the state

– of birth envy. by jhumphrey
Tuesday, 18 November 2008, 13:42
Filed under: -of health, -of jhumphrey, -of localism

after having a lovely, out-of-hospital birth in 2006, i owed exactly $99 dollars to my midwife.  everything else was covered by my washington state-based insurance company.


i was reading a recent NYTimes article and was struck by this final paragraph:

In contrast, health authorities in Britain view home births as a safe option for women at low risk of complications. In April 2007 the United Kingdom Department of Health rolled out plans for a “national choice guarantee,” to be put in place by the end of 2009, ensuring that all women can choose among giving birth at home, or at a hospital or another facility, and still have access to midwifery care.

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives issued a joint statement in support, agreeing that for most women, home births “may confer considerable benefits for them and their families.”


the preceeding statement was this:

The American College of Obstetricians and Gynecologists has had an official policy against home births since 1975, and this year it asked the American Medical Association to adopt a similar statement. The A.M.A. agreed, and in June also condemned home births.

americancollege americanmedical

perhaps because of policies from organizations such as ACOG & AMA, virginia moms often have to work hard to have their homebirths covered by insurance companies.  however, after appealing (sometimes multiple times), many have had success getting full or majority reimbursement of costs.  from the Northern Virginia Homebirth Community website:

We also had BC/BS [editor’s note:  Blue Cross/Blue Shield] Carefirst when we had our son’s homebirth.  You should call and call and call until you get the right person who will tell you it is indeed covered and that you can send your papers to them directly – ask for someone in appeals.  I was told prenatally that we would be covered, then when I submitted after the birth all of the birth related items were denied, the prenatals were all covered.  I called and somehow landed at the appeals desk and the guy kept going away and checking things and then coming back and asking more questions.  Eventually he told me that birth happens with a provider (Tammi) not a company (natural beginnings) and so I needed Natural Beginnings to send me a letter that said Tammi is a provider with them (of course, this was all just coming from Tammi!).  Anyway, we sent that in and I resent all the forms directly to this person and they covered us!  Of course, they covered 70% of the contract rate only because Tammi isn’t in the network.  In the end they paid about 75% of our total birth expenses.  They didn’t cover the birth tub, but I wouldn’t have given that up for the world.

Here’s the guy’s name and address who helped me, not sure if you’re dealing with the same plan, but maybe it will be helpful:

Craig Turner

BC/BS Carefirst

840 First St., NE

Washington, DC 20065


this is all really weird, considering that a homebirth is a HUGE costsaver from an insurance company standpoint.

but…it does make sense when you consider the potential losses to the revenue-driven medical system if the 80% of women who have normal, uncomplicated pregnancies & births take their deliveries (and money) out of the hospital.  sigh.

it’s distressing that the british medical system allows professional organizations to make research-based suggestions while our medical profession is left looking foolish.

here’s what i mean about research: (thanks to cara muhlhahn midwifery)

image by liz rubicam; from cara muhlhahn midwifery website

image by liz rubicam; from cara muhlhahn midwifery website

A recent study of 5,418 women across North America giving birth at home with certified professional midwives found maternal and infant mortality rates matching those of low-risk women giving birth in the hospital, with a significant decrease in medical interventions: 12.1% of women planning to deliver at home were transferred to a hospital, and only 3.7% of the homebirth group were delivered via C-section.

–  Johnson & Daviss, 2005

To read more about the results of this study, click here.

or this:

A study of 1836 women giving birth at home or in the hospital in the Netherlands found no difference between the groups in perinatal outcomes including fetal distress, newborn 5-minute apgar scores, perinatal death, operative or C-section deliveries. Multiparous** mothers giving birth at the hospital were more likely to have blood loss greater than 1000L and to require blood transfusions. In addition, babies from both primiparous* and multiparous mothers giving birth at the hospital were more likely to have problems within the first 24 hours after birth. Overall, multiparous mothers showed slightly better outcomes at home as compared to the hospital.

Wiegers, Keirse, van der Zee & Berghs, 1996

again.  i’m just sayin’…


4 Comments so far
Leave a comment

I’m forever greatful for the fact that we have options when either mother or baby need intervention, but I’m terribly saddened by the increasing use of what should be a life-saving measure as the first option in child birth. I’m also very envious of the way other countries view the process. Other countries see it as a normal activity and we see it as a medical condition.

I wasn’t brave enough to try a home birth after my c-section, but I was blessed to find midwives who would help me try (and succeed) a VBAC.

You’re right though…it’s all about the money.

Comment by Emmy

and it’s all about the chance to make a choice.

i am a firm believer that, as a general rule, childbirth is safest in the place the mother feels safest. for some, that is the hospital, for others, a birth center, and for others, at home.

i’ve said before that i am a labor & delivery nurse. so, i’ve seen many situations where a c-section, or an epidural has been exactly what was needed for a particular birth. i’ve been honored to attend beautiful surgical births, beautiful induced births, beautiful epidural births, beautiful birth center births, and beautiful home births.

i feel so strongly that it’s all about women a.) being able to trust, enjoy, and feel respected by her caregiver and b.) being empowered by the system to make educated choices about where to birth her baby.

Comment by jhumphrey

You’re totally right about that. I went into my first birth trusting everyone but myself. I ended up with a c-section that I believe was unnecessary. I was determined not to let that happen again so I empowered myself to find my comfort zone. I had a beautiful VBAC in a hospital and that situation was perfect. I had a midwife that I trusted, nurses that I trusted and I felt safe in the environment. I think so many women go into it blindly. Plans can change, but you have to have some idea of what you want.

Comment by Emmy

when you trust yourself, your caregiver and your surroundings, who needs a birth plan! plans can change (they always do to some degree) and you can let go of the need to fight; you know that everyone is on the same page already. birth is hard enough as it is. when women feel they have to go in armed to defend themselves, it is near impossible to feel good about the experience in the end!

i work with some great nurses and providers who are always ready to support what the mom and family desire in their hospital birth. it’s a nice environment

how excellent that you were able to have such an empowering experience. you have had the rare and amazing chance to go thought a little bit of everything when it comes to birth – strong mama!

Comment by jhumphrey

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