Homebirth: who pays and who profits?


Let’s make one thing clear: homebirth is an industry.

It’s an industry that involves providers charging large fees for services of dubious worth. If you have any doubt that it is an industry, consider the many groups devoted to lobbying on behalf of homebirth providers and the hundreds of thousands of dollars that are spent on lobbying on a variety of issues that always come back to the same thing: more opportunity for homebirth midwives to make more money.

Homebirth advocacy in the US is chiefly about the opportunities for homebirth midwives to profit. Contrary to the morally grotesque “human rights” argument advanced by homebirth advocates, every women in the US already has the right to have a homebirth and already has the right to be attended by anyone she chooses. Homebirth is completely legal and surrounding yourself with friends or even complete strangers of your choosing is also completely legal. The so called “right” to a homebirth is exclusively about the “right” of a layperson to pretend that she is a midwife, and most important of all, her “right” to charge for her services. In other words, homebirth advocacy is about the “right” of homebirth midwives to profit.

When viewed through the prism of profit, all major homebirth issues come into sharp focus.

The issue of licensing of homebirth midwives, which is currently playing out across the country, is at the heart of the drive to profit. The fundamental goal of the homebirth industry is to obtain access to insurance reimbursements. Insurance companies have deep pockets and access to reimbursement would allow homebirth midwives to collect the outrageous fees they already insist upon and to raise their prices even further.

There’s just a teensy, weensy little problem. Insurance companies will not reimburse providers who are not licensed. Therefore, homebirth midwives are seeking licensure, while desperately trying to avoid the standards and accountability that are always a part of licensing.

Licensing is designed to ensure public safety by standardizing education and training requirements, mandating malpractice insurance, mandating continuing education, and ensuring accountability for those who provide substandard care. That represents a serious problem for homebirth midwives who wish to be able to “practice” without any education and pathetically minimal training. Furthermore, the midwifery leadership has made it very clear that they reject the idea of ANY standards of any kind, and will almost never discipline members of their community regardless of how egregious the malpractice and regardless of how many babies die. And malpractice insurance is out of the question for two reasons; first, it cuts into the profits of homebirth midwives and second, malpractice insurers have standards that homebirth midwives have no intention of meeting.

The drive for profit stands behind homebirth midwives’ opposition any and all regulations of their practice standards and their scope of practice. Practice standards limit the number of laypeople who can pretend to be midwives, and therefore limit who can profit. Restrictions in scope of practice, designed to ensure patient safety, limit the pool of women from whom they can profit. Hence the inane insistence that a variety of high risk conditions (breech, twins, VBAC) are “variations of normal.” Acknowledging the greatly increased risk of these conditions would eliminate the possibility of profiting from them, and therefore is forbidden.

How about women and babies? Do they benefit in any way from homebirth midwifery? The answer is mixed. Women gain nothing directly homebirth midwifery that they didn’t already have. Women have the right to a homebirth regardless of the status of homebirth midwives. Women have the right to be attended by these women regardless of the status of homebirth midwives. What’s at stake is the right of these women to be paid and who will pay them. To the extent that licensing of homebirth midwives could lead to reimbursement, it might allow women to hire homebirth midwives without direct cost to themselves.

Who pays? That’s easy to answer. Women pay and babies pay.

Women pay because they are tricked into accepting substandard care from uneducated laypeople who they erroneously believe have been vetted by the state. They are tricked into paying women who call themselves midwives, but are just lay birth junkies who lack even basic knowledge about childbirth. Women risk complications such as hemorrhage and uterine rupture that threaten their own lives and have led to preventable maternal deaths at homebirth. They pay with months or years of bladder and bowel incontinence from unrecognized and unrepaired perineal tears. Women pay money, pain and suffering to finance the fantasies of a group of laypeople who misrepresent who they are and what they can do, with tragic results.

Of course no one pays as much as the babies. As the statistics from Oregon and elsewhere show, homebirth has a dramatically increased rate of preventable neonatal death. Extrapolating from the Oregon statistics leads to the horrific conclusion that nearly 90% of the babies who die at homebirth would have been saved in a hospital.

Homebirth is an industry. It’s an industry devoted to creating and expanding opportunities for lay birth junkies to profit from their fascination with birth. It is an industry that rejects regulations, standards, and malpractice insurance because all of them cut into the profits of homebirth midwives. And it is an industry built of deceiving women and letting babies come to harm.

The homebirth midwifery credential, the CPM, is a trick and it was designed to be a trick. By putting letters after their names, uneducated birth junkies dramatically increased their ability to fool women about their credentials while simultaneously rejecting the standards and accountability that credentialing implies. That’s why the CPM must be abolished and most surely will be abolished. The only open question is how many babies will die before the profits of these poseurs are eliminated.

84 Responses to “Homebirth: who pays and who profits?”

  1. Smarter Than An OB
    June 28, 2014 at 6:21 am #

    You are moron. You obviously do not know SHIT about home birth.

    • Trixie
      June 28, 2014 at 6:50 am #

      Could you elaborate? What specifically does she not know?

    • sameguest
      June 28, 2014 at 7:38 am #

      What is your point?

  2. CptKale
    April 1, 2013 at 8:06 pm #

    If that is so, than why did my homebirth cost only 2500 and my hospital birth 7k? Both were unmedicated, yet one cost a HUGE amount of money and 3 years to pay off.

    • suchende
      April 1, 2013 at 8:15 pm #

      If you’d had a bad outcome or an emergency transfer it would have been $$$. You rolled the dice and won, but if you divided that over a population it would almost certainly cost more for the population to home birth than always hospital birth.

  3. Nat
    March 30, 2013 at 11:18 pm #

    Dr. Amy PLEASE consider producing a documentary stating the facts that you make known here! You are an incredible, bold hero in the birth world! You have the power to make waves with the truth and not emotionally manipulative propaganda.

    • Susan
      March 31, 2013 at 1:25 am #

      But we need an emotional title to compete with TBOBB because making a documentary sells isn’t based on WWJD….

      What’s That Smell? Taking a Whiff of Home Birth Midwifery

      Home Delivery is for Pizza ( I know btdt with this slogan)

      But the Heart Rate was JUST normal

      Your body wouldn’t grow a baby bigger than you can birth and other fairy tales

      Death as a Variation of Normal

      Babies die in Hospitals too… making sense of the Natural Childbirth cult
      Not so Immaculate Deception
      Five Minutes from the Hospital
      Soggy Granola (

  4. March 29, 2013 at 7:14 pm #

    Don’t forget insurance: In my state, DEMs are not required to carry liability insurance. (The are the only healthcare providers in the state not to have this requirement.) This gives them an unfair advantage in the marketplace.

    If DEMs were to get liability insurance here, it would probably be inadequate to protect the public. The maximum recoverable per incident would need to be somewhere in the neighborhood of at least $500,000 these days for a trial lawyer to be interested in taking an injured party’s case.

  5. Grieving Dad
    March 29, 2013 at 11:42 am #

    I wish you had a bigger megaphone; that reached to Canada! This issue is bureaucratized up here – licensed midwifes collect a fixed amount (approx. $3-4k) per baby under provincial health insurance. Of course they are constantly striving to jack that number up by promoting the alleged safety of home births, suppressing adverse outcomes and pushing perinatal death statistics to hospitals – where the babies eventually die.

    ps. don’t forget that dads pay too – I pay every day for the death of my son, which is directly attributable to our midwife failing to recognize over the course of 6 hours that our baby was breech, which in turn led to a prolapsed cord in our bedroom. Why didn’t I push harder for hospital birth!?

    • Certified Hamster Midwife
      March 30, 2013 at 5:34 pm #

      I am so, so sorry for your loss. Fathers lose the chance to know their child. The entire family loses, and will always know that someone is missing.

    • Victoria
      March 30, 2013 at 9:49 pm #

      I am so sorry for you, your son and your family. It is so wrong that you were misled and paid such a high price. (Fellow Canadian who planned a homebirth and was luckily risked out by a pre-birth hospital trip and OBs).

  6. Lisa the Raptor
    March 27, 2013 at 1:16 am #

    I’m going to go to Oregon and become a HB midwife. I’ll charge $6,000 non-refundable and I’ll have 100% transfer rate.Tycoon FTW!

    • Karen in SC
      March 27, 2013 at 6:40 am #

      If you want, use my business model. Buy an RV, decorate really nice inside, park in the hospital lot. Keep the fees and transfer away!

    • Bombshellrisa
      March 27, 2013 at 4:39 pm #

      Or just charge that and be a “pregnancy coach”

  7. March 27, 2013 at 12:24 am #

    Odd. I was certain this provoke some response.

    Apparently lay midwives are comfortable with this portrait of their business model.

  8. Sue
    March 27, 2013 at 12:05 am #

    Here’s a parallel: the Australian anti-vax organisation that calls itself “Australian Vaccination Network”, but has been ordered by the regulator to change its name to something that reflects its anti-vax aims. The organisation’s officers argue that they are “pro-choice” and campaign against compulsory vaccination.

    Considering that vaccination isn’t compulsory in Australia, they are raising money to rail against something that doens’t exist, and isn’t likely to in future. Another scam. Save your money, folks.

  9. Amy
    March 26, 2013 at 5:25 pm #

    When I was into woo and considering a homebirth with my first, the cost was probably tied with nervousness about something bad happening as the #1 reason we opted for a hospital! Our insurance didn’t cover homebirth, and I paid all of $25 out of pocket for my perfectly perfect hospital birth. And my second was only $75 due to an extra couple days to watch for GBS as we didn’t make it in time for antibiotics. 🙂 No way was I going to drop a few thousand dollars for a particular birth “experience”!

    • Awesomemom
      March 26, 2013 at 8:39 pm #

      That is what kept me from even talking to a midwife. There was a birthing center near me when I was pregnant with my first but it did not take insurance so I didn’t even talk to them because free was so much better than several thousand dollars when you don’t have several thousand dollars.

  10. Laural
    March 26, 2013 at 5:23 pm #

    Yes! Another splendid post. You are calling it like it is.

  11. Captain Obvious
    March 26, 2013 at 5:09 pm #

    The real “Business of Being Born”.

  12. Daniel Descheneaux
    March 26, 2013 at 2:57 pm #

    Straight to the heart of the matter. Well done, Doctor Amy!

  13. Allie P
    March 26, 2013 at 1:04 pm #

    It’s the deluded parents (and the children) who I feel for. Few people who “educate themselves” really ARE educated on the issues. When you read the regretful writings of homebirth loss parents (like Wren’s Dad, whose newborn died of completely and easily preventable GBS infection) and you think about how they were told platitudes by the homebirth community and their insufficient care provider, when you think that they were deluded into being told that homebirth is to hospital birth like shopping at Whole Foods is to shopping at a normal grocery store (when it’s more like comparing stunt riding on the back of a motorcycle without a helmet to being bucked into a car seat in a volvo) — it’s heartbreaking. And it’s criminal that the HB community then turns around and says that they should accept the risk and educate themselves and stuff — how can they, when the HB community lies and lies and lies, or chooses ignorance or tells you tests are unnecessary — tests that could easily save the life of your baby. Even “smart” people are lied to — don’t think that you can be “smart” and avoid it, when there is a mass of very well written misinformation out there to lie and delude and deceive you. I was “smart” and I was scientifically informed and I was deeply suspicious of homebirth, but when you see HB woo creeping into even the magazines you find in your OBs waiting room (I can’t imagine she knew what was in there!) I didn’t have any reason to think it was as damaging and misleading and LIES LIES LIES as it was.

    • The Bofa on the Sofa
      March 26, 2013 at 2:16 pm #

      Yes and no, Allie. For example, if your midwife is also advertising services as a newborn photographer, doing belly-casting, selling a crapload of homeopathic medicines and encapsulated placenta, telling you to forego vaccination, and sending you to chiropractors, and warning bells don’t go flashing all over, then the problem goes well beyond the lies and deception of the NCB movement. They are certainly taking advantage of your delusions, but they aren’t creating them.

      • Allie P
        March 26, 2013 at 4:25 pm #

        Midwives aren’t creating lies when you have hired them with the understanding that they are “licensed care providers” and they don’t do standard prenatal care tests that you would have no way of knowing are standard because you aren’t actually going to a provider who provides standard of care? They tell you that whatever is happening to you is a “variation of normal” so that you aren’t risked out. They tell you that your GBS isn’t dangerous, that your GD isn’t dangerous, that your breech presentation isn’t dangerous. They tell you they don’t need to do continuous fetal monitoring. They tell you that going post dates poses no risk. They tell you that the standard whatever-they-presume-to-treat-with-placental-pills care is to treat with the aforementioned placental pills. Once you make the choice to put yourself in the care of one of these licensed midwives, a choice that seems reasonable because, hey, they are licensed, right? — you are shielded from how very dangerous their “standards” are.

        I was at an OB, I planned to give birth in a hospital, was pro all medical tech, and when I started to have the sneaking suspicion that the woman teaching my birth class was providing false and dangerous information to me and my husband and my fellow students, it was basically IMPOSSIBLE for me to find any information to counteract that — and that was with me looking hard because my husband was getting scared (by this idiot birth class teacher/doula) and not being embarrassed to ask my OB to counter this info for him. I can’t imagine the position women are in when they do not go in as skeptics, or when the provider they have unwittingly hired is the only one telling them how pregnancy and birth work.

        When my doctor told me that my severe morning sickness was not endangering the pregnancy and that taking Zofran would be fine, I believed her. When their midwife tell them that GBS+ will not kill their baby a few hours after its birth, and garlic or whatever will cure it, they have no reason not to believe HER just the same. And it’s this veneer of “licensing” that is making people think it’s okay. So that’s why it’s important to try to get the word out that these providers are NOT equal, and that one of them is providing very dangerous and low standards of care.

        My friends who hired midwives for home births are being lied to. I’m not a doctor. When I tell them they are being lied to, when I ask my friend for the name of the OB who is supposedly “backing up” her midwife, she doesn’t know, and her midwife tells her “not to worry about it” — who is she supposed to believe? (Hint: there was no OB.) And they have all these lies about OBs being “surgeons” who don’t really know how to take care of normal pregnancies that sound very convincing if you know nothing about actual OB practices…

        • The Bofa on the Sofa
          March 26, 2013 at 5:17 pm #

          I repeat what I said above. Regardless of what they are saying about childbirth, if they are selling a bunch of other woo crap, and you aren’t running away at top speed, it’s not their childbirth lies that are causing the problem.

          • Guestll
            March 27, 2013 at 12:36 am #

            What if they’re working within the system? What if your RM — the same RM to whom your GP referred you, the same RM who is licensed and endorsed and paid by your province — what if she’s pushing the chiropractor and the placenta encapsulation and the acupuncture and the TENS as pain relief and refusal of GDM testing because you’re thin and your homebirth will be safe because the paramedic station is right around the corner and besides, I am an expert in normal birth and I carry all of the same equipment as a doctor?
            It IS the lies that cause the problem. How can you discern what is true and what is false, when midwifery is not seen as a transgresseive choice, but a safe choice for low risk women? When your midwife is educated and trained, and sanctioned by the state? How do you separate the truth from the bullshit? It wasn’t my job to research the risks of GDM, it was my midwife’s job to inform me as to why the test mattered so I could make a reasonably informed decision as to whether or not to take it. If you’re not running away at top speed, perhaps it’s because the woo creeps just about everywhere.

          • Eddie
            March 27, 2013 at 2:01 am #

            I get your point. But I also get Bofa on the Sofa’s point…. There are a great many people who have an anti-scientific bent, who reject the kind of logical thought required for science. These people practically seek out the lies … the lies are their echo chamber. For that segment of the population, the lies are not the problem.

            This does not excuse lies — nor does this excuse people who are earnest in crazy, provably wrong beliefs. But it’s a reality that too many people WANT to believe in the lies. That why there are always so many snake oil salesmen. That’s why their are so many diet fads. That’s why supplements are unregulated in the US. Etc.

          • March 27, 2013 at 6:17 am #

            I find this both fascinating and deeply puzzling. It is isn’t so much anti-science, it is more just anti-rational, a belief in sympathetic magic and a fondness for a kind of cod-science that fits the facts to a pre-determined set of notions. Both those who sell this nonsense and those who buy it just love to dress it up in sciency facts, figures and theories. What I can’t figure out is how they fail to notice that the real world just isn’t that neat, tidy and predictable

          • March 27, 2013 at 6:31 am #

            ..but they know someone who told them about their amazing home birth and how wonderful their midwife was..
            (Or they watched TBOBB)

            Since they like and trust their acquaintance, they trust the n=1 evidence. Well, yeah, their cousin had a c-section but she probably had a pushy OB, and didn’t have the proper support.

          • Eddie
            March 27, 2013 at 12:25 pm #

            It’s a REALLY good point that most people intuitively MISunderstand anecdotal evidence. And since childbirth, even 100 years ago, was “mostly safe” — after all, a woman *only* had a 1 in 100 chance of dying each time a child was born. Anecdotally seems safe in the small. Until you look at the big picture and realize that 1 in 4 women who died during childbearing years in America — just 90 years ago — died during childbirth. But the NCB community seems to think that doctors washing their hands is what makes that big difference. (rolling my eyes)

          • The Bofa on the Sofa
            March 27, 2013 at 12:47 pm #

            Then again, by the same measure, drunk driving is also “mostly safe.” Shit, russian roulette is even “mostly safe” since you have an 83% of surviving.

            The problem is that we are not (nor should we be) satisfied with “mostly safe.” Those instances where it turned out not to be safe correspond to real people who suffered, and even lost their lives. That “it’s not likely to be me” is not sufficient for a civilized society.

          • Eddie
            March 27, 2013 at 4:14 pm #

            I find it tragic that, in fact, our inability to be satisfied with “mostly safe” is seen as “the medicalization of birth” instead of a reasonable, science-based, fact-based desire to reduce death and injury rate.

          • Eddie
            March 27, 2013 at 11:22 am #

            The way you put it is better than the way I put it. Anti-rational. I see it partly as this: There is a natural human desire to want a single, *simple* narrative explanation for why things are the way they are. The real world is multidimensional and complicated, but people want a simple explanation. This plus confirmation bias explains an awful lot of this.

            I’ve had long discussions in other venues with the anti-rational folks, and they are remarkably resistant to facts. Again: Simple, one-dimensional explanation trumps complicated facts.

            Humility is also a big factor. Those who have it are less likely to fall into the anti-rational traps.

          • Something From Nothing
            March 27, 2013 at 12:51 pm #

            It’s based on a strong desire to believe these things to be true. Same as the fact that people are uncomfortable with death and so we invent a lovely fairy tale about where we go when we die. It isn’t based on anything factual, yet, the vast majority of people on the planet believe in some type of deity / afterlife. Try convincing the religious (a good example is creationism) with science and facts and see where it gets you. No where. Home birth woo is religion. Very hard to change.

          • Disgusted
            March 27, 2013 at 9:09 am #

            I know way too many people like this. You can put as many facts and peer reviewed studies in their face as you want and they say things like “of course the medical-industrial-military complex is going to say that”. Then call you a sheep for “buying into the lies”. There’s nothing you can do there.

          • Something From Nothing
            March 27, 2013 at 12:49 pm #

            Because it is religion!!

          • The Bofa on the Sofa
            March 27, 2013 at 9:45 am #

            Exactly, Eddie. As you say, it does not excuse the lies, but the problem goes way beyond the lies of the NCB.

          • theadequatemother
            March 27, 2013 at 9:08 am #

            I agree with this…midwifery in Canada is sanctioned by the state and paid for by the provincial insurer in at least half the provinces…and the midwives are becoming more ideologically determined and woo-ish. I don’t know where it is coming from – I am thinking from the homebirth culture in the US but am not sure.

            But are the midwives “lying” or do they really believe it ie they are ignorant and their training isn’t adequate? They are selling a nice story for sure.

          • Guestll
            March 27, 2013 at 3:44 pm #

            TAM, I received great care from my secondary RM, and the head of my clinic. Both were evidence-based. My primary, however, was really into the woo, and you bring up a good point: did she tell me, for example, not to bother with GDM testing because I was thin because she genuinely believed that GDM does not happen to thin women? Or was she manipulating me to suit her own agenda?

            I spent 7 months under her care and I think it was the latter. In her case, it wasn’t a failure of training, but a selfish need to place her ideologies ahead of evidence-based care.

          • The Bofa on the Sofa
            March 27, 2013 at 9:48 am #

            What if they’re working within the system?

            So what if they are? Homeopathic doctors are still doctors, and can be licensed and everything, but they are still quacks, and the fact that they are doctors pushing homeopathy doesn’t make it any more legit.

            Within the system or out, if your midwife is heavily steeped into common woo, and it doesn’t make you run, then the problem goes well beyond the lies of the NCB.

          • Guestll
            March 27, 2013 at 3:40 pm #

            Homeopathy is not sanctioned by my province. It is not covered by insurance. My former GP would never recommend homeopathy, but did indeed strongly endorse midwifery care. My province isn’t building centres devoted to homeopathic care.
            Midwifery is part of the culture here. Homeopathy is a fringe pseudoscience. Do you not see the difference?

          • thepragmatist
            March 28, 2013 at 12:03 am #

            Amen. My midwife COMPLETELY understated the importance of the GD test. Totally. And you know what, my family has a high, high incidence of diabetes, AND my son was born with crashing blood sugars. I told her the family history (all aunts had GD… no sisters to test the theory on) and she sent me for the 1 hour test, and that was it. Totally understated. Only a year later (PP) did I connect my son’s crashing blood sugar at birth with the possibility that I had undiagnosed GD! Very frustrated in hindsight. He was close to needing an IV and I had NO clue that GD would produce anything other than a large baby. I didn’t know that it could produce a small baby, or that it could cause the baby born to have crashing blood sugars… in no other health arena do we expect anyone to know ahead of time what issues are important. In my case, I was vomiting so much that I didn’t gain weight and probably did not have crazy out of control sugars since I already eat like a diabetic (my dad is and I’d like to avoid that)… Still, my son was born with the crashing blood sugars indicative of an GD mum with no other apparent risk factors.

        • thepragmatist
          March 27, 2013 at 11:58 pm #

          Yes, exactly this. I would not have questioned my midwife’s expertise. And it is fortunate we live in a place where she actually had some. So I can see how a person can be duped.

  14. Renee Martin
    March 26, 2013 at 12:57 pm #

    They also hire actual lobbyists! These “poor, downtrodden, persecuted” wanna be MWs have lobbyists so they can get laws favorable to themselves. But they aren’t in it for the money….

  15. The Computer Ate My Nym
    March 26, 2013 at 12:54 pm #

    Given that the data from Oregon suggests that not having a DEM is as safe as having one* why should anyone profit from home birth? They appear to be a waste of money. If you simply must stunt birth, you may be as well off going all the way and UCing***.

    *Keeping in mind the important caveats that it isn’t clear what percent of the “non-DEM births” were attended by a CNM/MD/DO and what percent were unattended and also that the analysis was simply something Some Nut On the Internet** did, not a rigorous peer reviewed evaluation of the safety of home birth.

    **That’s going to be my next nym.

    ***Keeping in mind that UC is horrifically dangerous and that it is perfectly natural for a pregnancy or delivery to go horribly wrong and kill the mother, baby, or both. If you want a safe and comfortable birth, find a nice hospital with a birth center for low risk women with the nice bed, jacuzzi, birthing ball–and the OR down the hall.

    • Siri
      March 26, 2013 at 4:21 pm #

      Whatever you say, SNOtI!

      • The Computer Ate My Nym
        March 26, 2013 at 5:38 pm #

        As long as you don’t start calling me dave and telling me you can’t do that, Siri.

        • Siri
          March 28, 2013 at 4:32 pm #

          It’s when I call you pigeon pie you need to worry…

  16. The Bofa on the Sofa
    March 26, 2013 at 12:38 pm #

    Consider also the objection that OBs object to midwives because they will cut into their business. Really? Aside from the fact that most OBs are already swamped with patients (and finding one that will accept new patients can be challenging, so they aren’t hurting in that respect), note also that since HB is such a fringe market anyway, it means little to the OB. Seriously, an increase of women doing HBs with midwives from 0.5% to 1.0% constitutes a change of only about 1/2 of 1% of the business for OBs. However, it constitutes a DOUBLING of the business for midwives. So who has the largest financial impact? The OB who goes from 30 deliveries a month to 29? Or the midwife who goes from 3 to 6?

    • Renee Martin
      March 26, 2013 at 1:01 pm #

      The only times OBs get hurt due to HB MW is when they have to pick up the pieces of a messy transfer, then get sued because they are the only one that has insurance. And, when they get a new patient that had HBs and is now has a combative attitude, or is behind in their preventative care. Otherwise, HB MWs make zero difference to OBs, who are already in demand.

    • Antigonos CNM
      March 26, 2013 at 1:51 pm #

      In point of fact, the burden of malpractice insurance, let alone being on call 24/7 [which can be alleviated by working in a group practice] means that most OBs in some states actually agree to deliver babies for approximately only 8 years after going into practice. Thereafter, they change to office OB and GYN. There are parts of the US where it is very difficult to find an OB to take a woman for both antenatal and intrapartum care.

    • March 26, 2013 at 3:29 pm #

      I agree that it’s a tiny, niche/fringe “industry”. Yet Dr. A. just recently compared it to Big Tobacco, which is pure hyperbole.

      • The Bofa on the Sofa
        March 26, 2013 at 4:02 pm #

        What does niche or non-niche have to do with the comparison, which was based on misleading claims and distorting research?

        Apparently, “non-sequitor” was not one of the vocabulary words on your SAT, because you have no concept of it. Then again, I always thought SATs were testing things like reading comprehension and logical skills, and you haven’t shown that you have either of those, either. Makes that perfect score even more amazing.

        • March 26, 2013 at 4:28 pm #

          Not a non sequitor, as it does follow. Speaking of following: Dr. Amy’s words “Like tobacco companies…” immediately followed the assertion that “they are brilliant at public relations”. I have not been to business school (*shudder* perish the thought), but I doubt they teach that getting less than one percent market share is evidence of an industry being “brilliant at public relations”.

          • T.
            March 26, 2013 at 4:48 pm #

            It really depends on how big the market is, how tricky and your product. 1% is a good number for this particular market and product because:
            1. Would homebirth rises more in number (say, rise to 10%) so would the number of babies and mothers being harmed, and as such there would be probably a backslash.
            2. There aren’t probably so many women who wants to be that kind of midwife to begin with, so the offer is limited (this is postulated by me).
            3. It is not really 1% of the market to begin with, it is higher. It is 1% of ALL THE BIRTHS. Now, of course, we know that lower-income women have more children -and are more, I seem to recall that 50% of people in the US is under the poverty line-. So 50% of the “Birth-Market” is NOT *their* market, because those women don’t have the money to pay them. As such, it is probably an higher number if you count that their target is middle-upper class women with a panchant for naturalism (the so called crunchy type).

          • Guestll
            March 27, 2013 at 12:18 am #

            Depends on a number of factors but in certain business segments, 1% share is nothing to scoff at. I did go to business school and get an MBA, try to restrain your shuddering. 😉

          • AllieFoyle
            March 27, 2013 at 1:09 pm #

            Like a lot of industries, I suspect that much of the financial value of the HB world lies in hooking people on the philosophy and then selling them related products. Books, DVDs, classes, gear, garments, music, oils, etc.

        • Sue
          March 26, 2013 at 9:10 pm #

          (How easy is it to cheat on the SAT?)

      • Eddie
        March 26, 2013 at 6:35 pm #

        Uhhhh….. Dr Amy never compared the size of the homebirth industry to the size of the tobacco industry. As *you* clarify below, she compared their skills at public relations. Since you understand that point, that she is comparing skill levels of the two industries, why does the size matter? That comparison is not hyperbole at all. It was apt.

        • Sue
          March 27, 2013 at 12:20 am #

          But if each word of a sentence or article doesn’t fit Alan’s understanding of the world, it seems to cause him discomfort. He doesn’t seem to do flexibility very well. (Hmmm – it mustn’t be tested in the SAT.)

      • KumquatWriter
        March 26, 2013 at 7:43 pm #

        Dr. Amy was using “Big Tobacco’s” history of.hiding scientific evidence that their product was dangerous, even deadly. Sounds pretty apt as a comparison to MANA.

  17. krissy
    March 26, 2013 at 12:35 pm #

    Oh how I wish I read this before I choose a CPM. This is exactly right. I was fooled in to believing the license meant something. It only meant the midwives could collect more money from my insurance company. I hate when people say using a midwife is less expensive. My insurance would have payed 80% if I went to a OB, but only 60% for a midwife. My deductible was higher too. Also, with the ensuing complications I had my birth cost went up to $30,000 total. The midwife got almost $7000.00 without delivering a baby. I also read all of my EOB’s from the insurance company, the midwife would submit a fee and only when it was denied would they try again with a lower figure. They tried to charge for things they did not even do, like attend the delivery of my son. It took over 6 months for them to finalize my bill. Of course without malpractice insurance I could not recoup any costs. Leave CPM’s unlicensed, let they try to pry $7000 from families without insurance money. Then to make matters worse OHLA is now going to get disciplinary action fees from these midwives to continue their charade of protecting Oregonians from negligent useless birth junkies.

    • Renee Martin
      March 26, 2013 at 1:02 pm #

      Disciplinary action fees?

      • krissy
        March 26, 2013 at 1:22 pm #

        This is what happens in Oregon if you file a complaint against a licensed midwife. Two midwives were not licensed, so I could do nothing against them. The other 2 midwives I filed an OHLA complaint and have been waiting since Sept. 2010 for the case to be closed. They apply fees for the midwives to pay for their wrongful actions. OHLA will get these fees to use for their ongoing investigations against midwives in Oregon. I will so no money, as well as the fact that OHLA does not communicate with the families of the victims once they have interviewed the complainant. So basically, they just get money to keep their ridiculous licensing agency open. It does no greater good for the public.

    • Are you nuts
      March 26, 2013 at 9:08 pm #

      Wait… Is $7k the going rate?? I figured we were talking a few hundred bucks here so I always questioned if money was really a motivator here.

      I understand why OBs get paid so much. You’re not only paying her for the time she spends with you, but also for her education and years of practice. Oh, and that pesky malpractice insurance. What the *{£€ are you paying for when you write a check to a non-nurse midwife for SEVEN THOUSAND DOLLARS? Hours of commenting on message boards? Blog reading? I guess TFBcharges for her blog now so that’s some of it…

      Wow I’m truly shocked.

      • Eddie
        March 26, 2013 at 9:29 pm #

        We paid $5200 to my wife’s Ob/Gyn office for all prenatal care (not including fees for blood tests, ultrasounds, etc) plus the delivery. (To be fair, that is what was billed to the insurance.) It’s stunning to think of paying 20% more than that to someone with a fraction of the education, and someone who may not even be present at delivery if it needs to occur at a hospital.

        But looking at economics … an Ob/Gyn office will deliver MANY more babies per year than any given midwife (according to what others have said here). Thus, the midwife has to charge a lot more just to cover the fixed costs of running a business. Of course, there’s no malpractice insurance for the midwife and the costs of running her or his business should be quite a bit lower — no need to own capital medical equipment that costs tens of thousands of dollars, such as an ultrasound machine.

        • auntbea
          March 26, 2013 at 9:38 pm #

          I believe we’ve discussed the overhead of being a midwife before – I think a DEM was here explaining why midwives can’t afford insurance. I think the grand total involved a car and gas. Oh, and fresh herbs.

          • Bombshellrisa
            March 26, 2013 at 11:55 pm #


            Lorri Carr’s client contract states “The midwife does not currently carry malpractice insurance due to the

            prohibitive costs which would have to be passed on to the clients. ”
            ((the next line is of course this “As a woman freely choosing midwifery care and out-of-hospital birth, I understand that (please initial):

            _______ I am ultimately responsible for the outcome of this pregnancy and birth.

            _______ My midwife is responsible for providing adequate clinical management of healthy,

            normal childbearing, as outlined in her training, credentials, and licensing.”))

          • Eddie
            March 27, 2013 at 1:56 am #

            Hmm, if malpractice insurance is prohibitively expensive, what does that say about the safety of the service provided?

          • The Bofa on the Sofa
            March 27, 2013 at 10:16 am #

            This is something I have been mentioning lately. The reason insurance is expensive is because the activity is risky. This is not just about homebirths, it is basically the whole premise of insurance.

            Homebirth malpractice insurance is very expensive because if there is a bad outcome and a malpractice suit is filed, they will win. Almost guaranteed, because homebirth is clearly far and away outside of the realm of standard practice. It’s a slam-dunk malpractice suit.

            Consequently, if you are going to insure against it, it is going to cost a ton.

          • Sue
            March 27, 2013 at 12:23 am #

            But what about the outlay for the placenta dessicator and capsuliser?

          • Certified Hamster Midwife
            March 30, 2013 at 5:08 pm #

            I thought placenta encapsulation was a whole other birth worker you had to hire.

          • theadequatemother
            March 27, 2013 at 9:13 am #

            If DEMs/ CPMs really thought birth was safe, they could start their own collective insurance company. This is how the CMPA started in Canada (we have essentially one insurer for 98%+ of our physicians).

            But they wont, because they KNOW they will have to pay out and unless their insurer was guaranteed by the state it would go bankrupt in a hurry.

          • auntbea
            March 27, 2013 at 9:18 am #

            But, really, why insure yourself at all when you could just never pay anything to anyone?

          • theadequatemother
            March 27, 2013 at 9:25 am #

            Because you are a professional that believes that people who are harmed by negligence on your part (whether intentional or not) deserve compensation to help them cope with the outcome (parents should not be bankrupted by having a child with HIE for example).

          • auntbea
            March 27, 2013 at 9:28 am #

            Oh. So not a DEM then.

          • theadequatemother
            March 27, 2013 at 9:29 am #


      • Something From Nothing
        March 26, 2013 at 11:13 pm #

        In Canada, midwives get paid significantly more than obstetricians per birth. If I’m not mistaken, the going rate for a doula is $650 per birth, which is more than I get paid for a normal birth. We are undervalued significantly compared to our peers.

        • Guestll
          March 27, 2013 at 12:24 am #

          When I was doula-shopping in a major Canadian city, the going rate for an experienced doula was between $800 and $1200. Rates included 1-2 consults pre-birth, time spent in L&D, and one post-birth visit.

          • Something From Nothing
            March 27, 2013 at 12:58 pm #

            That blows my mind. I work in BC. I get paid $550 for a vaginal birth, no matter how long the labor. There are minor premiums for time of day, but I couldn’t make that much in the most complicated labor imaginable. How are doula services valued more than ob’s? Really? I have 13 years university education and after ten years in practice, I’m still paying off school debt. So frustrating.

      • Laura
        March 26, 2013 at 11:38 pm #

        A CNM in the Los Angeles area was going to charge an acquaintance of mine $7,000 for an HBAC. My friend went with an uninsured CNM.

      • Cellist
        March 27, 2013 at 1:00 am #

        As of 2009 it cost $3500 for Ina May to deliver your baby at The Farm. Probably more by now. Plus doula services, childbirth education classes, labwork(?) and $500-$700 per week in accomodation.

        Pretty good money for unskilled labour!!!
        (sorry, worst pun ever, couldn’t resist.)

      • theadequatemother
        March 27, 2013 at 9:09 am #

        you are also paying the OB for shouldering responsibility for the outcome.

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