Money and midwifery fees are not often talked about out in the open. Kelly and I realized this as we were studying midwifery with our mentors and became aware once again when we were opening our own practice. We wanted to be as transparent as possible with the cost of our services so that families could make important assessments of how their personal budgets would interact with midwifery costs, and not cause them to have to contact us or come in for a consult before knowing what we charge. We do however realize that cost is one of the greatest barriers to midwifery care and it needs to be adequately recognized and discussed in more ways that just the total fee.
The hardest part for many families affording midwifery care is the comparison to what insurance covers in the hospital for them. It's hard to swallow paying several thousand dollars, often without much time to prepare, and perhaps not fully understanding what you are getting out of it (yet). Midwifery care is hands down the best value when you look at time and care per dollar. At the time this post was written our global fee for homebirth (including almost 2 full years of service) is $6500. The average uncomplicated, natural birth in a hospital starts at eleven thousand dollars, and that's just the birth event!
It is true that many plans will cover most or some of the cost of midwifery care. We have been surprised ourselves when our insurance biller comes back with some reimbursement our clients were told by their insurance company they wouldn't get. There are also plans with very high deductibles, where families having a hospital birth are going to pay more than midwifery care would cost anyway. We can always bill towards deductible in this case so that families can work that number down over the year. Learn more about how we interact with insurance companies here.
Although we have been taught to interact with medical costs in a way that is covered under our insurance plans only, we know that birth is not just a medical event. Birth is a normal process of the body, as natural and sacred as the event that places the baby in the womb. Birth is the moment you meet a child, welcoming her to your family. A birth day is a process of the family, where women transform into mothers and men in fathers. Birth changes you and all that matters in your world in a matter of hours. Preparing for birth is not only nuisance in how to pay the bill, but it is a huge consideration- we know and respect this as your midwives. We have families too, and husbands who watch the budget carefully, and philosophies of stewarding our finances well.
Some of the barriers in affording midwifery care is the willingness to sacrifice financially for it. One of the analogies we use is the meaningful event of your wedding day. Weddings these days are costing around $20,000 and up. When I was planning my wedding so many years ago, I shopped, researched, planned and sacrificed for several months. We asked for contributions from our parents, we lived very frugally to save as much of our own money as possible, and we accepted any help offered to us to keep costs down. It was one of the best days of my life, and I bet yours was too! I want to believe though, that the birth of my children was even more meaningful, more transformative, more important to me and my husband than our wedding. A great wedding does not set you up for a great marriage (if only), but a supported birth does set the tone for empowered and confident parenting. What value do you assign to this experience?
We believe that families who truly want the experience of midwifery care and the benefits of homebirth will find a way to make the finances work. In fact, we are always so impressed when we have clients who have prepared for this cost ahead of time and have savings set aside for midwifery care. However, we also know that sometimes you come upon desiring homebirth unexpectedly and have to make some last minute changes in how all the pieces come together. Check out some of the ideas we have listed here. Sometimes it's helpful to hear how other families have made it work:
"We had 2 healthy babies with uncomplicated births, one in the hospital and one beautiful homebirth. We paid nearly 4x more for our hospital birth. Our hospital care included long waits in waiting rooms and short appointments. I felt rushed and forgot to ask the doctor questions that were concerning me. Our hospital birth felt like a transaction. The drive to the hospital in labor was not pleasant and I could barely stand at the desk while they expected me to fill out several forms. I felt like I was part of their system and had little control over the choices made during labor/birthing/baby care process. Our homebirth experience was so different! We were cared for as a whole family (my husband and 3 year old participated in almost every step). I was given lots of education and coaching to help me prevent problems rather than just treat issues as the arise. I was always given choices. I learned how to approach my own care in a more natural, gentle way. I felt so healthy, strong and supported. It was beautiful to be able to prepare for birth and labor at home. I felt expertly cared for and loved through the process."
- Jenny C., from Carlsbad
"For us it actually cost more to have a hospital birth with insurance than a homebirth without it. And we have pretty decent insurance so that should say something! The health care system is just not affordable for anyone. Also, you're practically rushed in and out, not everything is explained, and you're not taught how to prevent, only treat, you are less likely to have control over you and your baby's medical decisions and feel pressured. You are more likely to end up with an unnecessary intervention that will make the already outrageous cost go up even more and no one needs to come home postpartum stressed about medical bills. Homebirth is like paying for a house but getting a castle."
- Lillie C.
"Initially I didn't dare dream of having a homebirth outside of a hospital because I feared the cost (assuming insurance wouldn't cover anything). I really didn't want to be in a hospital, but thought it might be the only option for our financial situation. To our relief, we realized homebirth was actually the better deal. Aside from amazing care, it was also more economical."
- Homebirth mom in San Diego
As you navigate the cost aspect of considering homebirth, take in some of the options we share for saving money and making it more affordable.
Utilize the discount we give for paying early. We offer $500 off when families pay the balance by 36 weeks with cash or check. This option is great for families that have saved up before hand or can come up with the total cost by the end of pregnancy.
Utilize the payment plan option for getting monthly payments lower. When they are stretched out over a longer time, we will accept payments as low as $500 for up to 6 months after the birth for pay off. This option is great fo families who need a little more time to pay the total fee, or for families who come in late to care.
Get committed to a budget that allows you to live off of less and save more. We have been so shocked ad encouraged with some of the families we work with when they go without a luxury for a time in order to designate more of their income for midwifery fees.
Ask for contributions from family and friends who want to bless you. Instead of a registry full of items you may not need right away (or at all) for the baby, ask for the gift of helping with your homebirth cost.
Consider medical credit and medical loans. We don't love the idea of families going into debt for any reason, especially at a time when financial demands are unknown as they add a person to their household- but sometimes this is the only way for families to make a homebirth work and we believe so strongly in the value of this experience. We have contracted with a couple of viable options for care and credit that are often very low cost or no cost- depending on the borrower's credit and ability to pay within the terms. Contact us for more information on this option.
What aspect of digesting the midwifery fee feels alleviated? What aspect is still a concern for you? Have you thought of a creative option we didn't list? Reach out
to us with your thoughts and questions- this is definitely an area of homebirth planning we want to continue the discussion about!