The Cost of a Home Birth


Yesterday, the New York Times published an excellent piece entitled American Way of Birth, Costliest in the World. Following the struggles of several families without maternity coverage, Elizabeth Rosenthal examines the way maternity care is priced and the impact of high costs on care.

This about sums it up:

“We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

I truly wish I could say I’m surprised. I am not.

As I’ve said before, our system is broken. We spend more money on birth and get worse outcomes than any other industrialized nation. I saw the uphill battle I would face inside that system and decided to opt out. 

I chose to have a home birth. Let me tell you what it cost me.

My midwife charges a flat fee for her services. The fee includes all of my prenatal visits, including doppler monitoring, blood pressure tests, glucose screening, and urine tests. I see my midwife monthly in the first two trimesters and then bi-weekly in the last few weeks. My visits usually last from one to two hours. There is no waiting room or long waits in the exam room. I go to her house or she comes to mine. I have her complete and undivided attention the entire visit. She asks about my diet, my stress level, and my family. She answers as many questions as I have.

The fee also includes the birth. I purchase my own birthing pool and some of my own supplies. My midwife comes with an assistant the moment my contractions begin and stays with me until hours after the birth. She continuously monitors me and the baby, coaches and supports me through contractions, and is prepared in the case of emergencies. She stays for three to four hours after the birth and helps me shower, get settled, and establish breastfeeding.

The fee also includes my postnatal care. My midwife comes to my house the following two days after I give birth and once a week for two weeks after that. She checks me and the baby and again usually spends at least an hour checking in on my mental state. 

The level of care my midwife provides is priceless. I feel completely and totally safe in her care. I trust her to the core of my being and she is considered a member of my family.

But how much do I actually pay her?


That’s it.

I pay her directly because she does not accept insurance. My insurance company would technically reimburse a percentage of my expenses but in order to do that I'd have to submit a bill with all the official billing codes, which my midwife doesn't do.  

Now, my midwife cannot provide ultrasounds or do Group B strep tests. Therefore, I went to my OB-GYN’s office for those tests. I was very luck that my doctor during my second pregnancy was very supportive of my home birth (my first pregnancy is another story) and generally let me control my treatment. I had one ultrasound and the recommended screenings - nothing more.

Luckily, I had maternity coverage with both pregnancies so my out-of-pocket expense was minimum. I would estimate I paid approximately $200 to $300 dollars.

So, with supplies and additional doctor’s visits, that puts the total cost for each of my birth at about $2,000.

I paid less than almost any other pregnant person I know and got the births I had always wanted. (Well, I didn’t necessarily WANT nine pound babies but you get my point.) 

I wouldn’t recommend a home birth to someone whose main motivation is to save money. However, I would argue that the cost structure of my home birth - much less the care itself - offers a very simple lesson for the health care community.

Expensive care is not better care.  (Click to tweet.)

If you've given birth or had a partner that has given birth, how much did it cost? Were you surprised by the total? Was expense even something you considered?