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Home birthing and health insurance costs


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  #1  
October 12th, 2009, 03:12 PM
Quantum_Leap's Avatar frequent flier
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The thread on WIC and formula, along with the thread on TTC with no health insurance, got me thinking about this.....

How much money could we save as a nation if more women were to have home births with the use of a midwife rather than births in a hospital? I start from the premise that FAR more women are capable of having a homebirth than are currently doing it. After all, historically, almost all births happened at home, and there's no reason that women are biologically any different today from what they were in the 1700's or 1800's.

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?
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  #2  
October 12th, 2009, 03:36 PM
KimberlyD0
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How many deaths of mothers and babies would we once again have when uncomplicated pregnancies and births turn deadly at the last minute??

I am all for people doing homebirths if they want, but I don't think everyone should be forced to.
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  #3  
October 12th, 2009, 03:44 PM
beck12's Avatar Platinum Supermommy
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How much money could we save as a nation if more women were to have home births with the use of a midwife rather than births in a hospital?

Quote:
'Mothering Magazine has calculated that using midwifery care for 75% of the births in the U.S. would save an estimated $8.5 billion per year." (Madrona, Lewis & Morgaine, The Future of Midwifery in the United States, NAPSAC News, Fall-Winter, 1993, p. 15)
After all, historically, almost all births happened at home, and there's no reason that women are biologically any different today from what they were in the 1700's or 1800's.
And before anyone says women & babies died by the hoards BEFORE hospitalized birth became the norm:
Quote:
"The international standing of the U.S. [in terms of infant mortality rates] did not really begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologist (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950s the U.S. has consistently ranked below 12th place and hasn't been above 16th place since 1975. The relative standing of the U.S. continues to decline even to the present." (Stewart, David, International Infant Mortality Rates--U.S. in 22nd Place, NAPSAC News, Fall-Winter, 1993, p.38)
Corroborating Citations on the Safety of Homebirth

I guess for me to some degree home birth always seemed pretty safe as most of my family members who are over 60 were born at home.....and I have known this always. As a kid I thought it was "old fashioned" but not scary.

It wouldn't bother me if they changed the standard of care so that you only saw an Ob if you had some issue that needed more potential medical intervention & all others who were healthy & had no predisposition would see a midwife. I don't see this happening any time soon though. Heck at this point I would just love to see that every hospital would have a midwife that is associated with it so that every woman had access to a midwife - a problem I am dealing with now.
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We've begun to raise daughters more like sons... but few have the courage to raise our sons more like our daughters. ~Gloria Steinem

If a man has been his mother's undisputed darling he retains throughout life the triumphant feeling, the confidence in success, which not seldom brings actual success along with it. ~Sigmund Freud
My mom is a neverending song in my heart of comfort, happiness, and being. I may sometimes forget the words but I always remember the tune. ~Graycie Harmon
Don't wait to make your son a great man - make him a great boy. ~Author Unknown
You don't raise heroes, you raise sons. And if you treat them like sons, they'll turn out to be heroes, even if it's just in your own eyes. ~Walter M. Schirra, Sr.
A man loves his sweetheart the most, his wife the best, but his mother the longest. ~Irish Proverb
Mother's love is peace. It need not be acquired, it need not be deserved. ~Erich Fromm
Children need love, especially when they do not deserve it. - Harold Hulbert
Mother is the name for God in the lips and hearts of little children. ~William Makepeace Thackeray
God could not be everywhere, so he created mothers. ~Jewish Proverb
The best conversations with mothers always take place in silence, when only the heart speaks. ~Carrie Latet




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  #4  
October 12th, 2009, 03:49 PM
Quantum_Leap's Avatar frequent flier
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OR, how's this for an idea: women who chose to have a home birth could receive a tax credit from the government! Kudos to them for saving the rest of us money.
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  #5  
October 12th, 2009, 03:51 PM
beck12's Avatar Platinum Supermommy
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Quote:
Originally Posted by KimberlyD0 View Post
How many deaths of mothers and babies would we once again have when uncomplicated pregnancies and births turn deadly at the last minute??

I am all for people doing homebirths if they want, but I don't think everyone should be forced to.

What do you mean "once again"...like women & babies dont' die today in hospitals?
Quote:
"Every study that has compared midwives and obstetricians has found better outcomes for midwives for same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. The superiority and safety of midwifery for most women no longer needs to be proven. It has been well established." (Madrona, Lewis & Morgaine, The Future of Midwifery in the United States, NAPSAC News, Fall-Winter, 1993, p.30)
Quote:
The Texas Department of Health's own statistics show that midwives in Texas have a lower infant mortality rate than physicians. (Texas Lay midwifery Program, Six Year Report, 1983- 1989, Berstein & Bryant, Appendix Vlllf, Texas Department of Health, I 100 West 49th St., Austin, TX 78756-3199.)
Quote:
"Of the 3,189 midwife-assisted deliveries studied, episiotomies were done on 5 percent of the women, the Caesarean section rate varied from 2.2 percent to 8.1 percent, and perinatal mortality (the number of babies who die during or shortly after birth) averaged 5.2 per 1,000. Compare these numbers to those for New Mexico obstetricians and physicians during the same period: nearly routine use of episiotomies in many hospitals, a Caesarean rate that varied from 15 percent to 25 percent,and a perinatal mortality rate of 11.3 per 1,000. Looking at these numbers, Rebecca Watson, the maternal-health program manager at the New Mexico Department of Health commented, 'I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else's. " (Sharon Bloyd- Peshkin, Midwifery: Off to a Good Start, p. 69, Vegetarian Times, December 1992)
Corroborating Citations on the Safety of Homebirth

Stats & real numbers do not back up that low risk assessed women are at ANY greater danger for home birthing & in fact I have found NOTHING to show they are at any higher risk whatsoever.

If you have a source that says that the average low-risk pregnant women has a higher mortality rate or higher infant mortality rate with home birth - I would like to see it. There is NO way I would ever consider a home birth if there were increased risks...especially after having had so many losses. But the info I have been able to find that gives real numbers supports low risk women giving birth at home with a licensed/certified midwife to be the safest option.
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B - Crazy momma to my two boys
We've begun to raise daughters more like sons... but few have the courage to raise our sons more like our daughters. ~Gloria Steinem

If a man has been his mother's undisputed darling he retains throughout life the triumphant feeling, the confidence in success, which not seldom brings actual success along with it. ~Sigmund Freud
My mom is a neverending song in my heart of comfort, happiness, and being. I may sometimes forget the words but I always remember the tune. ~Graycie Harmon
Don't wait to make your son a great man - make him a great boy. ~Author Unknown
You don't raise heroes, you raise sons. And if you treat them like sons, they'll turn out to be heroes, even if it's just in your own eyes. ~Walter M. Schirra, Sr.
A man loves his sweetheart the most, his wife the best, but his mother the longest. ~Irish Proverb
Mother's love is peace. It need not be acquired, it need not be deserved. ~Erich Fromm
Children need love, especially when they do not deserve it. - Harold Hulbert
Mother is the name for God in the lips and hearts of little children. ~William Makepeace Thackeray
God could not be everywhere, so he created mothers. ~Jewish Proverb
The best conversations with mothers always take place in silence, when only the heart speaks. ~Carrie Latet




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  #6  
October 12th, 2009, 04:11 PM
**Badfish**'s Avatar Worth Saving
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I'm okay with midwives becoming the standard. I would not be okay with any type of incentive or force for home births. As someone who has never experienced an uncomplicated delivery, the idea of not being at a hospital is really scary to me. I hate that I ended up with a c-section, but I am grateful I was near an OR.
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  #7  
October 12th, 2009, 04:22 PM
fluffycheeks's Avatar Mega Super Mommy
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I'm all for women being able to choose the way they want to give birth, but that goes both ways. Homebirths are not for everyone and no one should be forced into it.
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  #8  
October 12th, 2009, 04:23 PM
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Quote:
Originally Posted by KimberlyD0 View Post
How many deaths of mothers and babies would we once again have when uncomplicated pregnancies and births turn deadly at the last minute??

I am all for people doing homebirths if they want, but I don't think everyone should be forced to.
Ditto. Not all women are comfortable with the idea of birthing at home, and I don't think they should be pushed into doing so. I know personally, with my son I had an uncomplicated pregnancy and a VERY difficult birth. Had we not been minutes away from a well-equipped OR, we'd have both died.

Now, if insurance companies want to stop covering epidurals, I would be much more amenable to that.
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  #9  
October 12th, 2009, 04:23 PM
fluffycheeks's Avatar Mega Super Mommy
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Quote:
Originally Posted by brui77 View Post
OR, how's this for an idea: women who chose to have a home birth could receive a tax credit from the government! Kudos to them for saving the rest of us money.
Well, the government has never paid a single medical bill of mine, so I don't see how me having a home birth would warrant money from the government.
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  #10  
October 12th, 2009, 04:48 PM
AMDG's Avatar Margaret
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Quote:
Originally Posted by brui77 View Post
The thread on WIC and formula, along with the thread on TTC with no health insurance, got me thinking about this.....

How much money could we save as a nation if more women were to have home births with the use of a midwife rather than births in a hospital? I start from the premise that FAR more women are capable of having a homebirth than are currently doing it. After all, historically, almost all births happened at home, and there's no reason that women are biologically any different today from what they were in the 1700's or 1800's.

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?

I prefer the idea of birth centers over home births - would there be a reason why you advocate home births and not birth centers as an equally viable option?
I think first there needs to be a lot more education - our societies perception of pregnancy, medical intervention, and overall health and well being would need to change. We may be heading in that direction but it seems to be a so go. So, I would say I agree that hospital births and unnecessary c-sections are huge waste of money and absolutely crazy but it is the norm in our day and age - we need to start with more education and then look at changing the insurance coverage.
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  #11  
October 12th, 2009, 05:19 PM
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I would just be happy with my health insurance paying for my homebirth. As it stands, I have to cover the total cost for it myself b/c they refuse to cover homebirths. By the way, today a homebirth with a midwife cost $2600 in Ky - that includes all pre-natal care as well. That is a heck of a lot cheaper than a hospital birth - Bella's hospital bill was well over $10K over three years ago and it was very uncomplicated - I did have an epi. but everything else was totally normal.

Since I am having a homebirth I have been doing lots of research on this. Statistically speaking, a woman who is low-risk is just safe, as well as her baby, having a birth at home as she is having one at the hospital. Some studies find the mortality rate to be a little higher for hospitals. Doctor's said that was b/c they had all the high risk patients. So one study looked at a hospital (in Brooklyn I think) with high levels of intervention (inductions, c sections etc.) and fetal/maternal deaths. They started a midwife program - although they didn't have homebirths the patients in that program were statistically far better off than the ones who saw the hospital's ob/gyns. The countries with the highest rate of homebirths have the lowest fetal/maternal death rates.
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  #12  
October 12th, 2009, 05:23 PM
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Liability. The government (or private insurances) don't want to be liable for any birth accidents that could have been avoided had they been in a hospital. Just because you have an uncomplicated pregnancy does not mean you will have an umcomplicated birth. I can't tell you how many times I have been called back to a delivery (I work in a NICU) of someone who had an uncomplicated pregnancy but for one reason or another the baby ends up in distress. Why would we put every woman (and baby) in danger to save a few bucks? For me, if one baby is saved because they had immediate care then it would be worth it for everyone to be in a hospital "just in case." There are so many things that can go wrong during labor and delivery that can't be predicted...why risk it? I could go on and on...
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  #13  
October 12th, 2009, 06:24 PM
AMDG's Avatar Margaret
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Quote:
Originally Posted by BabyBird View Post
Liability. The government (or private insurances) don't want to be liable for any birth accidents that could have been avoided had they been in a hospital. Just because you have an uncomplicated pregnancy does not mean you will have an umcomplicated birth. I can't tell you how many times I have been called back to a delivery (I work in a NICU) of someone who had an uncomplicated pregnancy but for one reason or another the baby ends up in distress. Why would we put every woman (and baby) in danger to save a few bucks? For me, if one baby is saved because they had immediate care then it would be worth it for everyone to be in a hospital "just in case." There are so many things that can go wrong during labor and delivery that can't be predicted...why risk it? I could go on and on...
But the government or private insurance isn't liable for the "birth accidents" that could have been avoided had they been home births rather than a hospital birth and so why would it be the case when it is the other way around?
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  #14  
October 12th, 2009, 06:26 PM
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Originally Posted by donomama View Post
Well, the government has never paid a single medical bill of mine, so I don't see how me having a home birth would warrant money from the government.
No, but your insurance premiums go up whenever someone else who is on your same insurance plan submits an expensive claim. Home birthers who are on your same plan save you money, at least relative to those who have their births in hospitals. (Technically, people who choose not to have kids would save you the most money of all).
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  #15  
October 12th, 2009, 06:29 PM
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Quote:
Originally Posted by brui77 View Post
No, but your insurance premiums go up whenever someone else who is on your same insurance plan submits an expensive claim. Home birthers who are on your same plan save you money, at least relative to those who have their births in hospitals. (Technically, people who choose not to have kids would save you the most money of all).
Oh, I understand how insurance works, I'm just unclear why the government should pay out when it doesn't affect them.
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  #16  
October 12th, 2009, 06:44 PM
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Originally Posted by Brie View Post
So one study looked at a hospital (in Brooklyn I think) with high levels of intervention (inductions, c sections etc.) and fetal/maternal deaths. They started a midwife program - although they didn't have homebirths the patients in that program were statistically far better off than the ones who saw the hospital's ob/gyns.
Yes! My hospital has a midwife program and the differences between it an the OBs are staggering. For instance, the c-section rate for the midwives is maybe 7%, while its 38% for the OBs.
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  #17  
October 12th, 2009, 06:57 PM
TheOtherMichelle's Avatar Platinum Supermommy
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Insurance companies should pay for homebirths and birthing centers, but no woman should be denied care in a hospital if that is what she is comfortable with or forced to pay out of pocket for an epidural.
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  #18  
October 12th, 2009, 06:58 PM
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Quote:
Originally Posted by AMDG View Post
But the government or private insurance isn't liable for the "birth accidents" that could have been avoided had they been home births rather than a hospital birth and so why would it be the case when it is the other way around?
Because the question was why shouldn't health insurance compaines EXPECT all women with complication-free pregancies to try for a home birth. As it is now no one EXPECTS a woman to give birth at home.

I am wondering exactly what birth accidents you are talking about that could be avoided at home rather than in a hospital? The things I am talking about are cord accidents, abruptions, fetal distress, secondary apnea resulting in respiratory distress, meconium aspiration...and more. These are things that have nothing to do with where the baby is born but without immediate attention can be deadly...but with immediate attention can be resolved safely.
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  #19  
October 12th, 2009, 07:05 PM
(.Y.)mom2dd(.Y.)
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Originally Posted by BabyBird View Post
Liability. The government (or private insurances) don't want to be liable for any birth accidents that could have been avoided had they been in a hospital..
I think that's the entire problem here. You're assuming that the hospital avoids birth accidents when statically it's the hospitals that cause the birth accidents.

Quote:
Originally Posted by donomama View Post
I'm all for women being able to choose the way they want to give birth, but that goes both ways. Homebirths are not for everyone and no one should be forced into it.
^ I agree with this.

I'm a huge advocate for homebirth, and midwifery because of my birth experience. However first and foremost, I advocate for the mothers. Too many moms out there are like BabyBird and truly think the hospital is the best place for them to give birth. Birthing moms need to be respected and feel comfortable. If they feel comfortable in a sterile hospital on a bed with drugs and surgeons close by, that's their choice.


Quote:
Originally Posted by BabyBird View Post
Because the question was why shouldn't health insurance compaines EXPECT all women with complication-free pregancies to try for a home birth. As it is now no one EXPECTS a woman to give birth at home.

I am wondering exactly what birth accidents you are talking about that could be avoided at home rather than in a hospital? The things I am talking about are cord accidents, abruptions, fetal distress, secondary apnea resulting in respiratory distress, meconium aspiration...and more. These are things that have nothing to do with where the baby is born but without immediate attention can be deadly...but with immediate attention can be resolved safely.
Midwives are trained to deal with these "accidents." I think you're assuming that only hospitals are equipped to deal with these senerios.

Last edited by (.Y.)mom2dd(.Y.); October 12th, 2009 at 07:07 PM.
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  #20  
October 12th, 2009, 07:07 PM
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Quote:
Originally Posted by donomama View Post
Oh, I understand how insurance works, I'm just unclear why the government should pay out when it doesn't affect them.
Because the government has a public interest in reducing health care costs for everyone, in order to improve the general standard of living. It's the same reason the government sponsors programs encouraging us to quit smoking, start exercising, and eat healthy. Not really their business, strictly speaking, but beneficial nonetheless.
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