Homebirth vs Hospital Cost….A few things to consider

Yvonne Silbernagel, CPM and Dawn Karlin, CPM

Many people in Oklahoma pay their insurance premiums every month reassured that if anything happens, they will be able to get what they need. Most have been reassured that birth and their care will be covered because of changes in healthcare a few years ago. Many want to have a homebirth, but find it isn’t covered or it is out of network coverage, and are torn about what they should do.
It is often surprising to people when they get their bill, just how much more it is between the OB, the anesthesiologist, pediatrician, medication, and their hospital stay. We took a survey among other moms and found out of pocket costs with insurance was ranging from zero to  $10,000. Unless they had Federal insurance, soonercare or tricare, many were surprised how much their out of pocket costs were. Those out of pocket costs averaged $2,000-6,000, with insurance.

So why pay a Midwife out of pocket $2,400-3,000? What is so different about the care?

• One hour visits
• Personalized care
• Very little wait time in the waiting room
• True Informed Consent and Refusal
• Costs are up front from the start
• Picking your birth team
• Being in the comfort of your home
• 24/7 – being able to call or text the midwife with any urgent questions or concerns, no answering services or nurse to go through first.
• Honoring your birth plan
• Not being a number….you are a client not a patient
• Less intervention
• Lower cesarean rate
• VBAC availability
• Automatically have skin to skin and delayed cord clamping

Why do moms say they chose homebirth?

– “Paying for a homebirth out of pocket wouldn’t be much more expensive – if at all – than paying our share of a hospital birth.  And I feel my risk for c/section would be higher at a hospital – thus skyrocketing our expenses, not to mention the recovery.  I loved the beautiful simplicity and calm of my homebirth.  And feeling more in control.  I knew everyone in the room well, I chose them.  No strangers, no rushing around doing things without notifying me or explaining – I was consulted and had a voice.  I was free to move about, not strapped to a bed.  I could eat, use the bathroom…I felt human!  Laboring and giving birth in the water – huge natural pain relief!  The water is my zone.  My older kids can be a part – they’re in their zone as well.  And when the baby arrives, it’s just calm.  We’re already home.  In our bed.  In our clothes.  I don’t know anyone who loves hospitals – even if you like the peace of mind of a 24-hour trained medical staff, the space itself is just not a comfortable place, incomparable to your own home.  (And aside from the actual birth, nine months of midwifery care is so much more relaxed and family-friendly than traditional dr visits.  No long waits, no germy clinics, having someone who gives me a solid hour of attention and knows me personally.  No wondering if who I’m seeing will be who actually attends my birth.  Involving my kids in the process.  Involving ME in the process!  Direct calling and texting available at all times of day.  It really feels like someone taking care of you rather than managing your care.)”- Jamie Fraser

– “1. Personal whole woman care

2. Not having to leave the comfort of your home during labor

3. Not having to worry about someone doing something to your baby that you didn’t want
-baths, vaccines, cord cutting, X-rays, sugar water, formula, etc.

4. Not having your baby taken away from you. That first hour to yourself!

5. Peace of mind

6. Instant family time and bonding with siblings and daddy

7. No hospital germs

8. No unwanted visitors

9. No unwanted interventions” – Candace Ousley

– “To put it as simply as possible I would say it’s worth the extra money to have the whole homebirth experience(prenatal care, comfort of home, much more personal and you have a relationship with your midwife, no pushing of interventions from doctors… just to name a few things).” – Kaci Cody

– “For me, I would be paying for a birth either way, so I wanted my births to be family-centered with no restrictions on me or my progression. I loved having water births. That was actually huge for me. The ability to immediately sleep in my own bed and be attended to by birth team was priceless. The personal care that I received in pregnancy and postpartum were worth their weight in gold.” – Deanna Norris

– “Control!  Short and sweet homebirth gave me control. And even though I never achieved homebirth the process empowered me and you can’t put a price on that!!”- Shyla Dwyer

– “People have asked me that and I just say because baby and I deserve the sort of care that comes with choosing the midwifery model of care and doula support.
What’s most important to me is pre/post natal care, laboring alongside people with whom I have a heart connection, and being able to actually rest afterwards in the comfort of my own bed with my own food and things and no timeline of when I need to put my sore vagina into a car and drive back to said home or people waking me up to draw labs and bring me lackluster food. The average American wedding costs 30k and sure, we didn’t even pay a third of that for ours but still more than each of these home birth experiences. Maybe there will be a season where we just couldn’t make it work, there’s no judgement there from me, but it will always be something we will prioritize because my babies and I deserve it. Ultimate self care 🙌🏽” – Erika Cerda

– “Because I wanted a waterbirth! I called every hospital in oklahoma to see if they would let me have a waterbirth and the response was a resounding no. I was healthy, low risk and there was no reason why I shouldn’t be able to have my baby my way.”- Megan Jennings

– “choosing who was going to be there (not random nurses or whoever was on call). The people who would be there were people who loved me and respected my family!”- Tavia Redburn

“I wanted to feel “at home”. To be in my own clothes and my own bed, making my own decisions. After our baby was born, and we were snuggled together in our big bed, my husband cracked open a beer and said, “We are never going back to the hospital. This is perfect.””-Cierra Jennings

“Even though we wound up needing medical intervention in the end (boooo pre-eclampsia) there’s nothing like midwifery care! Personal, client centered visits, so much good information and the ability to make informed decisions. It was worth every penny! Even if I had a hospital birth in the future I would have to do co-care because there’s nothing like good midwifery care!!!” Anissa Cornelius

“I switched to home birth late in my pregnancy after watching “the business of being born” and “breath.” I thought to my self I can do this…I felt empowered! How great will it be to welcome Fin earth-side in the peaceful comfort of our home I thought, and to truly have the uninterrupted bonding time I wanted for my first birth.”- Lillie Khorsand-nia

“I wanted to hold my baby! I didn’t want her rubbed, suctioned, gooped, and prodded if it wasn’t necessary.”- Kelli Walter
“I chose home birth because I was ready to finally trust my body to do the amazing thing it was made for.”- Dacia Pennington
“I wanted to give birth in a comfortable, intimate setting and to make my own decisions for how my baby was born. We wanted our birth to progress naturally rather than be rushed by medical personnel.” -Veronica Krause

“We chose a home birth because we wanted to give our son a peaceful and calm entrance into the world. After having a hospital birth with my daughter, I also knew I wanted to be surrounded by a strength-giving tribe, not by complete strangers. I completely trusted my midwives to do what was best for our family, not what was best for their schedule. Through our time together, they got to know me, and gave me an anxiety & fear-free birth.❤️”- Maryann Maimo

“I chose home birth because after two fine hospital births and one pretty great hospital birth, I finally decided it was time to make my DREAM a reality. I had to work harder than I imagined and there were times I was sure in the end it wasn’t going to work out, but every effort was worth it. Literally not a day passes that I don’t reflect on our homebirth and smile. ❤️” – Alisha Cary

“I chose to give birth out of the hospital because many of the standard practices and policies at hospital don’t give you the best chance at having a VBAC. I wanted to give my body and baby the best chance I could at having a VBAC so I chose to hire an amazing midwife and gave birth at a birthing center.”- Cacey Malone

“I was fortunate to know many other moms who had had home births so I knew it was an option. Not every state allows the freedom to choose. Once we explored the idea by interviewing midwives, we felt safe with it being a good fit for our family. It felt good knowing we could avoid certain risks that come from just being in a hospital. I had a strong desire to birth in my own time and not be rushed or feel that I may need to defend my choices if hospital staff didn’t agree. The idea of not knowing who you may be working with in a rotation of nurses and doctors compared to having one midwife and assistant and maybe a doula who you have built a relationship with and have discussed birth plans with and who you have chosen because you feel they respect your wishes makes for an easy decision.”- Keri Kelley

“I chose a homebirth because I wanted a birth team who love me on top of being wise, experienced, smart, and intuitive. I wanted to give birth in the comfort of my home, where we were amongst the microbes our bodies are used to. I wanted care providers who wouldn’t pressure me into decisions I didn’t want to make; who would see me as an intelligent woman who’s done research and decided what’s best for herself and her baby. I wanted people to care for us who wholeheartedly believed in me to have the birth of my dreams and would never suggest intervention unless it was very necessary. I wanted to eat, walk around, and be minimally monitored. I wanted to be understood, seen, and known. I wanted a team that valued the experience just as much as the healthy baby. I wanted people who understand the heart, soul, and mind are connected to the experience of the body. And that’s just some of my reasons for choosing homebirth. 🙂” – Mindi Hamell

“I chose homebirth because I wanted to feel the comfort and love and care throughout my labor instead of someone coming into the room when it was time to deliver. I wanted to know exactly who was going to be there during my birth and not wonder who would be on call and be introduced to someone at my most vulnerable time. I wanted someone that would watch me and my body and know that when I was in my weakest state would encourage me and remind me of my strength instead of reminding me that I have options to get out of this. Ones that told me it was ok to cry and ok to not be ok for a minute. I wanted a team around me that were safe-keepers of my space. Ones that I could look up and see eye to eye and know they were 100% behind me, praying for me and one look in their eye and I could see and feel the strength and love they were giving me. I wanted to hold my baby as long as I wanted to and not feel rushed to do anything other than hold him/her and just be. And I wanted that proud look after baby comes out. That look of you did it, and you did it beautifully, and I’m so proud of your hard work. That look, That look! you get from your homebirth team who has stood with you for hours and felt the pain and exhaustion along with you. I wanted different, and ones that were ok with whatever that different looked like.”- Morgan Phillips

As mentioned above some choose homebirth for the lower cesarean rate and the ability to VBAC. So, how do area Midwives compare to hospitals in their cesarean and VBAC Rates? 

Out of hospital birth CPM/Senior Midwife/CNM in Oklahoma- the last 5 years

Total births -2013
C-section rate- 6.4%
VBAC rate – 87%

Picture by Megan Markeyl

The World Health Organization says a cesarean rate should be between 10-15%.
It is truly hard to find a comparison for Homebirth vs Hospital data on Cesarean and VBAC rates, because homebirth clients are screened to be low risk and these hospital numbers do reflect women who did want a repeat cesarean.

2013 Cesarean Rates and VBAC Rates

1. OU hospital 28.5%. / VBAC rate >15
2. St Anthony 25.4% / VBAC rate 5-9%
3. Integris Baptist 33%. / VBAC rate too few to count
4. Lakeside 35.6% / VBAC rate too few to count
5. Mercy 37.5% ( The unicorn is bringing change )

Excludes deliveries with complications (abnormal presentation, preterm delivery, fetal death, multiple gestation diagnosis, or breech procedure).

Ok, we are convinced! Now, how do people pay for for their homebirths? What do moms say?

• tax return
• husband did pizza delivery
• art sales
• garage sales (everyone pitched in)  or B/S/T pages
• side work
• sale of a car
• handmade items
• budget cuts
• took photos
• HSA – Health Savings Plan
• payment plan

W. Yvonne Silbernagel, CPM, https://www.amotherslovemidwifery.com

Dawn Karlin, CPM, https://blissbirthok.com