Sunday, November 22, 2009

Frustration... You GET what you PAY for!

PLEASE!! Forgive my Ranting and Raving and Venting... but I MUST just SCREAM a little!

I have recently canceled TWO client consultations because the clients stated that for "financial reasons" they could not consider a home birth.

WHAT is WRONG with this statement??

Do people REALLY understand WHAT they are "getting" for the deductible and co-pay they PAY to the doctor and the hospital?

Consider the costs of hiring an OB/Gyn to conduct a delivery and the costs associated with hospital birth:
  • OB/Gyn fee: $3000+
  • Hospital: $6000+ (if vaginal, uneventful, with no interventions)
  • Minimum Cost: $9000
Insurance will pay a percentage of scheduled benefits after deductible and co-insurance are met.
(Not to mention the "allowable" amount they will consider paying! And charges that they deny.)

So, consider this:

A $10,000 total bill [doc & hosp] (Remember... this doesn't include ANY additional costs such as:
anesthesia/medication, supplies, medications, newborn care, nursery fees, pediatrician fees, anesthesiologist fee, etc, etc... and certainly doesn't TOUCH the costs involved with complications, cesarean section, extended stays, and NICU care!)

Now, suppose the patient's Deductible @ $500 & Co-insurance @ 20%...
Patient Responsibility: $2500 AT LEAST.
ADD additional costs that are almost inevitable and the patient responsibility goes UP!

Consider that the cesarean rate for most doctors and hospitals is OVER 30% and that infant mortality and morbidity rates (death & health problems immediately after birth) put the US in the BOTTOM of the list of industrialized countries...

Now... there's me... a home birth midwife of 16 years and a small-business woman.

My fee is $3500 ! Self pay clients get up to $500 off in available discounts. And what does the client get for paying out of pocket?
  • a specially-trained home birth attendant and her assistant(s),
  • self-determination (her birth ~ her way, including water birth if she desires),
  • daddy intimately involved in labor support & helping catch baby if he desires,
  • no strangers, and plenty of one-on-one, continuous labor support,
  • no unnecessary interventions,
  • freedom to move as she wishes,
  • freedom to eat and drink what she wants,
  • freedom to birth in the position of her choice,
  • having her children, family and friends in attendance according to her wishes,
  • immediate skin-to-skin uninterrupted contact with her baby,
  • delayed cord clamping,
  • immediate breastfeeding,
  • the option to keep her placenta, to do with as she desires,
  • Midwives at her beckon call, 24/7,
  • shall I go on...??

DO NOT forget all the prenatal visits she has (average number visits: 11) that are an hour in length EACH.
Midwives that are on call 24/7 to answer her questions, continuous labor support, 24/7 postpartum and breastfeeding support...


Your doctor won't take your call to talk about the nightmare that bothered you. He won't spend an hour with you at each visit to talk about the issues you need to know or talk about. He won't teach you how to avoid a cesarean section or how to turn your posterior baby around to anterior. He will teach you NOTHING about supplementation, nutrition, fitness, or complementary modalities to help you stay well. He won't educate you about your true informed consent and declination options regarding Rhogam; genetic, gestational diabetes & GBS testing; Circumcision; or the myriad of other important things on your list! He won't come to your home help your baby to latch on to your engorged breasts at 2am, spending the night to help at the next feeding.

Home birth midwives have a hospital transfer rate of ~10% and a cesarean rate of 3-4%.
Studies show that the risk of infant death at home or hospital is the same (for low-risk, term women).
Midwifery clients have:
  • higher satisfaction ratings about their birth experience,
  • breastfeeding success rates that are higher,
  • circumcision rates that are lower...
  • and the list goes on!

The study below indicates that an uncomplicated, vaginal birth at home costs 68% LESS than a hospital birth.
What is 32% of the $10000 total fee above? $3200. Most of my clients pay me $3000.
So there you are... Midwifery and home birth are a huge financial savings to women and their families!

You REALLY do GET what you PAY for!


Rondi E. Anderson MS, CNM and David A. Anderson PhDCorresponding Author Contact Information

12 February 1999.


As health care costs increase and a growing number of women are without insurance, the one health service that every family needs deserves further attention. Even for the 40% of births covered by Medicaid, safe birthing alternatives that permit a reduction in the $150 billion Medicaid burden would allow the United States to devote more resources to other urgent priorities. Informed birthing decisions cannot be made without information on costs, success rates, and any necessary tradeoffs between the two. This article provides the relevant information for hospital, home, and birth center births. The average uncomplicated vaginal birth costs 68% less in a home than in a hospital, and births initiated in the home offer a lower combined rate of intrapartum and neonatal mortality and a lower incidence of cesarean delivery.

My RANT is complete.


  1. Your rant is heard & understood! Get it off your chest and move forward! Thank you for all you do for women and our babies!

  2. Because our society has not fully embraced homebirth, it takes much higher level of commitment. Paying even that very reasonable fee, demonstrates that commitment. The ladies who do not see the value eith aren't there yet, or needed to be educated about homebirth long before they canceled that appointment.

    You should type up a form of this blog and make a brochure to handout at events! It is a great assesment of the value of a midwife.

  3. Yes! So many people don't understand that their "insurance paid-for" hospital birth may actually be more out-of-pocket than their "self-pay" home birth. An epidural alone could cost $2500! Yet some women can't "afford" $300 for a doula? Uh, yeah.


  4. Its about society acceptable excuses. Now after their cesarean they can say, "Don't blame me. I talked to a midwife but she was more than I could afford so its not my fault that the rapist - uh hospital hurt me."
    Look at all the, "I tried breastfeeding but..."
    I didn't make enough milk - okay so supplement don't just stop.
    No one helped me. LLL is free!!!
    it just goes on. No one wants to say I'm a f---ing lazy selfish b---ch who can't spend 60 minutes just talking to someone for free and gathering information. Besides then I wouldn't be just like all my other friends. Who wants to be different and stand out. So what if your health and your babies is at stake?
    I honestly have a family member who told me she would never have tried a home birth or worked with a midwife because she wouldn't want her friends to look at her funny. (Yeah she had a cesarean for failure to progress.)

  5. thanks for the information, Kim. My husband recently lost his job and we are now without health insurance and are living on 1/3 of what we lived on last month...I confess, I've considered calling you to say that we can no longer consider using your services for our current pregnancy. The thought of having another hospital birth terrifies me after all the interventions that took place during the birth of the twins. I'm going to continue to pray that God will give us the finances to cover a home birth this May. Thanks for the information and for helping me to put off making an irrational decision.

  6. Right on, Kim! This issue is truly about commitment and responsibility, and about women reclaiming their own's truly a frightening thing to stand on your own feet, make your own decisions, and accept the outcome as being of your own creation. I think that's the heart of the matter...some people are really just not ready to stop allowing other people to tell them what to do, or what is happening with their bodies that they are apparently not choosing to fully live in.
    I can say with certainty that choosing to pay our midwives out of pocket rather than using insurance 'coverage' was the right choice for my family both times I gave birth...this despite the fact that both times I had babies I found myself living truly on the barest minimum--we even had to sell one of our automobiles when we had our second baby. Even the money part of my relationship with my midwives became a sacred responsibility...and I will never, ever forget the night(3 nights after the glorious birth of my first son)that my milk came in voluminously(and painfully) and I was crying, my baby was crying, and YOU came just as soon as I called you, a shining angel with your long hair in braids and ready to stay the whole night with my family!!! Nothing else can match the level of service and commitment of a devoted midwife. The money stuff was squared away a long time ago...but my soul debt to you and Margie and my Oklahoma midwives can only be repaid by paying such kindness forward every day in every way I can. That's the kind of debt I like to have and it has been worth every dollar that I paid...even when I had no idea where it would come from.

  7. @ Aunt Phibian... Annabel!!! I LOVE you! Can I quote you on my website? Email/FB me!