely supportive of my VBAC wishes and I am utterly convinced that with anyone else I would've ended up with another c/s.<br><br>
And Mt. Auburn in general was definitely a nice place to birth, versus the BI.
 

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<div>Originally Posted by <strong>whiptail</strong> <a href="/community/forum/post/10291248"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">I'm an MIT grad student on fellowship, which includes MIT student insurance (a Blue Cross plan).</div>
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Most insurance won't cover homebirth, but Blue Cross is one of the few I've heard people actually having success getting coverage. I'd definitely look into it some more.<br><br>
That said, Mt Auburn is the only place I know where everyone I know who's birthed there has had a natural birth and has had good things to say about it.
 

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I did not have a natural birth – I had a medicated induction but, I did have a good experience for all of my prenatal & maternity stays (I was admitted a couple of times)<br><br>
I was not at all pleased with the care after birth.
 

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<div>Originally Posted by <strong>veganf</strong> <a href="/community/forum/post/10307522"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Most insurance won't cover homebirth, but Blue Cross is one of the few I've heard people actually having success getting coverage. I'd definitely look into it some more.<br><br>
That said, Mt Auburn is the only place I know where everyone I know who's birthed there has had a natural birth and has had good things to say about it.</div>
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I think that if you have BCBS PPO you have a chance but with an HMO you have none (unless you happen to talk to someone who doesn't know their job and lets you get away with it). Sucks!
 
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