The Cost of Being Born At Home


Yesterday
in New York City,
Julie Finefrock
appeared before the health fund subcommittee of the Service Employees
International Union (SEIU) as part of her appeal of their denial of
her homebirth coverage. Ms. Finefrock, who is six months pregnant, is
married to an SEIU employee. Their insurance plan excludes homebirth
coverage, despite New York State regulations that require that private insurance cover out-of-hospital
birth with a licensed practitioner.
Ms. Finefrock’s situation is just one example of a larger fight to
increase access to homebirth nationally, and it’s a fight that has
ramped up due to new media attention to the issue.

One
mother laboring with her midwife on the roof of her Cobble Hill penthouse,
gorgeous Manhattan skyline in the background. Another holding her newborn
on her living room couch, exposed brick and high ceilings behind her.
These are just two of the scenes from the November New York Times article and slideshow about the growing interest among New York
City women in birthing at home. These images paint a very specific picture
of homebirth–all the women were pictured in spacious, nicely decorated
apartments and, with the exception of one African-American woman, all
were white. Watch the popular Ricki Lake documentary The Business of
Being Born
, released
last year, and you get a similar story: Lake and her interviewees
were all financially well off and could afford to choose to birth at
home. Neither the Times article nor Lake’s film touched on one
thing that all these women seemed to have in common–money.   

Despite The Business of Being
Born
‘s
relative
popularity, the film only reaches and speaks to a limited audience.
"The Business of Being Born is fabulous, but low-income women
are not seeing it," says JayVon Muhammad, an African American Certified
Professional Midwife (CPM) in Sacramento  "The midwives that
are promoting it don’t typically have low-income women in their client
base…[Even when low income women see the film, they] don’t see women
that look like them, economically and ethnically, they can’t see themselves. 
They think that only ‘those’ women do that." 

Upwardly-mobile
moms in New York City may finally be catching on to the benefits of midwifery
and homebirth, but low-income women are still firmly planted in the
hospital most often with medicalized births overseen by doctors. Current
efforts to transform birth – offering women more options and preserving
their decision-making – are not reaching low-income women. Birth activism
draws attention to the ubiquitous media portrayal of highly interventionist
births, the normalization of c-sections, and the lack of choice afforded to women by their doctors, whose hands, in turn, are tied by hospital
policy and malpractice fears. The criticisms made by birth activists
are accurate yet incomplete. Missing from these conversations is how
low-income women – who suffer the worst outcomes for their babies,
including lower
birth weights and higher infant mortality rates

– are making decisions about where and how to give birth.  

The
maternity reform movement’s frame of consumer choice
(exemplified by the name of one of the primary advocacy organizations, Choices in Childbirth) may be at least partially to blame. This
frame neglects the reality that many women can’t make a choice at
all. "I work in a (very) low-income Medicaid clinic in Sacramento,
and the women all have Medicaid or Family Pact as insurance," Muhammad
explains. "Medicaid doesn’t cover homebirth, so even if women choose
to have homebirth, they are not covered, leaving no choice at all.
As a result, when women show an interest, and very few do, they don’t
have a choice. They are forced (due to lack of money, and insurance)
to deliver in the hospital."

There
are a number of barriers to low-income women giving birth out of hospital.
As Muhammad highlighted, Medicaid is the first. Medicaid and other state
health insurance programs generally do not cover out-of-hospital births.
According to Steff Hedenkamp, Communications Coordinator at The
Big Push for Midwives
,
only in nine states can CPMs (who account for the majority of homebirth
practitioners) register as Medicaid providers. Even in those states,
very few CPMs go through the process because of bureaucratic red tape.
Yet even if a woman has private insurance, she often faces similar barriers
when trying to choose out-of-hospital birth. The estimated $4000 that
a homebirth costs without insurance coverage might not be an impossible
hurdle to cross for a middle class family, but is a near impossibility
for low-income women.  

Medicaid
policy may be the most significant logistical barrier, but it isn’t
the only one standing in the way of low-income women delivering outside
the hospital. Doulas and midwives who work in low-income communities
of color see the barriers as being social in addition to financial. Muhammad explains: "In low-income black communities, which I am a product
of, we don’t learn about natural birth, or birthing choices." 

Claudia
Booker, an African American doula in Washington, DC, agrees. She explains
that women in low-income communities of color stopped giving birth outside
of hospitals at least three generations ago. There is also a sense,
she noted, that giving birth at home is "what poor people do and [that
homebirth] was something we did because we had no option." This history
reflects a larger transition among US women giving birth at home to
hospital birth, which happened in the 1920s. Low-income communities,
and particularly African American ones, took longer to make this transition
because of poverty, racism and lack of access to hospitals. Now the
paradigm has shifted and hospitals are where low-income people get most
of their health care.  

Another
barrier to home birth for low-income women is concern over birth certificates
for their babies. In recent years, particularly since 9/11, obtaining
passports and other citizenship documentation has become increasingly
difficult. The crackdown has focused on people born to midwives at home.
Immigration authorities have begun questioning
the validity of documents

from these midwives and holding those individuals to a much higher burden
of proof. This has had a disproportionate
impact on Latinos
and other
immigrants, requiring them to go to great lengths to obtain passports
and other documentation. Claudia Booker thinks this fear of citizenship
being questioned may keep low-income people from leaving the hospital
to give birth.  

The
media depictions of home birth moms are not far off from the demographics
of those at the helm of the maternity reform movement. This small collection
of organizations and individuals, primarily made up of midwives, doulas
and mothers, is predominantly white and middle class.  Steff Hedenkamp
from the Big
Push for Midwives
readily
admits these shortcomings. "You could say we’re not doing enough
to reach out and engage with lower income women, and it’s probably
true. We’re not doing enough on every level." It’s difficult to
say whether it’s merely a demographic issue, or reflective of something
larger, but it’s clear that the demands of the maternity reform movement
are not promoting the needs of low-income women. Even if the Medicaid
barrier were to be eliminated, the education provided by films like
The Business of Being Born
need to be geared specifically toward
low-income women or they aren’t going to leave the hospitals anytime
soon. "My clients don’t know a thing about homebirth, nor do they
understand why they would even consider such a thing," explains Muhammad. "They
are not educated about the benefits of birthing out of the hospital
or birthing without interventions.  Many of them think the elective c-sections
are okay, and can’t wait to schedule theirs, as they have friends that
have." 

One
thing that all these advocates can agree on is that the current health
care crisis may provide an opportunity for real maternity reform. During
such shaky economic times for the health care industry, cost cutting
is a definite priority. Steff thinks birth might be the perfect target
for savings, as midwives cost less than obstetricians, and vaginal birth less than a c-section. "If anyone is doing real healthcare reform, they have
to look at the cost of maternity care. A thirty-percent c-section rate
and rising? It’s not sustainable. No way." These reforms may have
a chance of reaching low-income women, particularly if lower cost birth
options, like midwives, homebirth and birthing centers become part of
a universal health care package.

Muhammad put it plainly: "If Medicaid
doesn’t start covering homebirth, any positive changes toward homebirth
will not benefit poor women.  They will have to choose between
homebirth and food, and food will win every time."

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Follow Miriam Pérez on twitter: @miriamzperez

  • http://www.unnecesarean.com invalid-0

    My experience with out-of-hospital birth was a free-standing birth center located minutes from Tijuana, B.C. on the U.S. side of the border. The women sitting with me waiting for prenatal appointments were often 50/50 English speaking and Spanish-speaking (maybe bilingual but conducted all interactions with staff in Spanish). When I started blogging about birth, I was kind of (but not extremely) surprised to see that EVERYONE is white. My doula at that birth is a homebirth midwife and is African American and she is the only African American midwife that I know. The fact that almost everyone I interact with in the maternity reform community is white has been glaring me in the face for the six months in which I’ve been involved.

    I’m really glad you wrote about this, Miriam. As a middle-class, white woman, I have my theories on why middle and upper class white women are way more likely to be vocal advocates for health care reform in general. We have agency and a voice in society. Grassroots campaigns are usually unpaid which means that only those with a certain socioeconomic status are typically going to be able to participate. We’re on the side of the digital divide that allows us to access and share information. I’ve been wanting to explore the racial gap but I don’t want to patronize or presumptuously assume that everyone wants what I want or has the same privileged journey in life.

    I think a lot of midwives are opposed to Medicaid because of the regulations that come along with it. It’s like the Massachusetts birth center that fought to remain open and was able to do so under the condition that they provide continuous electronic fetal monitoring for laboring women. Freedom of movement is one of the reasons women seek to give birth outside of a hospital, so it wasn’t really a total victory in being able to keep its doors open.

    Regarding African American-white disparities in birth, Michael Lu at UCLA has done groundbreaking research in the area. After study after study failed to explain why African American women have such dramatically worse outcomes in birth outcomes than white women, even after controlling for every possible variable, Dr. Lu and colleagues looked at women’s lives in a life-course context. They found a decline in reproductive health resulting from cumulative wear and tear to the body’s allostatic systems—in other words, when a woman experiences the cumulative effects of institutionalized, systemic racism in multiple areas of her life over the course of her lifetime as women of color do in the U.S., the cumulative stress affects her reproductive system, resulting in lower weight, premature babies. Hopefully this research will lay rest to the crack baby myth or the bootstraps mentality that “those” women should just do something differently during pregnancy to make healthier babies.

    • miriam-perez

      Thanks for your thoughts Jill, you brought up some good points. 

      I’ve also spent some time in El Paso at a birthing center there, where all the midwives were white and all the mothers were Latina from Juarez. It seems the midwifery students (it was a school for CPMs) were there because they could get the births they needed quickly (high volume). But the cultural competency was lacking, and the spanish skills were not so great. 

      Your point about Medicaid and regulation is a good one. I know many midwives want to practice unfettered by restrictions at all, and it’s so tough in our medical system. How do we balance this with a desire to make the services accesible to lots of women?

      You are definitely right that racism has an impact on health in so many ways we don’t even understand. The same goes for poverty and other systemic barriers. That sounds like great and important research. 

       

       

       

      Miriam Perez

      http://radicaldoula.com 

  • http://talkingoutloud-carmen.blogspot.com/ invalid-0

    First, I would like to say that with my first home birth, Medicaid did cover it but, my midwife had to do a lot of follow-up to ensure that they would cover it in full.

    Second, getting insurance companies on board is a very small aspect of the overall problem. For years now, women have essentially “checked out” throughout their pregnancies and labor, leaving us in the predicament that we are currently in. Natural childbirth in general is not the norm in our culture. We have to start dealing with that first before we can truly make any progress.

  • erin-wilkins

    Thanks for this great article, Miriam. If all women and families are to have true access to comprehensive birth options is so important that homebirth / out-of-hospital birth providers be covered by state insurance and Medicaid programs. In the past few years there has been increased visibility of midwifery care and out-of-hospital birth options in the media, but I certainly agree with you that it has largely been portrayed through a narrow lens of racial, sexual, and financial privilege. It’s really frustrating that there is such a lack of acknowledgment of the interconnections between pregnancy and birth options and outcomes, class, race, and sexuality. Thank you for bringing these issues up!

  • invalid-0

    In Washington state you will find *many* low income women are enjoying the care of licensed midwives and out of hospital births (both home and freestanding birth centers). In some counties where there are shortages of care providers many midwives serve low income women almost exclusively!

    What’s even more impressive is that a recent WA DOH Cost Benefit Analysis showed that LM care in WA saves the state $3.1 million per biennium in cost-offsets to Medicaid when low-risk women give birth with licensed midwives instead of in the hospital.

    LM/CPM’s and home and birth-center birth options have to be part of this country’s health care reform. You won’t find LM’s with a 31.8% cesarean section rate either.

    Thanks for a great article!

    • miriam-perez

      I’d heard some about the system in Washington State, I definitely need to look into it more! 

      This issue of cost saving I think will be what really pushes maternity care reform. If we have examples of states honing in on midwifery care as a way to reduce health care budgets, we might actually see the changes we want. 

       

       

      Miriam Perez

      http://radicaldoula.com 

  • invalid-0

    This is a fabulous article!

    It’s not just access to homebirths, low income women do not have access to postpartum or labor doulas, lactation consultants or any other self pay care that are no longer a luxury to most middle class women. All of these self pay services are the price middle class women can afford to have a good birth and breastfeeding experience.

    We have a two tiered system of giving birth in America, that should be a right for all women to have access to natural births at home, and breastfeeding and mother care after the birth provided in her home as it is in other western countries.

  • invalid-0

    Excellent points were made in the article. Though I agree with all that was said, as a birth activist, I’m all too aware of how daunting the task of reclaiming birth is.

    There truly is so much to be done–women are routinely not given choice in birth (breech vaginal birth and VBAC come immediately to mind) so I understand where you are coming from in your comments about the illusion of choice in maternity care.

    At the same time, I’m concerned at any “tearing” down, however unintentional, of allies, of which I assure you Choices in Childbirth most certainly is. In that respect, I was disheartened by that tone of the article.

    • miriam-perez

      I definitely would not want to tear down the important work of the allied organizations, most of whom are made up of advocates that really care about pushing for real maternity reform. Apologies if that came across unintentionally in the article.

      I’m interested in creating dialogues where we can constructively push one another to improve all of our efforts and expand the success of our movements.  

      Miriam Perez

      http://radicaldoula.com 

  • invalid-0

    Granted, I had the cash to pay for my midwife, up front. However, I want folks to know, that AFTER my home birth, attended by a Certified Professional Midwife, I submitted, to my insurance company, via a “professional billing agent” what is called a Global Bill, and, they reimbursed me 100%, for the care I received, as part of my planned, out of hospital home birth.

    Also, most midwives I know, will work out payment plans, with folks who really truly know they want planned, midwife attended home births. Yes, not having money can be problematic, but, it is not completely as simple as not having money. That is, just because you don’t have money does NOT mean you can’t plan and have a home birth. Don’t give up, and, insurance does reimburse, at times, even after the fact.

    L.

  • invalid-0

    I just wanted to point out that midwife homebirth services vary in price by area. I know homebirth midwives in Texas, Alaska, and Oregon, and none of them charge over $2000. Considering also that many midwives are willing to work with their clients (e.g. payment plans, sliding scale, barter), and the greater lifetime health benefits of a peaceful drug-free homebirth (for both mom and baby), birthing with a midwife is a bargain.

  • invalid-0

    My 78-year old mother, born to immigrants, was born at home with the assistance of neighborhood women in a small working-class community. Her seven siblings were born at home as well.
    …With the advent of employer-based insurance, in one generation (mine), the vast majority of babies were born at the closest hospital about 20 miles away. The subject of homebirths never comes up in my small town. College-educated women seem to embrace scheduled c-sections rather than question them.
    …So I’d say that small-town/rural women may have the same lack of knowledge concerning homebirthing. Geography may play a part as well. The northeast and west coast seem to lead the way on these issues.

  • invalid-0

    I think your article is spot on. There needs to be more financial support for homebirth via insurance and Medicade. However, there is a problem with the fact that people in general trust their doctors to do their job, and therefore they will usually just go with any recommendation that is made, especially if there is a baby involved. From my experience, most women don’t know about the general material risks involved in birth interventions until after their births because their doctor did not gain valid consent. They are told that whichever procedure is safe and that there is hardly any risk, and then are shocked to find out that that the emergency that they and baby hopefully lived through was caused by bad practice.

    It’s frightening that there is such opposition to homebirth. Insurance companies are dropping women after c/s because of added lifelong healthcare costs associated with the surgery, but won’t cover homebirth because of the dr. knows best mentality. Medicaid is paying out millions for surgeries and interventions which are detrimental to women and babies when made routine and abused, but won’t put out for taxpayers the way it does for doctors.

    What needs to end before there can be any rational policy reform is the love affair people have with their ideas of doctors. Doctors either do not know, or do not care what is physiologically in their customers’ interests. If they did, there would be a move toward unfettered birth in hospital, instead of the resistance to evidence based medicine which is driving the ever rising intervention rates.

  • invalid-0

    As someone living under the poverty line and giving birth at home I have to say this is a great article. For too many there is a desire to be at home but financial obstacles that are too hard to over come. Here in Oklahoma Medicaid does not cover home birth, but they will cover midwives in either a hospital or a freestanding birth center. Also most midwives here charge no more than $2000, are willing to drive for up to an hour to get to you, and are more than willing to work with you to do payment plans.

  • http://canow.org invalid-0

    Yes, the lack of coverage for home birth has a huge impact on women’s ability to choose how they experience birth, just as the medical focus on controlling the birth experience impacts how women experience it.

    Full reproductive freedom would include not only the right to choose whether to give birth, but how.

    We did a piece on this issue called The Womanization of Birth.

  • invalid-0

    This is a well written piece, from a U.S. perspective.
    Just to let you know a small piece of data from another country.
    I’m the daughter of a homebirth midwife based in Australia.
    My mama was doing her apprenticeship around 17 years ago, and has been assisting at births ever since.

    There seems to be a growing number of options for lower-income people to give birth at home. People who have worked privately in Australia like my mum have been exchanging their services for alternative goods/services (such as child minding, carpentry, plumbing, artwork etc), or waiving their fee for those who could not otherwise afford homebirth.
    Also, there are a number of programs that are funded under Australia’s public health care system, such as an organization that my mum worked for, for a time, Community Midwifery WA”. Groups such as this, do unfortunately have to turn a lot of people down, but do so often based on turning people down that probably *could* otherwise afford it. This organization has not had a smooth life, and has had to fight for funding, for ways to deal with public liability insurance, for venues for offices etc, but I believe was a pioneer in Australia of groups of this kind. Now there are a number of other publicly funded homebirth providers around the country.

    Due to groups like this, strong communities of families in poverty have grown based around their shared experience of publicly funded homebirth. This i believe strengthens their family life, and the community as a whole.

  • invalid-0

    Dear Elle,

    I just wanted you to know that I appreciate you writing this article on behalf of your Mom. She is a great and incredible woman who has made a huge difference in so many women’s lives. I am honored to have been the recipient of her care when we lived in Exmouth. The trials that we had to go through to achieve what we did will never be forgotten. Thank you again for supporting your Mom in what she does. She is a special woman :)

    Your friend,
    Cheryl Stark
    PS…yes you do know me. We were the “mad Americans” that brought her up to Exmouth in the dead of summer over Christmas to have Edyn. I love your family…

  • invalid-0

    I think this is a good example of making a mountain out of a molehill. How does she know that low-income women aren’t seeing this movie? How does she know that they only see the surrounding of the people giving birth rather than the beauty of the birth itself and think “Oh, they must have lots of money. Guess I can’t do that.”

    Low-income women do have a choice. Ever heard the saying “Where there’s a will there’s a way?” How about this one: “You get what you pay for.”

    Quit writing these women off as helpless. They aren’t. And I should know, because I am one. And I refuse to accept “free” government assistance. The government does NOT and NEVER will have my best interest at heart.

  • invalid-0

    I think that women who trust their bodies can get prenatal care and then do an unassisted childbirth or one where the community ladies get together. It is not so very medical, but you may end up rushing to a hospital.
    The media plays a major role in medicalizing childbirth. It is this impact that affects ones perception of birth more than economic empowerment or access to care that transcends income.
    As each woman who has had a good homebirth experience should reach out to other pregnant women and casually introduce the thought – Ex. Wow, when are you due? isn’t that so exciting? I recently had a homebirth and it was so complete…
    hospitals provide uncompensated care all the time – it’s a write off and yes some end up belly up. But there’s room to adapt this model for homebirth midwifery.

  • susan-hodges

    I really appreciate this well-written article.  As a white, middle class woman I am aware that I am responsible for working against the racism and classism that are endemic and institutionalized in our culture.

    I think the article is correct that most home birth advocates, and many home birth families, are white and middle class. Certainly that is what I’ve seen over my 20 years of activism.  There are a lot of reasons for this, and a lot of factors affecting this situation.

    One challenge is that fewer than 1% of all births in the US are midwife-attended home births, so the majority of women regardless of race, ethnicity or economic status don’t even know that it is a possibility. To arrange for a home birth one must go against “fashion” and the prevailing (though incorrect) belief that hospital is safest for having babies.

    However, in the last couple of years there has been a significant increase in public media attention to the serious problems in US maternity care, and the benefits of midwifery care, home birth and natural childbirth, which is encouraging. Because of her celebrity status, Ricki Lake’s film The Business of Being Born got a lot of media attention. But this is not the only film about maternity care and home birth. Orgasmic Birth (http://www.orgasmicbirth.com/), released just this past fall, includes a more diverse range of families, and has been very popular internationally, but has had less attention in the US. And Home Delivery (http://www.homedelivery-themovie.com/), also not well-known in the US, is a European-made documentary focusing on three New York City women, two of whom are African-American, and the reasons why they chose home birth.  Additionally, Rhonda Haynes’ beautiful and award-winning homage to African American midwives past and present, Bringin’in Da Spirit, released several years ago, explores the wide range of practice settings midwives work in.  Finally, some shorter, but no less important films expand the perception of home birth as an option only available to white women:  Naoli Vinaver Lopez’s Birth Day, and Maria Iorillo’s It’s My Body, My Baby, My Birth.

    Even if one has overcome some of the challenges associated with choosing to give birth at home, inconsistent state laws and uneven distribution of midwives means that the option for high-quality midwifery care is not easily available in many places.  State and national organizations of volunteer birth activists have been working against great odds to change state laws so that Certified Professional Midwives, the midwives especially trained to attend out-of-hospital births, can practice openly and legally. This is crucial, because only licensed providers can be covered by Medicaid.  However, the American Medical Association and the American College of Obstetricians and Gynecologists continue to issue policy statements strongly opposing home births under any circumstances, and are actively seeking to restrict the practices of midwives and to oppose licensing of Certified Professional Midwives, even though these policies and actions fly in the face of all the evidence. (For more information see “Background Information about the AMA and ACOG” at http://cfmidwifery.org/pdf/Background%20information%20about%20the%20AMA%20&amp_%20ACOG%20FINAL.pdf  .)

    Organizations like Citizens for Midwifery; the Coalition for Improving Maternity Services; The Big Push for Midwives; the International Center for Traditional Childbearing (which is especially committed to increasing positive birth outcomes and decreasing infant mortality in African American Communities); and Childbirth Connection are all working in different ways to provide accurate information about and promote improved, evidence-based maternity care, including midwives and out-of-hospital birth, and to work toward changes in federal legislation so that midwives receive Medicaid coverage. This is not to say that there is no room for improvement in these efforts, but to note that volunteers are doing their best against great odds, and there are many opportunities to join these efforts. For example, improving access to midwifery education for all women, but especially low-income and rural women, is another area that needs work.

    CfM believes that the kind of respectful, evidence-based care most often provided by midwives working outside the hospital should be available to ALL women, in ALL settings, and is a leader in the consumer-based grassroots effort toward this goal. CfM submitted health care reform recommendations to the Obama campaign, which included federal recognition for Medicaid coverage for Certified Professional Midwives (the midwives who specialize in out-of-hospital birth), and for Medicaid to cover facility fees for birth centers. (See http://cfmidwifery.org/pdf/CfMStatementObamaTeamFINAL200901_doc.pdf .) Other organizations submitted similar recommendations.  Reproductive rights organizations are beginning to realize that maternity care is part of reproductive rights.

    I encourage anyone who would like to see changes, from getting home birth covered by insurance and Medicaid, to seeing more women of color in birth movies or whatever else moves you, to get involved and take some action.  Anyone can write a letter to the editor or talk to their legislator, and some folks can make movies or influence legislators.  Or join Citizens for Midwifery, or one of the other organizations mentioned above!  We welcome new members, volunteers and viewpoints!

    Sincerely,
    Susan Hodges, President
    Citizens for Midwifery

  • invalid-0

    Hi Susan, While this is all true it still cannot explain or deal with the fact that despite all of this: white midwives and esp Black midwives have not been able to honestly sit at the table. We cannot move beyond the disparities (Institute of Medicine defines disparities not in terms of access, appropriateness of intervention or lack of but as something even more insidious). We have to have an honest discussion about race and privilege and the effects this have had. Yes there are many people including myself who have been fighting this fight for many years and not getting anywhere. It is by faith that I know we will succeed not by the base we can have not been able (but should) by our inability even amongst ourselves to have frand discussions and healing. Maybe we need a truth and reconciliation committee. One love, Makeda

  • invalid-0

    This is a fabulous, important article! My midwives’ walls were covered with baby pictures, and nearly all were white, middle class families.

    Even the white lower class families I know “would never” consider out-of-hospital births. For one thing, the cost really IS prohibitive! When the grocery budget is less than $800 for a family of four, there is NO wiggle room to find the extra to pay out-of-pocket. Most of those families are on Medicaid, without which they would receive no medical care at all.

    Another thing is the unfamiliarity with the idea of homebirth. Wandering outside your paradigm is scary, especially if you spend your life hearing that “this is the ‘it.'” Without real examples, nothing changes.

    It seems to me that the vicious circle is that not enough women of color have access to or choices regarding homebirth. So the communities in which these women live have no examples of homebirth, so there is no desire to learn about it (I never researched until a close friend of mine had a homebirth). And, with no one learning about homebirth, no one argues or fights to have one. So there is limited access to homebirth. And so on…

    Thanks for keeping this in the general conversation. We have to keep talking and keep working and keep hoping to make the changes we all desperately believe we need.

  • miriam-perez

    Thanks for your thoughts Susan!

    I agree with you that role of the AMA is important to recognize, as well as the interests of the hospitals and insurance companies in all of this. There is a real business interest behind all of this, as there was when obstetrics was invented. 

    Midwives face so many barriers state to state in their practice, it’s quite a hurdle for them to cross. 

    Thanks for the work you do!

     

    Miriam Perez

    http://radicaldoula.com 

  • http://theseagreenhouse.blogspot.com/ invalid-0

    Thank you so much for this article.

    As a black woman who had both of my children at home with a midwife in attendance, I can attest to the cultural barriers that can impede exploration of natural birth by pregnant black women.

    My grandmothers were the first women in their families to give birth in a hospital. That and formula feeding were seen as signs of economic arrival. Ultimately my extended family was very supportive of my choice. And I had the money and a living situation that made it a choice. And yes, $2,000 dollars pales in comparison to the actual cost of a hospital birth but for some women it is an enormous sum, especially when a hospital birth is going to cost them nothing out of pocket.

    On many occasions I’ve been involved with natural birth organizations that don’t want to acknowledge the limitations of their scope. Ignoring the problem doesn’t make it go away. Illuminating problems gives everyone an opportunity to address them head on.

  • invalid-0

    I am careful to presume for someone else what their financial priorities are – I have friends who could afford the $4000 it costs for a homebirth in my area but can’t get past the fact that a hospital birth (with their insurance) would cost them little out of pocket. I also have a close friend at poverty level who chose to scrape together the money because a homebirth was so important to her. I feel the education piece is foremost as so often when someone truly values something they find a way to make it happen. And I don’t know any homebirth practitioner that isn’t flexible on payment (within their means keeping in mind that midwives, doulas and educators need to put food on their table and feel their services are valued too).

    I am a prenatal educator and advocate and happen to live in an area where 40 minutes to one side there is a great small-town hospital where waterbirths and midwifery care is common and 40 minutes into Philadelphia women have no great hospital and mediocre birth center options. We have great homebirth care throughout but it is fairly under the radar so until the education is in place for any woman to know the benefits of homebirth, I don’t feel the financial aspect is the biggest limiting factor.

    So I would like to see the tone of this type of conversation change to ‘How can we get positive information about homebirth to more women? Is anyone doing this effectively? Is there a model others can follow and how does it differ for different populations…urban vs. rural, all the different cultures, different socioeconomic status?’

    Thank you for a great article and starting a thoughtful conversation.

  • invalid-0

    Great article! Thanks for writing it!

  • http://www.completemedicalbilling.com invalid-0

    It is a little bit sad to me that there is not more coverage for this type of birth. On the other hand though, I don’t know if I would want to give birth at home. What if there was a problem? I guess you could argue both sides of the issue. Just make sure that if you deliver at home or in a hospital that they keep track of everything with secure medical billing software. It is necessary to have a clear and concise record of everything that happens. Thanks for the article.

  • http://www.completemedicalbilling.com/site/products/ndcmedisoft.aspx invalid-0

    The thought of delivering my own baby at home is not an appealing option to me at all. I’m much more comfortable with the thought of being in a hospital just in case there was the need for emergency care during the birth. I think that if a mother wants to give birth at home, she should be ble to though. More power to her!

  • las-vegas-real-estate

    All three of my children were delivered by midwife and I could not have been happier with the experience. It is something that I will always treasure. She was with me through every step of labor. Summerlin real estate foreclosures