Wednesday, September 23, 2009

Baby talk: midwives, insurance, all that

I'd like to tap into the Biblical Christianity Brain Trust on my DAOD's and BSIL's behalf.

Here's what they'd like to know:
  1. Do any of you have experience with midwives (or are you one)? If so, how did it go? 
  2. Does anyone know what associations of midwives (or individuals) are compatible with the AIM program in California
For us in Sacramento, that would be a widwife who is a part of Healthnet Insurance.

If there is no one compatible with AIM, how much might a midwife cost, out of pocket (fee break down, please)? 

Do you know whether similar government aid available for home births as it is for ob's (AIM, etc).

If some of  you ladies have knowledgeable friends who don't frequent this blog — well, first of all, what's that about? Hah? But secondly, maybe they could drop by and leave a pearl or two.

Thanks in advance. DAOD will monitor your responses, and probably feed me some follow-ups... unless she takes the plunge and gets herself an ID. In that case... watch out.

27 comments:

Aric said...

Well, I don’t know if I would be an actual member of the BCBT, but if you will allow junior members to comment, I’ll provide what info I can.

My wife and I have 5 children. We had the first 3 in the normal, hospital fashion. For the last 2, we did home-births with a midwife. I cannot speak for my bride (maybe I will point her here for some comments), but I found the midwife experience to be great.

In talking with others who have done the midwife thing, a large part of the success depends on the midwife herself, so look for a good one. As a husband, I liked being in my own home and found it to be very relaxing. My wife would agree with the relaxing part.

We chose midwife for a variety of reasons. Money was on the list, but so was the opportunity to do a water birth (which my wife recommends). In addition to cost savings and freedom to use other birthing techniques, I liked that we weren’t jumping on the doctors and hospital bandwagon, as if that is the only way women have given birth in the last 6,000 years. Now before I receive harsh rebuke, please note that I am all for doctors, hospitals, and medicine. However, I think we sometimes think a certain route is ‘gospel’ just because our society holds it in high regard. If nothing else, I encourage everyone to examine why they do what they do.

Anyway, I cannot speak to the AIM program. I do know that the states differ in what the midwife can do (injections, stitching, etc.), so that may be a factor. If a midwife is out, another alternative that is offered in certain hospitals is a midwifery as part of the hospital. The midwife is there to deliver, but the wife/husband/grandparents can rest more easily knowing that the hospital is just down the hall. Friends have had wonderful midwifery experiences, and if we had one in our town, that is most likely what we would do for our next child (if we have more).

The cost of our midwife was $1,500, if paid in full by the 36th week (I think). If not, the cost was around $2,500 (?). I know she did have success with some insurance companies, so it may depend on the coverage. All in all, I would recommend exploring it as an option. Hopefully my exceedingly long comment will provide at least one granule of help. Feel free to email me if you need more details about our experience or friends who have used midwives.

DJP said...

Thanks, Aric! Welcome to the society.

TM said...

When we were in Maryland (we are now in NC), we used a midwife for our first child. Our second child (in NC) was with a ob/gyn because there are no local midwives where we live.

The midwife we used in MD was part of a midwife practice that was backed up by another ob/gyn practice. This is golden because midwives typically don't handle "emergency" procedures (e.g. if a c-section is necessary or high-risk pregnancies). So in the case that we actually NEEDED (which we didn't) a baby doc, we had instant access to one.

The experience was good, both for my wife and me. Usually the draw to a midwife is a more touchy-feely one, that you get more attention. For example, many ob/gyn's don't spend too much time with the patient prior to The Big Day.

Our midwife was attentive, answered our questions, reassured my wife about diet, weight gain, etc. And I liked that she was patient to answer my repeated questions.

During the birth, she was very patient about her patient (like you didn't see THAT pun coming). PLUS we were BOTH more comfortable with a female handling us.

Really the main thing for us was that we didn't feel "institutionalized" with the midwife. She was less concerned about watching her own back (which some docs tend to do, and unfortunately rightly so because of all the silly malpractice suits) and more concerned about us and our needs. Some docs are quick too quick to do c-sections or induce. We didn't get that feel from our midwife.

As for insurance, I can't speak on Cali. In MD, the midwife route cost no more through our insurance than a standard ob/gyn. But that was 3 years ago, and things change monthly in Insurance World.

That's my two cents.

In Christ
Tom

TM said...

Oh, and -- the birth itself was in the hospital. The midwife used to have a "birth center" at their facility, but it closed shortly before we started going to them. So I can't speak about the "home birth" experience.

Tom

dwitzke said...

Dan,
My daughter has used, and is about to use again, a midwife for birth. She is also a doula (a birth helper), so I know she is knowledgeable about this topic. I am going to send her the link to this, and encourage her to interact. I hope she can also be of help, as Aric was.

ulfbiggorilla said...

Though my wife and I haven't had children yet, I thought I'd pipe in and say that my older sister has had 4 kids, 3 in a hospital and 1 at home with a midwife. My brother's wife has had 3 kids, 1 in a hospital and 2 at home (water births)...both those ladies would tell anyone they met that they recommend home births wholeheartedly. And its cheaper. But I have no details so sorry..I'll see if I can get them to provide those for you.

Sir Aaron said...

Some friends at church used a midwife, I believe. I e-mailed them asking if they could drop by the blog or send you an e-mail.

Sir Aaron said...

Cheaper depends on your insurance plan. My wife has her second C-section scheduled. We pay nothing for maternity benefits at a hospital. Midwife...that's altogether different.

Most insurance plans have a benefits guide. You'd look for what your insurance covers under "maternity benefits."

Sir Aaron said...

http://www.gentlebirth.org/

Also, go to Healthnet.com and do a search. Nurse/Midwives is one of the search criteria

Student of History said...

I had all of our children at home with various midwives and they were wonderful rich and safe experiences. A good website to check out would be this one: http://www.collegeofmidwives.org/
and this one:
http://www.californiamidwives.org

At the second link you can find a midwife in your area. While we used only Christian midwives, there are all kinds out there. Ask the questions that are important to you up front!!

We did pay out of pocket for several births, anywhere from $2500-$4000 and this was almost seven years ago now. It was worth every penny to us because we really wanted homebirths. One midwife knew we could not afford to pay for her services so my husband went and worked off the money on her ranch. That was a blessing from God.

I cannot help you with information on medical coverage for a homebirth as the type of coverage we had did not cover it. (We did have Christian medical sharing for two births and they covered those.)

If your daughter has any questions about any aspect of a homebirth or wants more information from a mama who has been there and done that five times, have her email me. I am also in the Sacramento area.

underthesky@gmail.com

Congratulations to all!
Warmly,
Kate

Wascally Wepublican said...

I don't have any knowledge of midwives even though we have 6 children. But sense your talking about birth and I just looked at my calendar HAPPY BIRTHDAY!!! From the mountains of north Georgia.

DJP said...

Thanks, W{2}.

beachbirdie said...

I also don't have info about midwives but hats off to your daughter for exploring all the possibilities and not getting sucked into the "doctor-hospital" routine. All my 4 were born in the hospital, but I would have loved a midwife-attended home birth.

I really just piped in here to add to the "Happy Birthday" chorus. You share your day with my youngest (and most easily delivered!). Natal felicitations!

Rhology said...

My wife and I have used midwives for each of our two children.
First time - we were gonna have the birth inside their converted-house facility. We loved their care. Cost was ~$2800 for all prenatal visits and a coupla followups including the birth event. We had to provide a list of furnishings, towels, etc, for the birth event, which was probably ~$100-150.
(Ended up that our baby had fetal distress and so we went to the hospital. Midwife accompanied us. The doc was a collaborator with them, so it was a great experience, all-natural, dang my wife is a trooper [I'm very proud of her]. Only thing was that it cost another $2000 or so. Insurance paid most of that, but I paid cash for the midwives.)

Second time - diff midwives, with an established hospital. So it was all insurance-covered, usual copay and all that. My wife liked their care pretty well and of course their big distinctive is all-natural births.

This is in the OKC area.

DJP said...

Rachael asks me to tell you — really, she does; not like OSO — that AIM doesn't cover "alternative medicine."

Mary said...

I have had two births in hospital with certified nurse midwives. The
experiences varied greatly due to the interventiveness of the first
and much more hands off second. It's very very important to do your
own research and not just take what your provider is aging as the only
truth. I believe as Christians we need to very careful to be good
stewards of ours and our babies bodies, by bring informed and knowing
what is going on.
Interview any care provider before signing on. Ask questions such as those you can find here http://www.motherfriendly.org/pdf/Having_a_Baby-English.pdf
Homebirth is as safe as hospital http://acnm-midwives.blogspot.com/2009/04/bjog-study-finds-homebirth-as-safe-as.html In my opinion, it's usually safer for low risk moms, because a midwife is not going to be doing a ton of interventions, like are very common at the hospital, even with hospital midwives (like my first one). Cascade of Interventions http://www.childbirthconnection.org/article.asp?ck=10182

Great books to read:
The Thinking Woman's Guide to Childbirth by Henci Groer (this is a book that explains procedures and interventions, gives pros and cons and is very understandable)
Ina May's Guide to Childbirth by Ina May Gaskin, CPM
Sometimes midwives will barter or have a sliding scale, don't let $ be a deterrant from at least talking to her.
But overall, it's the woman and her husband's decision, and whatever they are most comfortable with. They need to do their own research, so they can really take responsibility for their birth, home or hospital, and know that they've picked the best provider possible, in God's will, so that they can really trust them.

Herding Grasshoppers said...

Dan... I had no idea.

Happy Birthday!



For your DAOD,

I worked for an OB/GYN before I had kids, and wanted that doc to deliver my babies. He had some kind of arrangement with a couple of the reputable midwives in our area to manage their high-risk patients. (Because reputable midwives don't let high-risk patients, which includes "ordinary" things like multiples, deliver at home.)

It's really, really a good idea to use a midwife who has "backup". Either she herself has hospital privileges or she has an arrangement with an OB/GYN.


Truly, I'm not biased against mid-wives or a home-birth, just because I've worked for a doctor :0)

In most pregnancies and deliveries everything goes fine, but when things go 'south' they can go faster than you might expect, so it's good to cover your bases just in case.


My word of warning is this:

Many, probably the vast majority of midwives, are wonderful!!! If your pregnancy and delivery is basically normal, you'll have a great experience (as great as L&D can be...) and a successful home-birth.

Some - hopefully a minority - midwives have a chip on their shoulder against the medical community and will hold onto cases they really shouldn't.

Congrats on your pregnancy :0)

Julie

Daryl said...

Of our 6 2 were born in the hospital with doctors (1 C-Section), 2 were born in hospital with midwives and 2 were born at home with midwives.

My wife would tell you that there was no comparison. One midwife was less than ideal, but, in both cases, the doctor's care was vastly inferior to even the poor(ish) midwife.
When my wife had her first home-birth and said, while expressing her pain in groans that cannot be uttered, "Why didn't anyone tell me about this before?" I knew that midwifery was the way to go.

The pre-natal care, post-natal care and the birth itself are all vastly superior with a midwife.

Oh, and they know about women and babies, doctors, even good ones, really don't.

Sir Aaron said...

AIM's website as well as that of healthnet both imply that they cover the use of midwives.

Autumn said...

You've already received some wonderful "pearls" so nothing new to really add but for us the the cost was never really an issue (for that matter neither was whether or not insurance would participate).

The reason being, our decision to use a midwife was due to a conviction that birth is not a medical emergency, which is what hospitals are for. We paid roughly $2000 for midwifery care. When choosing a midwife you want one that really clicks with both the husband and wife.

I can't imagine being limited to just the ones on my insurance plan. Sometimes it takes 8 interviews to find "the one".

And just in case she's worried about the "what ifs" I've experienced the "what ifs" which resulted in a transfer (that is what hospitals are for) and I'll still go back to having a homebirth for the 5th and future babies ;)

James David Beebe, Jr. said...

2 kids, birthing center, South Carolina. My wife and I say this humorously, but mean it truly: the idea of having a baby in a hospital seems weird and scary to us.

I have great respect for our midwife, Amy Leland. She has a good balance of knowledge of what is best left natural, the way God designed it ... balanced with some good old "sometimes you need a doctor and some drugs" common sense. Her knowledge, experience ... rapport and bedside manner with my wife ... I'm glad to have an opportunity to chime in with a positive comment for midwifery.

A hospital's attitude toward everything seems to be "we'll do everything we can." And that's a problem: they'll do everything they can find an excuse for, whether it really needs to be done or not. A midwife will tend towards "let it happen naturally, intercede if necessary."

I'm biting my tongue with the hospital anecdotes, I'm sure you don't need them...

James David Beebe, Jr. said...
This comment has been removed by the author.
Sir Aaron said...

JDB:

It's interesting to see just to see how different everyone's preferences are. Last week I was just talking to one of my friends about having the kids born at home. Neither one of us would do it, under any circumstance. Of course, I don't have a choice this time around anyways. No way a Dr. will allow a natural birth after a C-section these days. The C-section is already scheduled and we still have three months.

I would think that insurance would prefer the midwife route. My wife's hospital bill for the last baby was something like $30K. But then again the miscarriage in between was expensive too and that was just an outpatient procedure.

It's great that most of us have a choice. I'd hate to see everyone boxed into one method.

Daryl said...

Sir Aaron,

Are you serious? They really won't allow a natural birth after a C-Section? I'd push against that if I were you.
Our first was a section and the next 5 were natural, 2 of them at home.

Sounds like you've been unecessarily been boxed into one method.

Sir Aaron said...

Daryl:

In all honesty, I think my wife prefers the C-section. I don't go with her to all the appointments. The last appointment the Dr. had scheduled the procedure. when I asked my wife about it, I got the distinct impression she just preferred it this way.

Our first child didn't tolerate labor well so I'm just guessing that we couldn't do VBAC at this point.

Daryl said...

Aaron,

Either way, bless you and your wife and the little one yet to be met.

Children are a gift, however they arrive.

Van said...

My wife had our first child last month at home with a midwife. She wanted a water birth, which isn't available at our local hospital, so she went with a midwife. The midwife was well qualified, she has actually trained many of the other local midwives in the area. (I live in the middle of a fairly large Amish community, who mostly use midwives for birthing.) I did pay her cash... my wife's insurance would have covered the hospital completely, but the midwife wasn't included.

Our midwife wanted to meet with both of us before she would consider birthing our child, mostly to ensure that there wouldn't be any personality issues popping up during labor. Some good questions to ask a prospective midwife include asking about pain management techniques, policy regarding late births, what happens if there is tearing, and what the emergency plan is if there is a problem.

My wife has every intention of having future babies at home, in the water. She was very satisfied at the results of her first home birth.