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Home birthing and health insurance costs


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  #41  
October 12th, 2009, 10:49 PM
(.Y.)mom2dd(.Y.)
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Babybird: We're just going to have to agree to disagree. I feel at this point we will be just arguing to argue. (That and I have to go to bed.)

Kimberlydo: I didn't say all breeches as your posts insinuates.. I guess I just misunderstood your point in that other thread. (i don't have time to dig it up either.)

I'm glad to know that people are confident and happy with their hospital births. I understand that people aren't willing to birth at home because of their positive experiences. I look back at my birth knowing a homebirth would have prevented many medical mishaps that occured. I don't assume that my experience would supersede anyone else's experiences. Although homebirth may not as respected by all posters in this thread compared to a hospital birth, I do know that possible homebirth is the right choice for me, and others. Even though not all moms would want a homebirth, I would fight tooth and nail for their right to have a hospital birth without restriction.

((bowing out of debate))
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  #42  
October 13th, 2009, 01:08 AM
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Quote:
Originally Posted by KimberlyD0 View Post
Having had an "uncomplicated pregnancy" that became a "complicated birth" (breech baby) resulting in an unplanned, unwanted section, things are not always
When you look at states of midwives vs OB's it must also be noted that midwifes take ONLY low risk uncomplicated pregnancies. So of course they run a lower number of complications on average.
While this may be true for countries that are "friendly" towards midwives and homebirths it is not always true. I know for a fact my midwife takes patients that would be deemed high risk (breech, multiples, maternal diabetes, preeclampsia, all by one congenital heart defect etc). I can't say I would be willing to continue with a home birth if I fell into that category, but I know many others sill do. If my midwife will take on these patients I think others out there would also.

As for the stats being skewed, read my original post on the first page that talks about how one study factored out such a skewing and the midwife results were still MUCH BETTER than the ob/gyn outcomes.
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  #43  
October 13th, 2009, 05:42 AM
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Quote:
Originally Posted by brui77 View Post
No, birth centers would be fine too. From a strictly financial perspective, any low-cost, low-intervention form of birth would be preferable to a hospital. I'm not well-versed in the relative costs of birth centers v. home births, but I would imagine that they're fairly comparable.



Why not? They're nice, but they're elective -- not medically necessary. I have to pay out-of-pocket, if, say, I want the nice big comfy private room at the hospital to give birth rather than the small, tacky, shared room, because this is an issue of comfort and not of health. Aren't epidurals the same thing?
I don't disagree that epidurals are overused. But... Not all labors are created equal. Some truly suck. Mine did. I blacked out and felt like I was having an out of body experience. Some women have back labor, back to back contractions, days of labor where they need to get some rest to have energy for pushing. I've talked to other mother's who have had similar experiences in both hospital and homebirths/birth centers. I had flashbacks for several weeks following my daughter's birth. I'm not the only one. Some women have such traumatizing experiences that they never want to give birth again. Others only do it with an epidural and guess what? They actually have a happy birth experience the second time around. Sometimes you just get **** handed to you and I don't think an insurance company has any right to tell you that it's simply just comfort, like having a nice spacious room. Most of the women I've seen talking about their experiences are on Mothering.com and were ones who were prepared for a NCB, just like I was. I didn't get induced (if that's what you were thinking). I had a doula.. I did everything "right"

What about women who have to get induced for medical reasons? The pitocin tends to make labor worse, but should they have to suffer through it or pay out of pocket?

I support every woman to make an educated decision about her birthing decisions, and that SHOULD be backed up by the medical profession and insurance companies.
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  #44  
October 13th, 2009, 06:46 AM
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Originally Posted by (.Y.)mom2dd(.Y.) View Post
Kimberlydo: I didn't say all breeches as your posts insinuates.. I guess I just misunderstood your point in that other thread. (i don't have time to dig it up either.)

No but you did say midwives deliver breech babies. Which, strickly speaking isn't true. Dependent one where you are, there experience and the type of breech.

In Ontario at the birth of my first child no midwife OR OB would do a breech delivery. At the second she would have allowed it, BUT it it wasn't a compleat (frank) breech. DD#2 was a little off to the side, still "flouting" AND I had a previous section. So section is way.

Now I know that sections are WAY over done, but mine were not done lightly. Especially the second one.

Personally I think that we should have have the right to whatever we feel is safest IF its feasable. Someone with a prelaps or pre-e should not be allowed to birth at home, someone with no complication should be able to have a home birth. I hope that the US does become more excepting of midwives because they're wonderful, but I also know OB's are importent and in short supply.
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  #45  
October 13th, 2009, 06:56 AM
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Originally Posted by brui77 View Post
So, why shouldn't health insurance companies expect all women with complication-free pregnancies to at least try for a home birth first, before they offer to cover the costs of a birth in a hospital? After all, for all other medical issues, insurance companies expect you to try the least-cost, least-complicated intervention/treatment first before they refer you to anything more elaborate (i.e. you don't go to see a specialist right away, you have to see a GP first).

Of course, women who opted to have hospital births could still choose to do so, but they would have to pay the difference themselves, the insurance companies would only cover the cost of a midwife. In the long run, this would save health insurance costs for all of us.

Thoughts?
This may be beyond the scope of this debate, but if we were to realistically go forward with this it would require so much research, studies, statistics to determine exactly what qualifies as a "complication-free pregnancy." Maybe I'm wrong, but I doubt that insurance companies have the time or resources to examine every pregnancy individually to determine that. And I can't imagine them coming up with hard and fast rules that would encompass all factors. Including this: what if a woman who has an uncomplicated pregnancy lives too far away from a hospital to risk a home birth? Should insurance companies determine how many miles is too far away? What if they set it at 50 miles, but someone 49 miles away and is required to have a home birth under this policy has a problem in delivery but doesn't get there in time?
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  #46  
October 13th, 2009, 06:57 AM
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I would just like to add that I also feel that my insurance not covering midwives (not that one would take me, but there are lots of other women with the same coverage) forces women into hospital births in the same way that if my insurance didn't cover a hospital birth it would force me (or the women with the same plan) into a home birth. It's not fair either way and I think it should be up to the mother. It would be nice if you could just go to the hospital and labor there without a dr shoving an IV and a pair of stirrups at you, but once you are there you are their responsibility so they'll want to do what they were trained to do even if you don't like it.

Anyway you ARE readinga lot into those statistics, there is no evidencet hat the dutch have a better infant mortality rate due to their system. you do realize that those numbers are DEATHS per LIVE births? Maybe the dutch have more stillbirths, those don't get counted in the infant mortality stats. In fact a lot of countries boost their rankings by NOT reporting the uh close calls. In the US a lot of what would have been still births get counted in the infant mortality rankings because the baby is barely alive when born and then dies anyway. A midwife does not have the equipment to percieve whether or not a baby is just barely alive not to mention the fact its a lot easier on the parents to hear "stillborn" rather than "oops your baby just died". PS I'm sorry if my previous arguement on the stats didn't make sense the point I was trying to make is that you can explain those numbers anyway you want to make your point. They don't mean much in the industrial nations, the infant mortality rate is basically the same across the board, its just in how the still births are counted. It's been well documented that Japan and Singapore in particular (two of the top rated countries) leave out anything even close to a stillbirth, a baby with a serious defect, anything. They really only count babies that are clearly alive and in one piece who then die. So those numbers don't mean much because those countries have turned it into a giant p****** contest. Kind of funny and kind of wrong.

I'm sure midwives recieve a lot of training and really know how to get a woman through a text book birth, but I'll take my chances in a hospital. I definately think that midwives should be covered by insurance as well as OBs. I think a lot more women would go for it if they could afford it, I would have gone for it but I definately would have gone with a birthing center attached to a hospital and not a home birth.
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  #47  
October 13th, 2009, 07:54 AM
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I think homebirths and hospital births should be equally covered. To say epidurals are a luxury is not always true. I had a planned natural delivery with my youngest. I actually ended up with PTSD afterwards and numerous health issues. Only after I lost the ability to walk, and the use of my hands did I learn that people with my condition (EDS - Ehlers-Danlos Syndrome) should not give birth without drugs because our labors tend to be shorter and more painful and therefore put a lot of strain on our already weak bodies. I wonder how different my body would be had I gotten an epidural.

I'd love a homebirth, but thats not in the cards for me. I actually want(ed) to be a midwife if I can ever regain the use of my wrists. But I support choice, and the womans right to chose what type of birth she has.
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  #48  
October 13th, 2009, 08:13 AM
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Originally Posted by pumpkinpie24 View Post
This may be beyond the scope of this debate, but if we were to realistically go forward with this it would require so much research, studies, statistics to determine exactly what qualifies as a "complication-free pregnancy."
They would do it the same way they do for any other issue whether it's unclear whether or not insurance should cover something -- through a doctor's referral. If you had some kind of complication or other issue that would merit coverage for a hospital birth, you would simply need a doctor to sign off confirming that this was the case. All the insurance companies would need to see is the 'permission slip.'
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  #49  
October 13th, 2009, 08:21 AM
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But you are talking about two totally different things. I am all for the government offering programs to teach people about these different topics, but so far, as far as I know, the government doesn't cut you a check if you quit smoking.
Well, no, because for that issue there's no bright line. How could I prove that I had quit smoking? I could claim to have done so, then pick up the habit again as soon as my check was cashed. In contrast, it's easy to prove whether someone had a hospital birth or a home birth.

And, for the record, the government quite often offers tax credits in order to encourage people to do things (for example, the first-time home buyer's tax credit). Maybe our country's health care crisis would be more manageable if we simply added home births to the list.
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  #50  
October 13th, 2009, 08:26 AM
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Also... women are biologically different, sorta. Our nutrition is better... makes us healthier, right? Well it also means BIGGER BABIES and MORE FULL TERM BABIES. Bigger, more full terms babies, and women with the same sized hips.
Um, I don't know for sure, but I think that better nutrition would also lead to bigger hips. (At least in my case )
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  #51  
October 13th, 2009, 08:29 AM
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To answer the original question, I wouldn't force any type of delivery on anybody. I do think insurances should pay for homebirths, birth center births and hospital births. I'm not sure about having an incentive. It would be nice. We get to pay less for our insurance because we don't smoke. So, would it be nice to pay less for insurance for agreeing to try to have a homebirth, that would be great.

I have had 4 hospital births and am planning a homebirth with this baby. In my first three, I had a midwife who delivered at the hospital. With my fourth, I didn't have that choice. So, I found a family doctor who had the same beliefs I did and she delivered. However, I had a doula present and my midwife with my 3rd baby came and "helped out". With each of my hospital births, more and more interventions happened. Never a c-section.

This time around I want to have a homebirth. My choice. My insurance will pay 80% of it if I give birth before January. If not, I will end up paying for it. (Our insurance is switching). It sucks. But, certainly not something I would check myself into the hospital for an induction a couple weeks before my due date. We'll deal with paying it.

I also am at risk for a breech. My last 3 have flipped around. My 3rd baby flipped breech and back in labor. My midwife now has delivered breech babies at home and is comfortable delivering mine if she's breech. She has also delivered twins before at home.

I also have MTHFR - a folic acid deficiency and even though I was told I was high risk with this, I did research and my midwife did research and we are both comfortable doing this at home.

Now, something may change and I may end up transferred. I will be extremely disappointed if this happens. But, I trust my midwife to know something is wrong and to tell me it's time to transfer.

But, back to the question... I think insurances should pay for all deliveries, no matter what.
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  #52  
October 13th, 2009, 08:39 AM
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Quote:
Originally Posted by Lilmom View Post
I would just like to add that I also feel that my insurance not covering midwives (not that one would take me, but there are lots of other women with the same coverage) forces women into hospital births in the same way that if my insurance didn't cover a hospital birth it would force me (or the women with the same plan) into a home birth. It's not fair either way and I think it should be up to the mother.
I have to agree with this. Maybe this is being approached the wrong way. I think if there were more education/coverage for homebirths, more women would be inclined to at least consider it as an option.

If the insurance companies are really inclined to save money, maybe a better approach would be a difference in coverage. For example, my job's insurance covers delivery. If I deliver at my job (I work at a hospital), my copay for it is $250. However, if I deliver somewhere else, it's $600. So while I am not "forced" to deliver only at one place, if I want to deliver somewhere else by choice, I'm choosing to pay the extra to do so. I probably would have even considered homebirth had the cost been closer to what I was paying for my hospital birth.

I think to deny coverage altogether is wrong. Despite what happened years ago, some people just don't feel comfortable delivering at home, just the same as I felt/feel more comfortable delivering at a smaller hospital than a large hospital, despite the fact that the smaller hospital doesn't have a NICU. However, I don't see the problem with paying more for those same comforts.
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  #53  
October 13th, 2009, 08:45 AM
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Originally Posted by brui77 View Post
Um, I don't know for sure, but I think that better nutrition would also lead to bigger hips. (At least in my case )

In my case as well, but thats fat. HAving fat on your hips doesn't make it easier to have babies. The size of the actual pelvis is unchanged. And anyway, my poorly made point was that I could misinterpret those statistics just as well as anyone else. Liek I said the real trick is that those countries misinterpret still birth vs/ live birth in an attempt to get a better number.
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  #54  
October 13th, 2009, 09:35 AM
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Originally Posted by brui77 View Post
Um, I don't know for sure, but I think that better nutrition would also lead to bigger hips. (At least in my case )
^Ditto. And let's not forget about those corsets that were so en vogue; the whale bone or steel "stays" compressed and deformed a woman's torso, often misaligning ribs and vital organs.
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  #55  
October 13th, 2009, 11:02 AM
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I'm with the group of not forcing anyone into one particular type of birth. However, I'd like to see more education on the benefits of having midwives and/or a home birth if the situation merits it. I've had midwives for all of my births and would trust each and every one of them with a home birth. I had some minor complications in my first delivery and my midwife called in an OB just in case. Turns out he wasn't needed but she didn't hesitate to call in for a back up resource just in case. Just like I know she would have me rushed to the hospital should I have wanted to birth at home and the same minor complications arose. I can see having some sort of incentive but like some PPs have mentioned, it should come from the insurance companies.
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  #56  
October 13th, 2009, 03:07 PM
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Originally Posted by brui77 View Post

Why not? They're nice, but they're elective -- not medically necessary. I have to pay out-of-pocket, if, say, I want the nice big comfy private room at the hospital to give birth rather than the small, tacky, shared room, because this is an issue of comfort and not of health. Aren't epidurals the same thing?
Not in the hospital where I gave birth. The midwife just nagged and nagged and nagged and told me how I needed it until I gave in.
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  #57  
October 13th, 2009, 03:17 PM
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How exactly does a hospital cause a prolapsed cord or placental abruption...or other things that have nothing to do with where they are? These things happen without warning.
Breaking the waters may cause the cord to prolapse. I was hounded to have at least my waters broken at the hospital when I was "stalled" at 4cm for over an hour.
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  #58  
October 13th, 2009, 03:38 PM
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Breaking the waters may cause the cord to prolapse. I was hounded to have at least my waters broken at the hospital when I was "stalled" at 4cm for over an hour.
OMG - I came in dialated at 3 (5:30pm) & I didn't hit full dialation until about 7amish the nest morning....no one ever suggested I had stalled...but I am SURE I stayed the same somewhere in there for more than an hour....since it took me 14 hrs to go 6cm....I was average a centimeter every 2 hrs.
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  #59  
October 13th, 2009, 04:09 PM
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Originally Posted by Lilmom View Post
If you take away insurance coverage for it, you are taking away the choice. If my insurance didn't cover a hospital birth there is no way I could pay for it and we both make decent salaries really.
Maybe, but there is also an issue of supply and demand at work here. If fewer women were to have hospital births, then it is very possible that the cost of a hospital birth would go down. The hospitals would have to lower their price in order to do business. (Which, come to think of it, also means that the cost of a midwife would go up, but let's not go there).

Also, the insurance companies would still give you the amount of money that it would cost to have a home birth. All you would have to pay is the difference.
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  #60  
October 13th, 2009, 05:13 PM
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Originally Posted by brui77 View Post

Also, the insurance companies would still give you the amount of money that it would cost to have a home birth. All you would have to pay is the difference.

Which is only several thousand dollars. Out of reach for many Americans. I am all for the insurance company (not the government) giving incentives for home births, but denying coverage for hospital births is one of the silliest ideas I have heard yet in the healthcare debate.
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