October 21, 2009

approximately 4,000 more reasons it would have been great to have birthed at home:

Despite all the planning and preparation that we did before Lincoln's arrival, one thing we never really spent much time thinking about was the expense of the actual birth itself. Part of the reason for that was the fact that we are fortunate enough to have health insurance, and the midwives that we worked with were chosen from a list of preferred providers on the insurance company website. Once we were certain that our midwifery care would be covered at the same rate as a traditional hospital birth (80% in our case), we just filed it away as something that we didn't really need to be concerned about.

We were soon pleased to discover that one perk of midwifery, and especially homebirth, is that the cost of care is really minimal. And by choosing to birth at home, we were even able to avoid the fee that the midwives charge to labor and deliver in their (lovely) birthing center. Instead, we were simply given a list of things to order from a hospital supply website. The total cost of our birthing kit was just $35 and included such things as a footprint kit, a nasal aspirator, and a whole slew of various absorbent and protective pads. We opted to spring for the labor tub ($300) and the doula ($350) out of pocket because we felt that it was a small price to pay to have everything just the way we wanted it to be in the comfort of our own home.

Well, obviously, things didn't exactly go as planned. We ended up starting our birthing adventure at home with our midwives, labor tub, and doula, but ending it at UW Medical Center in an operating room. And again, fortunately for us, we have health insurance through my husband's employer. And yes, it covers labor, delivery, and recovery at 80% regardless of where it takes place as long as you're with a network provider. And yes, UW and their doctors are in the network just like our midwives.


(I know you had to see that coming!)

Turns out that giving birth in a hospital is A LOT more expensive than giving birth at home would have been! And since hospitals and doctors charge based on what's known as fee-for-service, we even got to pay extra for the cesarean! And we got to pay the anesthesiologist once for the epidural that I received when we first arrived at the hospital, and again for the anesthesia that I received during the surgery! And one fee for the room that we were set up in when we arrived, and a separate fee for the room that we recovered in! When it's all said and done, even just our 20% portion of the hospital bill amounts to more than the total fee that we would have owed the midwives without insurance! And not even just a little more- like a thousand dollars more!

Does your brain hurt yet? That means that for less than $3,000, we had nearly a whole pregnancy's worth of prenatal care- including home visits, three midwives in attendance during my long labor, and post-natal follow-ups. Our 72 hours at UW? More than $20,000! Something just isn't adding up!

I'm not going to get into the politics of the whole thing here, but I think that it is sufficient to say that health care here in America is a broken system. I am grateful that we are fortunate enough to be among the insured, but even with that benefit, Lincoln's birth is going to cost us much more than we ever imagined. And what if we hadn't been insured? The family that doesn't have access to health insurance benefits probably doesn't have $20,000 to pay hospital bills.

The last two episodes (391- More is Less & 392- Someone Else's Money) of This American Life offer a glimpse into the health care system in America, and as always, they're intriguing to listen to. Listen on the web or download in iTunes, it's a good use of an hour or two!

You can also visit the website of The MAMA Campaign to read about some important work that our midwives are involved in to help make midwifery available to more families.