While it is still very common for childbirth to occur in hospitals, there are now other options available. There are now birthing centers as well as home and water birth methods for childbirth. Doctors and obstetricians aren’t the only options anymore as well. Today you can also choose from doulas and midwives. With these changes, health plans have changed as well.
Childbirth in the United States Now
In the early part of the 20th century, almost all childbirth happened outside a hospital. By the 1940s less than half of the births happened at home. By the 1960s, the number of at-home births dropped to 1 percent.
While hospital childbirths are still the majority, out-of-hospital births are on the rise. According to the Center of Disease Control, out-of-hospital births went up from 1.26 percent in 2011 to 1.36 percent in 2012.
The use of doulas, midwives, and night nurses are part of the increase. As of right now, 6 percent of U.S. women use doulas in the birth process. A bit over 8 percent use midwives while pregnant.
What is a Doula?
Doulas assist with birth and labor. They are there to provide emotional and physical support before, during, and sometimes after, childbirth. Their roles include:
- Assisting pregnant women who are on bedrest to prevent preterm labor
- Provide care during delivery
- Support new mothers in the first weeks after birth
Please note that doulas aren’t medical professionals. They do not directly deliver babies or offer other medical care. While not professionally trained, they provide highly sought out services. With their assistance, you may be able to:
- Spend less time in labor
- Avoid a Cesarean (C-section) delivery
- Give birth without needing many–or sometimes any–pain medications
The price tag for a doula’s services depends on where you live. If you live in a rural area, a doula may only be a few hundred dollars. If you live in an urban area, however, you might pay thousands for one.
Another cost factor for doulas is the extent of employment. The longer you need one, the more it’ll cost.
Health care coverage for doula services is not uniform. Some plans help pay for the costs of a doula where others do not. The best way to find optimal coverage is to shop around.
You should do the same if you’re on Medicare. A couple states require Medicaid programs to cover certified doula services. Some areas cover doula service without requiring legislative involvement.
In any case, it’s worth it to look around. Some doulas volunteer their time and expertise to those unable to pay. At the very least, you might find one that will charge less.
What is a Midwife?
Midwives differ from doulas in that midwives are trained medical professionals. Midwives can fulfill the roles of doulas, but their range of services are wider. Midwives are able to personally direct labor and delivery.
It’s a best practice to look for a certified nurse-midwife (or CNM). Certified midwives (CMs) and certified professional midwives (CPMs) are great choices as well, but CNMs are the only ones of the three that are certified to work in all 50 states and the District of Columbia.
Regardless of type midwife you hire, they’ll be able to help whether the birth is at home, private office, birthing center, or hospital. They can also assist with:
- Prenatal exams, tests, and screenings
- Diet, nutrition, and exercise advice
- Emotional support
- Lactation and breastfeeding counseling or education
You should know is that most experts recommend the use of a midwife only if you’re at low risk of complications. If complications do arise, you’ll want your midwife to consult with a physician or obstetrician. Unexpected incidents and their costs can arise in any sort of birthing option, so it’s good to have all the possible bases covered going in.
Midwives can cost more than doulas, but not much more. The average midwife costs about $2,000. Like doulas, the actual cost depends on your location and the extent of services.
The current relationship between insurers and midwives is sporadic. Some do not cover midwife services at all. Some cover their services if childbirth occurs in a hospital or a birthing center, but not at home. Check with your insurer before hiring a midwife to make sure you know what your coverage includes.
Medicaid tends to do better with covering midwife services, but you’ll still want to check with your health plan and agency.
What is a Night Nurse?
Night nurses, despite the name, are often not registered nurses. Many simply have experience taking care of newborns.
Despite this, they help new mothers in many ways. They can spend nights in the home, feeding and otherwise taking care of the babies while the new mother sleeps. Night nurses are often hired for the first week or two after the birth. Others stay on longer until the mother returns to work.
For as helpful as night nurses are, they’re not cheap. On average they charge between $25 to $40 an hour. This sums up to upwards of $200 a night and over $1000 a week.
Very few insurers cover night nurses at this point. It’s good to check with your agency to see what postnatal care it will cover.
Alternatives to the Hospital
As how childbirth occurs in the U.S. Has changed, so to have where it occurs. Along with the hospital you now have the options in birthing centers, home birth, and water birth. It’s good to know how each of them works, and how they fit in with your insurance.
What is a Birthing Center?
Childbirth in a birthing center is more like having the baby at home than at the hospital. The atmosphere tends to be cozier and more low-tech than a hospital room. Midwives usually serve as the main care provider in birthing centers as well. Natural childbirth tends to be the main method used. It gives priority given to the levels of medication and intervention known in hospital settings.
One of the benefits of birthing centers is the difference in recovery time. On average, women spend a few hours in a birthing center after giving birth. A couple days’ stay is standard after a hospital birth.
Also, there’s a cost difference. Birthing centers on average cost $3000 compared to the many thousands a hospital birth can cost.
On the downside, birthing centers aren’t the best places for a complicated births due to their low-tech nature. Furthermore, insurance coverage is spotty.
More insurers are covering birth at a birthing center than before. See if your policy covers a birthing center before you commit. Medicaid currently covers the services of licensed birthing centers. Check with your local agency to get the full details.
What is Home Birth?
Home birth is common with women who want childbirth to be in a comfortable setting. Normally home birth involves a midwife with focus on natural childbirth. Home birth avoids much of the medication and interventions used in hospital birth. This choice also tends to be a favorite of women who want to have more control over the birth process.
The cost difference over hospital birth tends to be lower as well, normally about $3,000. You want to check to see if your policy covers it, however. The lower bill might not mean much if you have to pay out of pocket.
Even if your health plan does cover home birth, there will probably be some requirements. You may need a state certified midwife. Another option is that you’ll need to pay for various supplies or equipment.
What is Water Birth?
Water birth shares some overlap with home birth, birthing centers, and midwives. Many water births take place at home or birthing centers (Less so in hospitals.) with a midwife overseeing. As the name implies, water birth is when labor, delivery, or both occur in a pool or tub of warm water.
Water birth has become popular due to the benefits of:
- Easing pain during birth
- Keeping the pregnant woman from needing pain killers or other medicine during birth
- Speeding up labor
Costs involved in water birth vary. Water birth in a hospital can cost more than traditional methods. Whether you have a water birth at home or a birthing center can have cost differences as well.
Insurance is more likely to cover water birth in a hospital or birthing center than it is at home. Very few Medicaid programs cover home water births as well. All the same, check with your agent to see what your policy covers.
As these alternative birthing options start to become mainstream, health insurance plans are going to take even more attention to helping people get covered. Let’s just hope sooner rather than later.
This is all very interesting information. Every pregnant woman should explore her options.