Should Health Insurance Call the Shots?

What do you remember most about your child’s birth and the days that followed? Was it the moment she was laid on your stomach and you counted her tiny fingers? Was it when you held him in your arms, claiming his nose and mouth as yours and conceding his hair and eyes to your partner?

I sincerely hope your memories aren’t of worrying how to pay for the birth or hearing that insurance won’t cover rapidly adding up expenses. But sadly, for many of us, that is one of the memories that cannot be erased from among so many happy ones.

In 2009, the average national cost for a vaginal hospital birth (no complications or anesthesia) was $9716, with a cesarean costing nearly $22k! The alternatives to giving birth in the current healthcare dictated system are to not use health insurance and use the hospital’s cash rate, try to negotiate a better rate, or opt out completely and have a home birth.

Although my husband and I are not in a rush for number two, this is a very real issue for the birth of our next child. Our health insurance changed recently and won’t really cover a birth at our choice hospital, which has an amazing team of certified nurse-midwives on staff. Which leaves us with only a few options:

  • birth at a not-so-great but covered hospital
  • birth at the better hospital, but pay minimum $7-8k, but potentially much more, out of pocket (which is just not really an option for us)
  • birth at home

Regardless of what we decide, the underlying issue remains:

At some point in history, our right as women to birth how we want, where we want, and with whom we want, was taken away. I may be just one person fighting her insurance company, but I hope I’m not the only one. As more of us demand midwife-covered births and birth centers, we are more likely to change the very broken birth system in this country. We owe it to ourselves and to our daughters and sons who deserve better.

How has health insurance, or the lack thereof, affected your ability to birth how you wanted? Or are you pregnant now and facing some difficult decisions?

Kate is passionate about women having the birth experience they desire and supports the inclusion of midwifery into the OB/GYN-dominated model. She writes about family life and her inspiring little peanut at Boomerang Mama.


7 thoughts on “Should Health Insurance Call the Shots?

  1. There were MANY reasons why I chose the birth for my daughter that I did but insurance, in general, played a HUGE role…along with liability and hospital protocol.

    I had originally planned to have a hospital birth with my CNM. When I kept finding things the hospital did as routine that I was unable to waiver (which still irks me), I began to seriously consider a homebirth. I had a very healthy and easy pregnancy and I’ve always been a healthy kid. I knew my baby was healthy and all of my red flags went up when the hospital wanted to do EFM, antibiotics, no water birth, force me to undergo a series of questions upon arrival WHILE IN LABOR, etc etc. I finally decided a homebrith was where I felt most comfortable and safe. When I asked my midwife if she was able to attend me at home, she replied “No, because I work under an OB, my insurance policy does not allow me to attend any births outside of a hospital.”.

    So, I went in search of a midwife that could attend my birth at home. There are absolutely none in the town where I live. I emailed every midwife I could find an email address for in the entire state of Arizona and only two responded that they would be willing to drive down to my town (a whole 3 hours by the way) for the big day. One of them wanted to charge me her full $2600 fee which would be out-of-pocket for us since my insurance was already covering the cost of my prenatal care with my CNM. The other one never got back to me. So, at 39 weeks pregnant, I decided to continue with our homebirth plan sans midwife. I could not even find a doula to attend the birth because they are only allowed to attend births where a midwife is present.

    So, to answer the original question, I delivered my perfectly beautiful baby girl at home in my bathtub with the help of my husband and sister because, due to insurance company policies, I was unable to have the hospital birth I wanted and unable to have a midwife come to my home to assist in the delivery of my baby. I am so, so happy I made the choice I did – everything went just as I had imagined and dreamed about – but how pathetic is it that that was the only choice I was left with in the supposedly “free” country that my husband proudly serves, protects and defends??? I think it is absolutely ridiculous. Most women would not choose an unassisted homebirth therefore, they would be left with a choice that they are not 100% comfortable with and that makes me sad.

    This entire experience has made me passionate about educating women, and people, that they SHOULD be able to choose how and where they birth their baby. And that there ARE alternatives and we should all push to make these insurance companies and hospitals and ambulance-chasing attorneys back off and allow women to choose what is comfortable for them. It should be nobody else’s choice but the pregnant woman. I have had so many friends say to me, “I would have loved to have had a homebirth but my insurance company will not cover one”. I had zero expenses in delivering my baby girl other than her pediatrician’s bill when we took her in for her first exam the following morning. Why does it need to be so expensive to bring new life into this world?

    1. Wow Lindsay, your story really impressed me! I don’t know that I would have the courage to birth unassisted, especially with all the baggage I have after my last birth experience.

      You touched on a very important issue. Americans proudly fight for and champion our “freedom,” but yet, women do not usually have freedom of choice when selecting a birthing option. I think it is a major problem in this country that we have such limited access to the midwifery care model or that hospital and birth centers can be quite expensive. And you’re right, for a perfectly healthy baby/birth, it should not be so expensive! Until the model of care changes and women begin demanding something different, we will continue to have to deal with limited options at a high-cost.

      Thanks for sharing your story!

  2. Halfway through my second pregnancy, my husband’s insurance changed. We went from having to pay only one $25 copay, to having to pay at least $2,500. It was a shock and also made the extended maternity leave I had hoped for a lot harder. We had less than a week to figure out how much it would all cost, but thank goodness for flexible spending accounts!
    Keeping my fingers crossed for you that it all works out!

    1. Ugghh…..that’s terrible! They should have “grandfathered” in your pregnancy since you were pregnant prior to the switch. But what employer would foot the cost these days? My pregnancy fell over two insurance calendar years, so I had to pay my deductible twice.

    2. We had a similar issue. Our deductible changed and we owed $5k. But a homebirth midwife was at least that…and in the event I had to transfer to a hospital? I shudder to think of the cost.
      This is such an important issue for many, Kate. Unfortunately we don’t stop to think about it or advocate for others until it’s too late (money-wise). We have even considered going uninsured and saving the money on the front end. No easy answers!

  3. I only had insurance for my second birth of seven. Because I had made a contract for my birth with the doctor that if there were no complications we could go home just hours after the birth the insurance company tried to treat it as outpatient and not pay for the birth. We had to fight it and won after appealing to the state insurance commission. That was back in 1978. My first birth was a hospital birth and cost us a total of $600 for the doctor and hospital. We paid off the second birth before we were ever reimbursed, again about $600. The next 2 births were homebirths attended by doctors in 1981 and 1984 and both cost about $600. My fifth birth was my first unassisted birth and just cost what supplies I got for the birth. That was 1993. My last 2 births in 1999 and 2001 were also unassisted and cost very little for the supplies. I found that not having insurance gave me the freedom to birth as I wanted and work out the best situation at the time for little money compared to most people’s births. Insurance does not pay for the kind of health care I want so I take responsibility for my own health. If I got seriously ill I would still do so. I do not have confidence in a system where dollar bills are the deciding factor and people are not given instruction or treatment that leads to real sustained health, only drugs that mask the symptoms or surgery that maims in many instances.

    1. Wow, Serena. I’m pretty impressed with the way in which you took charge of your health. Many of us (myself included) feel like the “system” is the only way to have a baby, but in fact, opting out might be the healthiest route to go.
      Thanks for sharing your experiences! I would be interested to hear more about your homebirths.

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