Is Home Birth Care Worth the Out-of-Pocket Expense?

Screening refers to the application of a medical procedure or test to people who as yet have no symptoms of a particular disease, for the purpose of determining their likelihood of having the disease. …The goal of screening is to reduce morbidity or mortality from the disease by detecting diseases in their earliest stages…Examples of screening tests: Pap smear, mammogram, clinical breast exam, blood pressure determination, cholesterol level, eye examination/vision test, and urinalysis.

-From the NY State Department of Health website

The placenta is arguably the most important organ of the body, but paradoxically the most poorly understood. During its transient existence, it performs actions that are later taken on by diverse separate organs... Its principal function is to supply the fetus…with oxygen and nutrients. The placenta is structurally adapted to achieve this…In addition, it adopts other strategies that are key to facilitating transfer, including… to ensure optimal perfusion.

-From, “The placenta: a multifaceted, transient organ,” by Graham J. Burton and Abigail L. Fowden, found here: link to article

With the out-of-pocket expense of home birth, why is it worth it? The most obvious answers have to do with the experience of giving birth and being born at home. The safety, the comfort, the freedom, the gorgeous and sacred process of undisturbed and quietly supported psycho-physiological birth. But wait - there’s more! Let's talk about prenatal care.

Certainly home birth midwives ask questions and perform tests to evaluate our clients for concerning signs and symptoms. And we have our regulations, policies, and limitations based on risk factors. But care with a home birth midwife is about so much more than risk screening! It even goes far beyond preventative care. The experience of prenatal care with a home birth midwife is meant to be therapeutic, nourishing, healing, enriching, responsive, adaptive, creative, inspiring, empowering, luxurious, educational, encouraging, affirming, validating, and full-service.

In contrast, the screening method of prenatal care in the medical model is risk-based and aims to prevent poor outcomes by predicting possible problems and using medications and procedures, oftentimes just in case. Hospital policies and success rates are determined by statistical analysis. Prenatal appointments are short and often impersonal. Pregnant people are called “patients” and often feel unsatisfied and even traumatized, especially after giving birth. Self-advocacy and self-education are crucial to prepare to exercise informed consent in the institutional environment. Outcomes are comparable to home birth, but interventions and traumatic experiences are far more common.

That said, many nurses, certified nurse midwives (CNMs), doulas, and maternity care activists and advocates moving and shaking in hospital settings work their butts off day in and day out to provide personalized, compassionate care to pregnant and birthing people and babies. They fight for the implementation of evidence-based practices, more and better care options, and longer prenatal visits, and they come up with innovative ways to pack excellent holistic advice into the time they have with the families they care for. The positive strides they make within the hospital system benefit many, many women, babies, and families. Here is a hearty shout-out and massive respect and admiration to all of those heroic individuals! For those birthing in the hospital by choice or necessity, I believe and trust in you and would be honored to support you on your journey as a childbirth educator or doula.

My own path as a mother and midwife is different. As a dancer, my mother taught me body sovereignty from a young age. My martial arts family exposed me to Hawai’ian indigenous wisdom. And my experience with organic farming, nature connection, and Jewish practice revealed my deep-seated desire for living life aligned with nature, spirit, community, and traditional wisdom. My midwifery practice is thus garden-scale, which means I take on about three birthing clients a month. I am on-call 24/7 for my clients as their primary midwife (with back-up!) so that I can provide continuity of relationship-based, whole-being care and still be available for my craniosacral clients, my four children, and my wider family and communities. I like to think of myself as a human placenta (if my husband reads this post, I may never live that one down), conveying personalized nourishment to my clients during the gestational cycle. When all is said and done, you can have your time with me encapsulated in the form of memories and experiences. Or bury me in the back yard and plant a tree. No don’t. Should I edit this part out? Too much with the placenta metaphors? Anyway…

I schedule an hour for each prenatal visit. As long as my clients want to, we use the whole hour. The earlier clients come to care, the more of my time they get. And spacious visits in a safe, relaxed, positive, and richly supportive environment provide the whole being a safe haven in which to unwind and just be.

At each visit, I want to know how my clients are feeling on every level and address what comes up holistically, while staying grounded in the knowledge that pregnancy is healthy and normal and a sacred time of transformation and growth. Symptoms often present an opportunity to create greater ease and alignment. I aim to provide a full-service, one-stop shop, offering lab work, personalized nutritional counseling, herbal and homeopathic guidance, recommendations for movement and meditation practices, bodywork, and sometimes childbirth education. I don’t offer ultrasound imaging. And I will refer midwifery clients for chiropractic care, acupuncture, doula services, childbirth classes and other services as needed.

Another benefit of prenatal care with a home birth midwife is that our appointments are a time for learning about self- and family healing modalities in a way you can really take home with you and carry over into your parenting. As the most direct, primary care provider for the family, a mother or parent is called on to apply their skills, knowledge, and confidence every single day. We get to build resources through experiential education and direct transmission. While my professional designations are midwife, doula, and craniosacral therapist, the truth is that I built up most of my skills as a mother. When I share knowledge, it’s coming from experience working with my own body, my own children, and my clients. It’s personalized for my clients, and easier to absorb and integrate because the learning is experiential. Book learning and internet research can then be layered in more easily atop the experiential foundation.

So, yes, prenatal care costs more out-of-pocket with a home birth midwife, but the benefits extend far beyond anything insurance will cover. Meanwhile, we barely touched on the birth part and didn’t even start in on the postpartum and newborn care! Another time…