If you do not have insurance or your insurance will not cover our services, a cash discount is available. Many clients have reported that the cash fee is comparable to what their copays have been for a hospital birth with insurance. Payment plans and discounts are available because we understand that paying out of pocket for midwifery services can be a big expense.
Here is more information about what you are paying for.
In addition to spending an average of 1 hour at each prenatal appointment, the midwife spends a fair amount of time in her car driving to the office locations and home visits. The midwife might spend anywhere from 3 hours to 2 days at a birth and is on-call for her client throughout care. Phone calls, individual research, and responding to e-mails adds to the investment of time.
When you call your midwife, she answers the phone- not a receptionist. Your appointments are designed to offer individualized care for you and your circumstances.
Most midwives choose to limit the number of clients she takes to be sure that she is able to give her best to her clients and her family. When she puts your due date on her calendar, she commits to being on-call for you: this includes arranging backup care for the possibility of two clients in labor at once or while on vacation. Scheduling a vacation requires turning away clients due within a month of the vacation or having a back-up midwife lined up.
The rule of thumb is that a self-employed professional's income is only half of what they earn, after deductions for vacation and sick time, self-employment taxes, health insurance, and business expenses. Communication and travel expenses can be very high for a midwife, which means many midwives spend quite a bit more than half of her income on expenses. I drive an average of 25,000- 30,000 work-related miles per year: this means increased frequency of gasoline fill-ups, maintenance, wear-and-tear, and new tires. There are also routine professional expenses and equipment that needs to be maintained or replaced periodically.
TRAINING AND EXPERIENCE
It’s important to pursue continuing education, and continuing education units (CEUs) are required to renew certification every three years. Neonatal Resuscitation and Basic Life Support (CPR) must be renewed every two years. As with scheduling a vacation, in order to attend conferences and training opportunities, a midwife has to limit the number of clients she can accept due around the time she will be unavailable or hire a back-up midwife. Conferences can be expensive and often require out-of-state travel. Online midwifery schools cost $285 or more per credit hour.
Being on-call requires a certain level of personal sacrifice from a midwife and her family. This includes a willingness to be awakened in the middle of the night to go attend a labor and missing the occasional family event or holiday. Shopping trips and dinner plans mean that a midwife must plan ahead in the event that she is called to a birth before it is over. Additionally, midwives who are also mothers must have childcare or transportion lined up for her children and a dependable vehicle gassed up and ready to go at a moment’s notice.
We believe that two sets of hands are better than one, so a birth assistant is on-call for every birth.
When you put it like that, you may be thinking, “Why would anyone want to do this job?“. Because we love what we do, and we are honored to attend this important moment in your life!
One of my new favorite t-shirts states: "Water Birth Isn't Just for Mermaids". While that is true, it may or may not be the right choice for every woman.
Common reasons that women choose to labor in water include:
While laboring in water doesn't guarantee you a pain-free labor, it can help to take the edge off. Sinking into a deep pool designed for laboring in water gives the mother a small, private space in which to relax. Some midwives report seeing fewer lacerations in the water.
Some things to be aware of: sometimes babies born in the water take an extra moment to transition and may not cry right away. Purple is a normal color for a baby who has not taken a breath yet; when baby does take a breath you will see baby's color transition to pink. Studies have not shown an increase in infection for baby's born in water. It is believed that air hitting the baby's face will stimulate baby to breathe and that babies will not try to breathe until then, but to be conservative the midwife likes baby to be gently brought up out of the water immediately. The midwife may ask a mother to get out of the water in cases of possible fetal distress or if there is difficulty assessing blood loss following the birth.
Concerns about infection due to the water birth have been brought up with the recent headlines about a baby dying of Legionnaire's Disease after a water birth. Our practice has chosen to adopt the recommendations of the National Health Service in England. We do not use pools which are filled in advance or spa pools that circulate the water. A brand-new liner is used for each birth and the pool is not filled until the mother is in active labor.
For more information, visit Comprehensive Review Affirms Safety of Waterbirth or talk to your care provider.
The reasons that families choose to birth at home vary, and are often multi-faceted.
Birthing at home statistically reduces the rates of interventions such as cesarean section and episiotomy, which is a reason many mothers consider it. Laboring and birthing at home can be a comforting experience for not only mothers, but fathers as well. It is easier to be uninhibited in labor in your own space, which is helpful to the birthing process.
Water birth is another common reason for seeking out home birth, as many hospitals do not offer water birth. Laboring in water can provide pain relief in labor as immersion in water provides a feeling of weightlessness and the ability to easily change positions. Some mothers choose to stay in water to push, which may help reduce the rate of perineal tears.
For parents with other children at home, home birth is an option that allows the children to be involved as little or as much as the family chooses. This can facilitate a smoother transition as a growing family. Sometimes an older sibling is given a special job such as announcing the baby’s gender immediately after birth, cutting the cord, or dressing baby in her first outfit.
Recovering in the comfort of your own home is another reason that families choose home birth. While it is true that you are provided meals in the hospital, family and friends can (and should!) be willing to set up a meal train. You can also set back some freezer meals during pregnancy to feed the family while you recover and bond with the newest family member. A postpartum doula or mother’s helper is another option if you wish to be at home while having additional help.
Immediate postpartum care for mom & baby and a 2-day postpartum visit are provided in home as well.
This blog post was originally written for the Evansville Birth Network blog and posted on October 14, 2014.