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Old 02-08-2012, 01:34 PM   #1
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Help! Completely changing plans for birth?

I'll be 24 weeks on Thursday, and for about a month now I've been having major second thoughts about my ob/hospital birth. It's just not the experience I want and it's stressing me out so much.
I would prefer a midwife and possibly a homebirth. First of all, I can't even figure out how to find a midwife that delivers in my area- Raleigh, NC. A few obs (including mine) have a midwife but they do not deliver.
Then, what about the cost? I am two payments away from finishing the payment plan at my ob's office (this does not include delivery). A lot of homebirths are a couple thousand out of pocket, right? I don't even know if I can do that.
Incase you couldn't tell, I'm really confused and very nervous and concerned. Any advice would be appreciated!

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Old 02-08-2012, 02:40 PM   #2
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Re: Help! Completely changing plans for birth?

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I would prefer a midwife and possibly a homebirth. First of all, I can't even figure out how to find a midwife that delivers in my area- Raleigh, NC. A few obs (including mine) have a midwife but they do not deliver.
You should probably check you state laws first and see if midwives are allowed to attend homebirths. It's illegal in my state, Louisiana.

I checked my insurance company's website to see who was in-network. There were quite a few CNM's in network, but when I called to ask questions, those clinics told me that the CNM's ONLY deliver in hospitals. We do have a couple of freestanding birth centers in Louisiana, but they are waaaaay too far away. I ended up finding a birth center right across the state line in Texas, where midwives can attend birth center and homebirths.

I found my midwife just googling her. That turned up her website, and then I verified her credentials on a state website, got referrals, etc.

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Then, what about the cost? I am two payments away from finishing the payment plan at my ob's office (this does not include delivery). A lot of homebirths are a couple thousand out of pocket, right? I don't even know if I can do that.
The midwife I talked to in Mississippi was $2800, not including labs, u/s, etc.

Mine in Texas is $3200, not including the same. This will likely be entirely out of pocket; she said some of her clients have had success using the same insurance that I have, but it has been a hassle. Her accountant prepares all the billing info for you if you want to file on your insurance after delivery. She said the u/s tech they use may be in-network for u/s (she said she would have to check). If not, it would be $200 per u/s. I think I remember labs being $80-$100, but like I said, I haven't had any labs there, so I'm not sure. She has a list of all the labs and u/s she expects a client to need or want, so I guess I could have estimated costs outside of her actual $3200 fee, but I'm using an OB for shadow care, so I haven't had a need for tests through the MW.

I remember finding one SUPER nice (like, insanely posh) birth center in Dallas that was around $5400. I found another one for around $4000.

So there is considerable variation even between midwives in the same state, or even the same area of the state!

Mine has a very detailed fee schedule, but she said she preferred to discuss the fees in person, so it wasn't on her website. If you find midwives you want to consult, you may just have to interview them individually about their fees.
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Old 02-08-2012, 04:34 PM   #3
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Re: Help! Completely changing plans for birth?

I think that you definitely have to find out the costs first, and then decide whether it's worth it to you to avoid the hospital. My midwife is going to be about 2800$ out-of-pocket, and it's important enough to me to have this birth at home that we're paying it even though a hospital birth would be absolutely free.

In our state it's nearly impossible to find a CNM that does homebirths, so if CPMs are licensed in your state, that is probably your best bet, and prices vary for each midwife.
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Old 02-08-2012, 08:52 PM   #4
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Re: Help! Completely changing plans for birth?

The cost of the midwife usually covers all your prenatal visits, the actual birth, and post partum with the exception of labs, testing, and ultrasounds. Since you would be transfering you care most midwives I've talked to would prorate the price because they didn't provide you care the entire time. Also, most midwives will work with you on payment. All in all, I think it's entirely worth it to have care from a good midwife. I wouldn't trade it for anything.
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Old 02-08-2012, 09:05 PM   #5
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Re: Help! Completely changing plans for birth?

I'm honestly not sure how to go about finding a midwife, I got the name of my first from my mom's midwives reccommendation, and my second from word of mouth. Perhaps google? Obviously meet with them and check their credentials Midwives usually don't charge a flat fee, they charge by the service. Some is for prenatal testing, some is for prenatal appointment, and some is for the birth and postpartum care. My birth (in Montana) was $2,600 OOP for the entire birth from start to 6 weeks postpartum, but cost vary. GL mama, my home birth was amazing!
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Old 02-09-2012, 06:17 AM   #6
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Re: Help! Completely changing plans for birth?

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A lot of homebirths are a couple thousand out of pocket, right? I don't even know if I can do that.
I forgot to add... my MW has a payment plan. There was a $400 nonrefundable deposit due by the 2nd appointment. Everything else just has to be paid by 36 weeks. She gets a lot of "tax refund baby payments" in April. She said in some rare cases, she does extend payments beyond 36 weeks, but she charges a late fee.

She said most midwives in this area also do special pricing for Medicaid patients. I assume Medicaid doesn't pay for MW's? So she gives them a discounted rate.
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Old 02-09-2012, 07:50 AM   #7
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Re: Help! Completely changing plans for birth?

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The cost of the midwife usually covers all your prenatal visits, the actual birth, and post partum with the exception of labs, testing, and ultrasounds. Since you would be transfering you care most midwives I've talked to would prorate the price because they didn't provide you care the entire time. Also, most midwives will work with you on payment. All in all, I think it's entirely worth it to have care from a good midwife. I wouldn't trade it for anything.
I agree. What I paid to my midwife was still less than my insurance deductible, and that doesn't even include any co-pays, etc!!

I think you need to sit down and ask yourself what you want from your birth experience. I've known since before I was pregnant that I wanted to birth outside of a hospital. But I have a VERY strong desire to avoid drugs (I don't even like to take tylenol when I have a headache!) or machines/tests/labs/etc. I also happen to have a friend who midwives, so it is easy for me to trust HER with my life and my child's life than a doctor I don't know.

My favorite book I read while pregnant was Active Birth. That book is going to be more slanted towards a birth center/homebirth experience, though. If you want a more mainstream book, I would actually read The Birth Book.

One more thought: are there any birthing centers in your area?? If you are hesitant about a hospital birth, but also unsure of a home birth, I think a birth center might be a happy medium! HTH!
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Old 02-09-2012, 08:12 AM   #8
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Re: Help! Completely changing plans for birth?

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One more thought: are there any birthing centers in your area?? If you are hesitant about a hospital birth, but also unsure of a home birth, I think a birth center might be a happy medium! HTH!
Thanks for all of the thoughts and input! I hadn't even considered that they might offer a payment plan. Although, I guess I'd be kind of rushed to pay it off since I'm already 24 weeks.
There is a birth center, but it's over an hour away. It would be my preference, since the thought of a homebirth does still make me a little nervous (hospitals are 45 min away from my house), and I know a lot of family members would be very concerned if I chose a home birth. Not that I would allow them to make my decision for me, I'm just considering what is going to cause me the least amount of stress. I know that our ins covers the birth center, and I have been back and forth about maybe switching to it...but the thought of having to drive over an hour while in labor and possibly in traffic completely freaks me out.
That was what was causing me to lean toward a home birth- knowing that I wouldn't have to race to get anywhere. And of course that I wouldn't have to fight for what I want at a hospital. (and dd would be able to be nearby and we could all sleep in the same house that night)
Maybe I'll just call the birth center and see what they have to say. I read reviews online and it gets a lot of good ones, but also some people said that they were really great at first, and then once they had completed payment the mws started blowing them off and not being helpful....so that makes me nervous too!!
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Old 02-09-2012, 08:47 AM   #9
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I use a hospital that is between 30-45 minutes away, depending on traffic, as opposed to the local hospital. The drive isn't really that bad when you're in labor. Your mind is so focused on the labor that it seems to go quickly. I've delivered there twice and will deliver this LO there as well. The better care is 100% worth the drive.

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Old 02-09-2012, 08:52 AM   #10
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Re: Help! Completely changing plans for birth?

I would look into the birth center. NC from what I understand isn't very home birth friendly so you may have a hard time finding a hb midwife in your area.

Online reviews I generally take with a grain of salt - there's always going to be somebody unhappy not matter how many good reviews there are.
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