I’m from what you might call the Cesarean generation. Back when I was born, women were smoking while pregnant, drinking while pregnant, and getting all kinds of unnecessary Cesareans (indeed my mother was three for three); and it all happened in hospitals. According to Midwifery and Childbirth in America, by 1970, over 99.5% births occurred in a hospital setting. Cut to the present.
We have Slope writer/performer Christen Clifford writing comics about home birthing. Erykah Badu twittered from her Brooklyn home-birth early this year. Brooklyn midwives are reviewed like restaurants on Yelp. Advocates say having a baby in your living room is better for everyone involved (except perhaps the carpet cleaners) for a whole bunch of reasons. Aside from the most obvious advantage of home birth—you get to watch your own TV instead of the dinky hospital kind—can it save you a few bucks?
I called several midwife/home-birth centers in Brooklyn and got the same answer time and again: that it’s impossible to say on average how much a home birth costs, because each one is different. And while simple logic might suggest that home birth would of course be cheaper—anyone who’s stayed in a hospital overnight knows how absurd the costs can be—the fact is, whether home birth is truly cost effective depends on one’s insurance.
New York states that requires insurers to cover midwifery services including home births, but it sometimes takes months of wrangling by the midwife and prospective parents to actually see that money.
Says one Brooklyn father, “We’re having a homebirth in a few weeks. Insurance will reimburse a little for ‘out of network provider’ — they say $1,570, our midwife’s money person says the hospital might pay as much as $4,000 and there’s no way to know ahead of time. The midwife is billing $9,000, but she will accept $7500. Basically, we’re going to be screwed on out-of-pocket costs and probably be in debt to the midwife for several years, even if she knocks the cost down somewhat.”
In his case, home birth is turning out to be the more expensive alternative.
He writes, “The real story here is that the insurance company would, without the slightest hesitation, write $20,000 in checks if we chose to have a hospital birth in a city where over one in three ends up in a C-section, yet they stick us with all the costs of a cheap home birth because they have no in-network providers of home births. So the perverse incentive—full-press financial pressure—is for us to go to the hospital and rack up the hugest debt possible, in which case the insurance company will pay without batting an eye.”
Of course, home birth can also be the cheaper alternative. Says another Brooklyn home-birth mom, “My insurance paid the agreed upon amount of $6,800 to my midwife for [my son’s] birth. It is a hassle, but they will pay it in the end from my experience.” Says Laura, also from Brooklyn (if you had to ask), “With my firstborn—we planned a home birth, but ended up in the hospital because of non-emergency conditions—I was fighting my insurance company right up until my 7th month.”
So the actual costs of home birth are probably cheaper, but you may get less back from insurance. But if you’re badass enough to push a kid out with no epidural, why should an insurance company scare you?