A birthing WWYD...

[staceyobu]

I just found out I am pregnant with #4. What would you do if you were me? #1 was born at our local, overly medically managed hospital. I had her naturally, but they aren't really promoting natural birth there. #2 was born in a different city at a birth center, underwater with a delightful CNM. For #3, we moved back to conservative small town with c/section happy, induction happy docs. The doctor I had for #1 had moved away. We went with choice #2. I couldn't do it. We wound up having her unassisted at home.

 

I do not want to have this one unassisted, so that option is off the table. There are a couple of brand new, just out of school doctors at the hospital that some are saying are a bit more natural (although they are so new, most people don't know much of anything about them yet). There is a new homebirth midwife in town (she wasn't here when we had #3 unassisted). She has no physician back-up due to the local birth climate. As far as I know, she doesn't work with anyone locally (so I fear she could be deathly ill when I go into labor and then I could be left in the cold for a midwife).

 

The midwife fees will run us over $4000. The hospital copay with our insurance will run between $400 and $1200 (the absolute max being $1200 for alll prenatal care and delivery). With a normal vag delivery, we will total out at $420 for everything.

 

I want the homebirth midwife. I can't stand the whole hospital scene... and at our local hospital, you are going to get the constant monitoring, stuck in the bed, baby goes to nursery experience unless you pitch an absolute fit. And even then, I think they will force the issue. I'm a little more optimistic with the new docs, but even then, the doctor isn't there for that much of the birth.

 

However, the homebirth midwife will be difficult for us to afford. If anything goes wrong, I'm stuck walking into the ER to see the doctor on call at the last minute. If the baby is transverse at 37 weeks, I'm completely screwed. So many what ifs on every side.

 

Thoughts?

 

(One more side note... going to another city to deliver is not an option. The closest place with better options if over 4 hours away. I'm not willing to spend that kinda time in the car during labor.)

Edited September 2, 2011 by staceyobu

[Tangerine]

In the event of a hospital birth, how confident are you in your ability (or your partner's or doula's) to stand up for what you want, in both prenatal appointments and in the midst of labor?

Edited September 2, 2011 by Tangerine
no need for the giant quote!

[Ellie]

:grouphug:

 

I'd be inclined to go the hospital and be prepared to pitch fits the whole time. That $4000 is a lotta money. :001_huh:

 

But in my heart of hearts, I would SO want to do the home birth.

[staceyobu]

In the event of a hospital birth, how confident are you in your ability (or your partner's or doula's) to stand up for what you want, in both prenatal appointments and in the midst of labor?

 

During labor I am useless for anything. DH has done this a few times, so I think he can advocate.

[creativish]

Can you just do most of your laboring at home and then get to the hospital for the finale?

[boscopup]

Have you talked to the midwife? Sometimes they'll lower their fee if it's a hardship to pay it. Always worth asking.

 

I don't feel comfortable going unassisted either, so I end up having to cross the state line and give birth in a rented house. My midwife is cheaper than yours (it was around $2800), but it was still much more than a hospital birth would have been. The out-of-hospital birth was worth every penny to me.

 

Also, as far as the hospital is concerned... The doctors are only one part of the equation. It's the NURSES that are there with you off and on. If you can get a natural-birth-friendly nurse, the hospital would probably be fine. If you get one that isn't friendly to that, it could be awful. I got lucky in that I labored in the Antepartum unit, and the nurses didn't think I'd give birth for several hours, so they left me alone and didn't push medication.

[Ria]

:grouphug:

 

I'd be inclined to go the hospital and be prepared to pitch fits the whole time. That $4000 is a lotta money. :001_huh:.

 

Yep. I'd go there, and be firm in what I wanted. Best of all worlds, imo.

[indigomama]

It sounds like you'd be a little more comfortable with knowing you had a provider there for sure, instead of taking a chance with a midwife without support options.

 

Could you go with one of the new doctors, make sure you clearly spell out your concerns/expectations and desires, and also hire a strong, supportive and assertive doula. That way your Dh can concentrate on you and the new one and your doula could be "the heavy" with the hospital?

[Momof3littles]

My oldest was a CNM (but med-wifey) hospital birth. My 2nd birth was at a freestanding birth center. DH was in grad school at the time, and I wanted a homebirth, but insurance would pay for most of the birth center birth (although we still had a hefty OOP-something like 1K). DH was wrapping up his dissertation when I had baby #2. I was really torn between a homebirth and the FSBC. I started w/ the FSBC because the homebirth midwives were all an hour from my home and I had a really fast labor with baby #2. Very, very late into my pgcy a CNM opened a HB practice within a half hour of me. We switched late in the game. My insurance paid for some of it, and we still paid some OOP. I realize how tough of a decision it is. Hugs.

 

I would opt for a hospital in your situation if I was confident I could fight unnecessary intervention and stand firm, and had really excellent support and a supportive doc. Even the best docs and midwives delivering in a hospital environment that is intervention-happy kind of of have their hands tied. I drove 45 mins w/ my first to have a CNM attended hospital birth, and that CNM really has her hands tied in many ways because she is forced to toe the line on hospital policies (EFM, etc.). Even though those policies are often dated or not well supported by research, etc. sometimes the care provider is stuck having to abide by them. For that reason, even a doc who is somewhat sympathetic or supportive of natural birth can be in a sticky situation and unable to deal w/ you. (eta: you may not be fighting the doctor, but may be stuck fighting the hospital policies, even with a "supportive" doc, kwim?)

 

I would at least talk to the HB midwife. SHe may be able to work payments out with you, barter, etc. She may have a backup plan that you aren't aware of. It wouldn't hurt to at least talk with her.

 

On the flip side, you sound like a confident woman, you are experienced, and you seem like you have educated yourself about birth, etc. I think a hospital birth can be doable if you can manage to stay home as long as possible, have good support, etc. It can get tricky at the end w/ a care provider (are they going to press you to induce because baby is "too big" or for other sketchy reasons, kwim?) and it is tough sometimes to be lead along thinking you are getting one thing, and then finding out at the end your care provider is going to head down a different road than you expected (without medical necessity).

 

I'd start w/ talking to the HB midwife as you can't make a decision without knowing if there's any way she can work with you financially, etc. kwim?

[sweetbasil]

We have sacrificed, financially, for my homebirths. It was absolutely worth it, and would be at more than twice the price.

 

Birth is such an intense, profound, emotional experience that unless it was medically necessary I would do anything I could to birth at home. My birth experiences were all life-changing, and I still morn that my first was born in hospital -- even though I managed to go drug-free, it was not the birth experience I desired. The nurses fought my natural birth every step of the way. Had it not been for the fact that I had a very patient midwife and a husband who was able to run interference, it would have undoubtedly ended in an unnecessary c-section. It still makes me sad that I could not bond with my first the way I've been able to with my homebirths.

 

The wonderful bonding with my new baby, the new baby bonding with the family, the relaxed atmosphere, the lack of MRSA ;), the home visits from the midwife (rather than having to take my newborn to a germ-infested physician's office), etc... those things are priceless. There is NO comparison between a sterile hospital, shift nurses and all of their concerns about litigation and making you a "good" (read: compliant) patient and being in your own safe and cozy home, with your own germs, with a midwife who has built a relationship with you and genuinely cares about you.

 

If finances are a concern, most midwives will work with you.

 

When faced with a decision like this, I feel that money is just money. A year from now, what will I remember? The cost, or the experience? What about 10 yrs from now? 20?

 

I try not to make long-term decisions based on short-term circumstances, so that's how I see it. :)

[Runningmom80]

I would get a doula and do a hospital birth. The what -ifs get me with the MW option.

[WishboneDawn]

I want the homebirth midwife. I can't stand the whole hospital scene... and at our local hospital, you are going to get the constant monitoring, stuck in the bed, baby goes to nursery experience unless you pitch an absolute fit. And even then, I think they will force the issue. I'm a little more optimistic with the new docs, but even then, the doctor isn't there for that much of the birth.

 

Okay. Now I'm starting to get it.

 

I loved my two hospital births. I'm up in Nova Scotia, Canada and I went to a local maternity hospital. I could not figure out why people here are so down on them. But stuck in bed? Nursery??? Really? I thought that stuff went out of style 20 years ago!

 

I was in a hotel style room, encouraged to walk, nurse and my babies were with me from the beginning.

 

Wow. Not sure what I'd do.

 

But congrats!!

[twoforjoy]

With #3, I had a doula and a hospital birth. It worked out extremely well.

 

I think having the doula there really helped them know that I was serious about wanting as little intervention as possible. Honestly, they pretty much left me alone until it was time to push. I also think the fact that it was my third helped, because I had a better sense of what I was getting into. I was able to articulate what I wanted at each point--heplock instead of IV in my arm, intermittent monitoring, a birth ball, etc.--and they were very, very cool about respecting that. The whole experience was extremely positive.

[J'etudie]

It sounds like you'd be a little more comfortable with knowing you had a provider there for sure, instead of taking a chance with a midwife without support options.

 

Could you go with one of the new doctors, make sure you clearly spell out your concerns/expectations and desires, and also hire a strong, supportive and assertive doula. That way your Dh can concentrate on you and the new one and your doula could be "the heavy" with the hospital?

 

If I were in your position I think this is the path I'd choose.

Edited November 23, 2012 by In Light of Eternity

[happypamama]

If you opt for hospital, I'd also opt for a doula who was familiar with working with the hospital, so that she can help advocate for you. I'd also talk to the docs and say things like, "I want to go drug-free. How can you support me in that?" (Rather than, "how do you feel about natural birth?," because, of course, they'll say they're in favor of it, but you need active support for it.)

 

One option to consider, even though you are thinking you don't want unassisted, is planning an unassisted birth (it sounds like your unassisted birth was a last minute unassisted, not a planned one -- world of difference there), but with the MW backup. See her for appointments and see if she will agree to come only if you feel you need her. That might lower your cost a lot, and if you ended up calling her for the birth, you'd know you spent the money because you needed it.

[celticmom]

I would definitely try to avoid a hospital like the one you describe. If I was concerned about a possible transfer, I would do shadow care with one of the younger doctors. I would definitely go the midwife route. INMHO almost any price is cheaper than risking PPD or PTSD from the psychological and emotional abuse some hospitals subject mothers to.

[Embassy]

I would get a doula and do a hospital birth. The what -ifs get me with the MW option.

 

:iagree: I had a doula for my last birth that did a great job advocating for me. She made sure everyone knew what kind of birth I wanted. I was free to focus on baby.

[Starr]

I wouldn't want to have to go to the hospital and take whatever doctor was on call. That's the part of home birthing that would make me anxious.

[Heather in OK]

If I didn't feel at peace about UC (which I have done before too BTW), I would:

 

#1 Talk to the midwife about working with me financially. Talk with her about what you told us. What your desire is to birth at home. Then just see what she says.

 

If she won't/can't come down enough on her price (and please, don't assume she'll reduce it to almost nothing...she is worth her time and expertise)...

 

#2 Talk to the midwife about doing monitrice care and go with the newer doctor.

 

You are right, even if the dr is natural birth friendly, he's not going to be there much. The RNs run the show and if there isn't a natural birth friendly RN working when you go in, it's not going to be a good environment. Fighting against unnecessary interventions is VERY hard when you are in the tough work of labor. A laboring women should not be fighting...she should be in a safe place, feeling supported.

 

So I would go with monitrice care and get to the hospital when I was VERY close to pushing.

 

If you don't know what monitrice care is, it's similar to doula care. A monitrice will do clinical tasks such as listening to heart tones, monitoring your blood pressure, doing vaginal exams at your request, etc. She can help you know when a good time is to head in (I suggest clients go in around 7cm).

[Kate CA]

I was you 9 years ago!

 

I found I was pregnant with number 5 and had had all previous babies at home with wonderful midwives and great experiences. We had very little money yet I *dreaded* the thought of going to the hospital. I even went through their initial meeting (a group meeting where they told me my "options") and I was horrified and so distressed. I called the midwife that had assisted at the previous birth and she agreed to a barter system. My dh worked on her ranch several times in lieu of payment and I received services and the most amazing birth at home.

 

I don't think any of my midwives had what you are describing as back-up--certainly not a doctor back-up. We knew we would transfer to a hospital if there were complications, but it would, at that time, be a true emergency and I wouldn't care what happened as long as I had a healthy baby. This is how I have always viewed my home births. In my experience, it is a rare thing for a midwife to miss a birth. I wouldn't go into it expecting that she would, but I would prepare for it in case she did - just like I would for any unexpected happening during pregnancy.

 

I will say that someone suggested "shadow" care with one of the younger doctors. I did that with my first because my mother was not happy at our home birth choice and was really fearful. I promised her I would. This is a good suggestion if *you* are genuinely fearful of the possible emergency/midwife sickness. For me, it was fine until I went overdue and then they wanted to induce me. I just didn't go in to the office. :D It can be done and you can be in charge. I suggest you meet with the younger docs and ask them questions meant to draw them out and have them give you examples of what they feel is the ideal birth and what they do in various dangerous situations.

 

Now that I am 40, that is probably what I would do if I found myself in your place. I always go overdue though, a full two weeks, and would just hold fast until I was darn good and ready to give birth and then induce myself with castor oil or herbs. :001_smile:

[jenL]

I would get a doula and do a hospital birth. The what -ifs get me with the MW option.

 

:iagree: Along with the doula, I'd take one of the newer doctors as well.

[Veritaserum]

I'd choose whichever I determined to be the safer option. I had a medically-(mis)managed hospital birth with my first baby followed by four home births. I chose home birth because it was safer than the alternative (hospitals with stupid/dangerous policies). We are trying for baby #6 and I'm leaning heavily toward a hospital birth because we have a new hospital that actually practices evidence-based care (no standard IVs/monitoring/etc.). If I can birth within the emergency safety net of a hospital without anyone pushing unnecessary procedures, I will.

 

However, I wouldn't go to a hospital where I'd be fighting an uphill battle the whole time, even with a doula. Doulas can't magically transform a medically-minded L&D ward into a birth center. Doulas can't speak on your behalf. They can only remind you that you have a right to ask more questions/decline/etc. I'm not willing to compromise and do things like get a heplock instead of a full IV. I want to give birth without any extras unless they are medically indicated and I consent. That's why I gave birth at home.

 

Money really shouldn't be a factor, IMO. If you believe hospital birth is the safer choice for you, that's what you should do. If you believe home birth is the safer choice for you, that's what you should do. Best wishes as you figure out what to do. :)

[Sara R]

Keep in mind that if you are with the homebirth midwife and have to transfer to the hospital (which happens about 10 to 15% of the time--not exactly what I'd call "rare"), you have to pay the hospital AND the midwife. BTDT. I'd go with the doula at the hospital.

 

Remember that if you are unhappy with your nurse, you can request a natural-birth friendly nurse. The nurse probably really wants you to! :)

[WiseOwlKnits]

We had this choice with DS. $3000 for a home birth or $230 for all prenatal care plus delivery. I chose the hospital. I didn't have DS till 42 weeks 2 days so I would have risked out of a home birth anyway. (We were 1000% sure of our dates and he looked post-date when he came out so its not like we miscalculated.). And he ended up a repeat c/s to boot.

 

I probably could have found a midwife to do a home birth this time as a VBA2C, but we have the same maternity coverage so I can't justify thousands when we can do it for hundreds. Having said that, there's a part of me that mourns never getting to home birth. DD says she's having only home births so maybe I can live vicariously through her in 20-something years. :)

[MeerkatMama]

The midwife fees will run us over $4000. The hospital copay with our insurance will run between $400 and $1200 (the absolute max being $1200 for alll prenatal care and delivery). With a normal vag delivery, we will total out at $420 for everything.

 

Are you sure your insurance policy won't pay for your home birth midwife?

 

This greatly varies by state, and I don't know where you live, but I want to make sure you at least check into it. I know in my area, a lot of insurance companies will pay for a Certified Professional Midwife (CPM) care. They will not pay for a Direct Entry Midwife (DEM), however.

 

If you haven't already, I encourage you to check in with your insurance company to see if they will pay. I believe Medicare even pays for CPM's? I know it does in our state, at least.

[daughterofsarah77]

Read up on the patients Bill of Rights. You have your rights to refuse medical treatment. Including your baby going to the nursery.

I personally never advocate for homebirths. I had a daughter who was born with a serious birth defect, and had she been born at home, without medical intervention being right there and immediate, she would not be here.

[funschooler5]

I wouldn't want to have to go to the hospital and take whatever doctor was on call. That's the part of home birthing that would make me anxious.

 

When I had my hospital births (DC #1 & #2), neither one of my OBs were there. One didn't make it there in time for the birth, and the other was on vacation. So even if you're planning a hospital birth you can't guarantee that you'll have that same doctor there.

 

Also, most midwives will travel with you from your house to the hospital, if a trip there is needed.

[HLDoll]

I'm in your same position expecting #5 and struggling with the decision. I had my other 4 in the hospital and the last 2 experiences were awful. We've since switched insurance companies and the new one will only cover CNMs, not CPMs, and the only CNM homebirth/birthcenter practice has me as number 8 on a waiting list. The CPM practice that comes highly recommended by several friends costs $3900. We could have the baby at the hospital for about $100 in copays. I'm having such a hard time with justifying the costs, even though in my heart I really think I'd be happier with the CPM. My husband will likely deploy in the spring and not even be around for the birth and I'd love to be either at home, or able to go home a couple hours after delivery. But cost is a big factor as he gets paid less when he deploys with the national guard than he does in his civilian job. It's heartening for me to hear that most people who paid out of pocket for the midwives don't regret the decision, but in this economy, it's really hard to consider that kind of cost when we're already paying so much for insurance.

[dragons in the flower bed]

I would go with the homebirth midwife. Hospital births are dangerous. Your baby's health is worth $4000. It's unlikely that she will be unavailable, and all of the midwives I have known have worked with apprentices who provide backup if they're unavailable.

[ktgrok]

Well, it seems that your choices are : go to hospital and have a birth experience you don't want, or, choose midwife and have a tiny chance of still going to the hospital and having a birth experience you don't want. In other words, if the worst part of choosing the midwife is you MIGHT end up with going to the hospital, doesn't that still seem better than definitely having to go to the hospital? The only difference I see is that you won't know the doctor already, but I'm not sure how well you would know him anyone with the length of most appointments being all of 5 minutes.

 

I'd do the homebirth midwife. I'd discuss payment with her. She will at the least work with you, i'm sure, on a payment plan. You could end up with a year's worth of payments, or a lifetime's worth of regrets.

 

Also, remember, there isn't just the hospital fee. The anesthesiologist charges separately, so that is a different copay. In fact, the prenatal visits, anesthesiologist, hospital bill, etc are all separate. Ask me how I know :)

 

Do the homebirth.

[ktgrok]

:iagree: Along with the doula, I'd take one of the newer doctors as well.

 

Sorry, I've seen a few births lately with newer doctors. Newer means inexperienced. Newer means probably NEVER saw a natural birth. The one I am thinking of pulled the dead baby card, you will bleed to death scenario to scare my friend into a c-section, only to admit when we questioned her that any of the other doctors in the practice would be comfortable with a vaginal delivery, but she wasn't experienced in twin vag delivery and wanted a c section because she knew how to do that.

 

I'd take an experieneced midwife over an inexperienced doctor anway, just for safety reasons. I want someone that knows how to handle any situation because they have already seen every situation.

[jjins]

I had a situation with baby number two, where the insurance had changed policies. I spoke with my midwife, we worked out a deal where she sort of watched over me, planned to be at my house for the birth, but did not officially take care of me until we were down to every other week. At this point I requested a change to a midwife, insurance declined payment, but I still could go to the hospital if I needed. Midwife would have come in as a VERY good friend, but could only give my husband quiet advice... no privileges at the hospital we had to be at. Ended up costing us 600 instead of several thousands...

 

Mind you my two are only 17 months between my two children and first one was with the same insurance, completely under her care and was born in another hospital, which she had privileges at.

 

So, my advice, talk with who you want to deliver that baby with you, see what you can work out.

[staceyobu]

Are you sure your insurance policy won't pay for your home birth midwife?

 

If you haven't already, I encourage you to check in with your insurance company to see if they will pay. I believe Medicare even pays for CPM's? I know it does in our state, at least.

 

Insurance will definitely not pay. And, the one local midwife isn't working with insurance. So, I don't think it would even be worth trying to fight the insurance policies because then the midwife won't work with them.

 

Also, remember, there isn't just the hospital fee. The anesthesiologist charges separately, so that is a different copay. In fact, the prenatal visits, anesthesiologist, hospital bill, etc are all separate. Ask me how I know :)

 

Our insurance is weird. It is a copay only plan. We have a $20 copay that covers all prenatal care. The hospital is $400 copay for each night maxing out at $1200. There are no separate anesthesiologist, doctor, medication fees, etc. I'm not sure what would happen if a baby went to NICU. That might be it's own bill. But the nursery fee is covered as part of the mother's care. We've (unfortunately) had opportunity to test the hospital fees several times over the last several years. I have never gotten an unexpected bill. So, for a normal vag delivery, with a 24 hour stay, I know for sure I'll pay $420 for the entire pregnancy and delivery.

[Pretty in Pink]

I would hire a doula if you aren't confident in your or your dh's ability to advocate for you during labor/delivery. Are you sure the hospital birth will be *that* bad? I'm only asking because you said, among other things, that they will push for baby to stay in the nursery, which is fairly uncommon these days I believe. I've had four hospital births and I can honestly say that no one *ever* tried to take my baby to the nursery.

[ktgrok]

Insurance will definitely not pay. And, the one local midwife isn't working with insurance. So, I don't think it would even be worth trying to fight the insurance policies because then the midwife won't work with them.

 

 

 

 

Do you have out of network coverage? Also, what are your state laws? Florida insurance law mandates coverage for homebirths, and says that if there is not an in network provider that provides the service they have to cover one that is out of network.

[staceyobu]

I would hire a doula if you aren't confident in your or your dh's ability to advocate for you during labor/delivery. Are you sure the hospital birth will be *that* bad? I'm only asking because you said, among other things, that they will push for baby to stay in the nursery, which is fairly uncommon these days I believe. I've had four hospital births and I can honestly say that no one *ever* tried to take my baby to the nursery.

 

Yes. The baby can room in other than during a transition time for an hour after birth and for an assessment once a shift. So, the baby doesn't have to stay in the nursery the entire hospital stay, but must go to the nursery for the hour after birth and for the checks. These are uncommon practices, except at our local backwoods hospital. :glare:

 

Do you have out of network coverage? Also, what are your state laws? Florida insurance law mandates coverage for homebirths, and says that if there is not an in network provider that provides the service they have to cover one that is out of network.

 

We have no out of network coverage. You either see "their people" or pay 100%. But again, even if I could somehow, by some miracle, get insurance to pay, the midwife isn't working with insurance. So, I don't see any possibility there at all.

[ktgrok]

Yes. The baby can room in other than during a transition time for an hour after birth and for an assessment once a shift. So, the baby doesn't have to stay in the nursery the entire hospital stay, but must go to the nursery for the hour after birth and for the checks. These are uncommon practices, except at our local backwoods hospital. :glare:

 

 

 

We have no out of network coverage. You either see "their people" or pay 100%. But again, even if I could somehow, by some miracle, get insurance to pay, the midwife isn't working with insurance. So, I don't see any possibility there at all.

 

wow. can you just tell them no, they can't have the baby? I couldn't tolerate that! As for the insurance, I mentioned it because if state law mandates it you could at least get reimbursed by the company. but still, I'd pay the out of pocket fee rather than have the baby separated in that critical hour after birth, personally.

[staceyobu]

wow. can you just tell them no, they can't have the baby? I couldn't tolerate that! As for the insurance, I mentioned it because if state law mandates it you could at least get reimbursed by the company. but still, I'd pay the out of pocket fee rather than have the baby separated in that critical hour after birth, personally.

 

Technically, by law, you can tell them no. I actually called and talked to the nurse manager when I was pregnant with my 2 year old to *nicely* ask if they could make an exception. The conversation deteriorated with me *nicely* saying they wouldn't be taking the baby without my permission. period. She kept saying "you can't do that!". So, I really wonder what happens when you say no. :confused: I didn't try it with my 2 year old since we had her at home instead... I mean, legally, they can't touch the kid without your consent... but if they do, then I wonder what recourse you really have? And, of course I worry that they will say they think the baby is in distress to get me to cooperate. Even if she's not... But then it gets harder to argue.

[sweetbasil]

We have no out of network coverage. You either see "their people" or pay 100%. But again, even if I could somehow, by some miracle, get insurance to pay, the midwife isn't working with insurance. So, I don't see any possibility there at all.

 

Most plans have an allowance that, with prior approval, an out-of-network provider will be treated as an in-network provider if there's no in-network provider within 50 miles.

 

I've dealt with this extensively with my homebirths when I had insurance.

 

Also, most insurers will tell you homebirth isn't covered. HOWEVER -- midwifery care is. :) Somehow despite all the legal-ese, 2 of my homebirths were covered. I had to use a CNM with those (CPMs were not covered)

 

Even if your midwife won't file your insurance, you could still pay her and file it yourself.

 

Not sure how much of this is applicable to you, but thought I'd put it out there anyway.

[Veritaserum]

Technically, by law, you can tell them no. I actually called and talked to the nurse manager when I was pregnant with my 2 year old to *nicely* ask if they could make an exception. The conversation deteriorated with me *nicely* saying they wouldn't be taking the baby without my permission. period. She kept saying "you can't do that!". So, I really wonder what happens when you say no. :confused: I didn't try it with my 2 year old since we had her at home instead... I mean, legally, they can't touch the kid without your consent... but if they do, then I wonder what recourse you really have? And, of course I worry that they will say they think the baby is in distress to get me to cooperate. Even if she's not... But then it gets harder to argue.

 

When you are admitted you have to sign a blanket consent form that gives the medical staff permission to do whatever they deem medically necessary to you or your baby. So, they actually can take the baby if they say it's medically necessary. :(

 

You can alter the consent form, though. Above your signature write, "Subject to my informed consent at the time." If the admitting nurse freaks and says you can do that, sign an unaltered form, get settled into your room, and then give a written paper that says, "I hereby withdraw my consent for any nonemergency drugs or procedures for myself or my baby unless you obtain my informed consent at the time." ;)

 

Mandatory nursery time is unjustifiable. Most of the hospitals around here have that policy, too, and it's just so aggravating.

[staceyobu]

Most plans have an allowance that, with prior approval, an out-of-network provider will be treated as an in-network provider if there's no in-network provider within 50 miles.

 

I've dealt with this extensively with my homebirths when I had insurance.

 

Also, most insurers will tell you homebirth isn't covered. HOWEVER -- midwifery care is. :) Somehow despite all the legal-ese, 2 of my homebirths were covered. I had to use a CNM with those (CPMs were not covered)

 

Even if your midwife won't file your insurance, you could still pay her and file it yourself.

 

Not sure how much of this is applicable to you, but thought I'd put it out there anyway.

 

I'm definitely open to ideas on fighting the insurance system. The last time we tried it, they said that to cover an out of network provider, they need a letter sent by a physician stating why you needed medical care that none of their providers can give. Then, that would have to go through their committee and be approved. I know of people who have done this to get a developmental pediatrician covered. However, I couldn't really figure out a way to get a letter from a physician stating I needed care that an OB couldn't provide but a midwife could. Horrid fear of a hospital, maybe? Unfortunately, I don't have a relationship with any doctor here who I think would write me a letter to start with.

 

As far as I know, my state doesn't require insurance companies to provide a midwife option. Everyone I know of who has used a midwife seems to have paid out of pocket for it.

 

When pregnant with my 2 year old, I talked with some out of town midwives. They had never had luck getting insurance to pay for anyone on my type of insurance.

[mycalling]

I'd go with a doula at home. I know, technically unassisted, but you'd have support without the huge cost. I'd use an ob for the pregnancy without telling him/her of the birth plan.

 

That, minus the doula, is our plan for this pregnancy...our 4th unassisted after 2+twins with midwives.

[celticmom]

I would go with the homebirth midwife. Hospital births are dangerous. Your baby's health is worth $4000. It's unlikely that she will be unavailable, and all of the midwives I have known have worked with apprentices who provide backup if they're unavailable.

:iagree::iagree::iagree:I would add that your mental and physical health is also worth $4000.

[butterflymommy]

I "made" my husband spend several thousand dollars on a homebirth despite the fact that it would have been covered 100% in hospital. I really regret that now and wish I'd just gone into the hospital. There are a lot of things you can do to avoid a section, like not going into the facility until you are 3-4 cm, not having an epidural, or if you do, wait till 5 cm. Have a doula with you, etc. In retrospect I feel I was very selfish to take money away from my family to have my "fantasy" homebirth (which turned out to be anything but a fantasy). Sometimes you just have to make unpleasant choices based on financial realities.

[Barb_]

Would a midwife be willing to Doula for you? You could see the doc for regular appointments, and the midwife could show up to monitor intermittintly, watch for any worrisome signs, and help you to realize when you need to head to the hospital to let the doc catch. By that point it's too late for IV's, monitoring, etc.

 

Barb

[ktgrok]

I "made" my husband spend several thousand dollars on a homebirth despite the fact that it would have been covered 100% in hospital. I really regret that now and wish I'd just gone into the hospital. There are a lot of things you can do to avoid a section, like not going into the facility until you are 3-4 cm, not having an epidural, or if you do, wait till 5 cm. Have a doula with you, etc. In retrospect I feel I was very selfish to take money away from my family to have my "fantasy" homebirth (which turned out to be anything but a fantasy). Sometimes you just have to make unpleasant choices based on financial realities.

 

Another way to look at it would be that perhaps it would be selfish to cut costs by having a hospital birth, at the expense of the baby's best interests. If they mom feels that the baby will be subject to things that could cause harm in the hospital it would be selfish of the family to put the baby through that just for the sake of money. Or, if the OP feels that she is in greater danger at the hospital, it would be selfish of her family to put her in harms way to save money. (for instance, my local hospitals all have c-section rates OVER 40 percent. Another county in this state has hospitals with rates over 70 percent! Surgery carries risks) Now, if the money truly isn't there, and there is NO WAY to pay for it, that is different. Or, if the OP feels that she and the baby would be treated as well or better at the hospital, then what I just said doesn't apply. We worried about paying for a homebirth, but my insurance company ended up paying. If they hadn't we would have borrowed money from our 401K though.

[staceyobu]

Another way to look at it would be that perhaps it would be selfish to cut costs by having a hospital birth, at the expense of the baby's best interests. If they mom feels that the baby will be subject to things that could cause harm in the hospital it would be selfish of the family to put the baby through that just for the sake of money. Or, if the OP feels that she is in greater danger at the hospital, it would be selfish of her family to put her in harms way to save money. (for instance, my local hospitals all have c-section rates OVER 40 percent. Another county in this state has hospitals with rates over 70 percent! Surgery carries risks) Now, if the money truly isn't there, and there is NO WAY to pay for it, that is different. Or, if the OP feels that she and the baby would be treated as well or better at the hospital, then what I just said doesn't apply. We worried about paying for a homebirth, but my insurance company ended up paying. If they hadn't we would have borrowed money from our 401K though.

 

This hospital has a c/s rate of just over 50%.

[raceNzanesmom]

Homebirth with a midwife.

 

ETA: Congratulations!!!

[Sara in AZ]

I haven't read all the replies, so my apologies if this has already been suggested or not an option. I had a home birth for my last even though DH was very resistant for many reasons, including financing. I didn't even have an exam until 29 weeks because we couldn't agree on how to proceed. I ended up getting prenatal care at the hospital through the midwives I had used in the past. Then at about 37 weeks I switched over to the homebirth midwife I wanted.

 

In our case that made it so that I got all the prenatal care for the price of one copay and about a 50% reduction in the cost of the homebirth because the midwife deducted all those visits we didn't have with her. Plus baby was born in January so we were able to plan ahead to fund our flexible spending account to pay for the birth.

 

So perhaps you can find someone flexible enough to work with you? Congratulations and I hope you get the birth you are hoping for!