10 even worse reasons to have a homebirth

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Mommyish just posted a piece entitled 10 Terrible Reasons To Have A Home Birth by Bethany Ramos. It’s partly serious and partly tongue in cheek, and accompanied by lots of animated GIFs.

Ramos’ reasons include:

You hate you doctor
You don’t trust modern medicine
You want a memorable birth “experience”
You don’t want to have a C-section
They used to do it in the 1800′s!

It seems not to have occurred to Ramos that these are actually among the top reasons that women choose homebirth.

But there are even worse reasons to have a homebirth, and they include the following:

1. You think it’s safe.

It isn’t. Homebirth kills babies who didn’t have to die. Indeed ALL the existing research on American homebirth, as well as state and national statistics, show that homebirth with a nurse midwife doubles the risk of neonatal death, and homebirth with a non-nurse midwife has a death rate 3-9X higher than comparable risk hospital birth

2. You think homebirth midwives are real midwives

Most homebirth advocates have no clue that CPMs (certified professional midwife) are actually laypeople who carry a certification made up and awarded to themselves. They are a second, inferior class of “midwife” ineligible to practice in any other first world country because they lack the education and training of real midwives.

3. You trust birth

Homebirth advocates appear to be unaware that childbirth is inherently dangerous. It is, and has always been, in every time place and culture, a leading cause of death of young women and THE leading cause of death of children. There’s nothing trustworthy about birth and only a fool would trust it.

4. You actually think that because homebirth midwives carry resuscitation equipment they know how to use it

Hospital personnel train incessantly on how to manage emergency situations. They’ve performed hundreds or even thousands of resuscitations and probably did one within the past week. Most homebirth midwives have never performed a successful resuscitation.

5. You live only 10 minutes from the hospital

Can you hold your breath for 10 minutes? Neither can your baby if he or she is in distress.

6. You are afraid of hospital acquired infections

The major infectious threats to babies (and mothers) live within the mother’s vagina. These include group B strep and herpes.

7. You think waterbirth is “natural” even though primates don’t give birth in water

Yup, all indigenous peoples give birth in plastic kiddie pools in their living rooms.

8. You actually believed the nonsense and propaganda in The Business of Being Born

BOBB is a one sided, inaccurate piece of propaganda produced by a woman who has no training in midwifery, obstetrics or science. Most of the people presented as “experts” in the film are experts only in their own minds. No one with actual training in science or obstetrics pays any attention to them (if, indeed, they are even aware these “experts” exist).

9. You think that breech, twins, VBAC, gestational diabetes, pre-eclampsia and group B strep colonization are “variations of normal”

Apparently it has not yet occurred to you that homebirth midwives reclassify all high risk situations as “variations” of normal in order to retain control over high risk women and profit from them.

10. You had no idea that Ina May Gaskin is a layperson who lives in a cult and has no training in midwifery; that Henci Goer is a layperson with no training in science, medicine or midwifery; and that Ricki Lake is the Jenny McCarthy of birth

You probably also think that reading books, blogs and websites written by laypeople for other lay people constitutes “research.” It doesn’t. Only reading and analyzing the full breadth of the scientific literature on homebirth and obstetrics is actual research. Anything else is only kidding yourself.

The bottom line is that most women who choose homebirth do so for reasons that range from terrible to even worse. That’s because they have no idea of the risks of childbirth, no idea of that homebirth “midwives” are just lay people, no idea that watching a documentary is not “research.” and no idea that homebirth kills babies who didn’t have to die.

  • The Computer Ate My Nym

    My personal feeling on the worst single reason for having a home birth is this: You’ve been duped into believing that it’s safer than hospital birth and you want the best for your baby. So wrong and yet so plausible to someone who doesn’t know a lot about medicine.

    • Ash

      http://www.homebirth.org.uk/youcant.htm

      If you click on the links, NOTHING is excluded. It is truly appalling. Anticoagulated after a history of postpartum DVT&subsequent pulmonary embolism? Whatevs, it’ll be fine! Actually I’m most appalled that one person said their GP approved a homebirth in this situation.

    • Poogles

      Yup. I think that pretty much sums up why I had been considering it; I completely bought into the “cascade of interventions” and that the hands-off approach allowing the labor and delivery to proceed “unhindered” and “naturally” would be the safest for the baby and myself, that pretty much all labor/delivery complications are caused by interference from others. Which then logically led me to believe that an unassisted birth would be safest – can’t get anymore hands-off than that.

      So glad I found Dr. Amy before ever getting pregnant.

  • Burgundy

    A bit OT, I saw this news from a Taiwan news site today. A midwife group in Taiwan tried to push their agendas to all the OBGYN hospital. During the presentation to the National Health Department, they requested that the doctors would not provide pain med, only check baby heart beats 3 times during the labor, no induction, absolutely no episiotomy, minimum interference and the patients could chose giving birth anyway and anywhere – the hospital has to accommodate a patients request no matter what. (The example they gave was if a patient choose squatting down in a bathroom to give birth, the hospital needed to provide a bathroom for the patient), even during an emergency C-section, patient’s family members should be able to record the whole thing. Taiwan Association of OBGYN had a news conference calling this midwife group irresponsible and what they proposed deviated from medical practice norm that no reasonable medical professionals would accommodate that. Now the midwife group said they just wanted to open communication channels with hospitals so the patients could have a more “humane birthing environment”. WFT? I guess woos are taking over the world. I included the news link, Google translate it for a laugh?

    http://www2.cna.com.tw/news/ahel/201407240278-1.aspx

    • Young CC Prof

      So they want the hospital to accommodate the patients’ requests… for anything EXCEPT pain relief or induction? You can have your Model T in any color you want, as long as it’s black?

      How do people say these things and not realize how inconsistent they’re being?

      • Burgundy

        Also no forceps and no “machine” interference (whatever that mean). I also did not know that squatting was the preferred position of birthing for Taiwan midwife. I learned something new today.

        • Phascogale

          I’m guessing machine interference is talking about CTG’s

    • The Computer Ate My Nym

      I hope the NHD laughed them out of the room, but I’m worried that they might not have. The midwife/NCB route is cheaper, if you don’t count the cost of caring for the damaged children, and patient autonomy is hot right now so accommodating the patient’s request to give birth wherever might sound good to non-medical people.

    • The Computer Ate My Nym

      a more “humane birthing environment”.

      Trying to imagine in what world refusing pain relief to someone in severe pain is considered a humane environment, much less a MORE humane environment than the one in which pain relief is given.

  • Anna T

    This is probably really stupid, but the only coherent thought in my head right now is, “who on earth is Jenny McCarthy?”

    • Daleth

      You lucky, lucky woman, not to know that! :)

    • Amy M

      Just google her…in a nutshell, she was a playboy bunny who decided her autistic son became autistic due to the MMR vaccine, so she got behind Andrew Wakefield and almost single-handedly started the massive wave of anti-vaccination in the US over the last 10-15yrs. There’s a website called the Jenny McCarthy body count, for children who died of vaccine preventable diseases.

      • Amazed

        Don’t. Anna, that is. Don’t google her. You’re better off not knowing. Another self-proclaimed medical expert and the darling of Dr Jay “won’t try to influence my AIDS patient not to breastfeed and won’t try to brainwash anyone into thinking vaccines save lives” Gordon.

      • Therese

        I always thought that body count website was pretty stupid. As far as I understand, they contribute every vaccine preventable death to Jenny McCarthy, even if there is no evidence that the parents were influenced by her. Seems like that is just making her out to be way more influential than she really is.

      • Poogles

        Don’t forget that she originally believed her son was an “Indigo” child, and that was what made him “different” – then he got older and was diagnosed as autistic, so suddenly she deletes all the “Indigo Child” stuff and starts proclaiming that the evil vaccines caused “the light to go out in his eyes”. Ugh.

    • Anj Fabian

      The pop culture version of the story is that Jenny McCarthy had a son who had a very scary seizure which led to his diagnosis of ASD.

      She hooked up with the woo vendors and ended up on Oprah telling the world how vaccines damaged her poor, blue eyed, curly haired son.

      Her story has a few important players in it such as Wakefield, but Oprah was key in getting this story out to the widest audience possible. Attractive and passionate mother, adorable child and a convenient scapegoat…plus a national soapbox.

  • Sara

    During my first birth I had shoddy prenatal care from a HB midwife who said “eat a whole chicken!” after my BP readings started creeping up. I also had trace protein in my urine. Thankfully I delivered in a hospital atfer labor began spontaneously at 38 weeks. I shudder to imagine what might have happened if I foolishly waited it out, as the midwife would have advised, and didn’t go into labor naturally until 40 or even 42 weeks.

    This time (2nd pregnancy) I planned a hospital birth with a CNM who referred to a team of OBs, and they take pre-eclampsia seriously. I developed pre-e again around 36 weeks, and I was safely and uneventfully induced at 37 weeks. I feel blessed to have a healthy baby, and that I did not suffer any ill effects from pre-e. Yet, I am horrified that there are people out there practicing midwifery who have no respect for serious, life-threatening medical conditions like pre-eclampsia. I’ve read birth blogs by people who speculate that high BP prior to delivery is just one of those benign things that happens to some women– a “variation of normal.”

    Yeah, well like birth, death is as normal and natural as it gets– premature death in childbirth is just a variation, right?

    • Trixie

      A whole chicken to cure BP issues? Were you to make a burnt offering and then use the organs to predict the future? Just when you think you’ve heard it all…

      • The Bofa, Being of the Sofa

        For some reason, I have this line from Ghostbusters II in my head: “So your alien had a room at the Holiday Inn in Paramus?”

      • attitude devant

        Brewer diet.

        • Trixie

          Ah, of course. I was thinking WAPF, bury then it would’ve involved raw milk.

      • SuE

        Better off reading the chicken entrails…

  • Trixie

    Here’s another reason not to homebirth, from a woman claiming to be a doula, posted to the public VBACfacts FB page, in a thread about placenta accreta (Jen Kamel’s point being that accretas are terrifying so therefore people should VBAC to prevent them).

    • Sara

      I recently read a story in the Above Rubies magazine about a midwife who delivered her baby at home (by herself, I believe) and had placenta accreta despite having no risk factors at all. Thankfully she was wise enough to get to the hospital pretty quickly after realizing the placenta would not deliver and she was able to get proper care.

    • Anna T

      This is very scary. Can placenta accreta go undiagnosed up until the moment of birth? Would it be seen in an ultrasound?

      • attitude devant

        It’s pretty clear this woman never had an ultrasound…..
        But the answer is sometimes yes, sometimes no.

        • Anna T

          Then it’s even scarier. Is it possible for an accreta to be missed if a woman has multiple scans during pregnancy? Fantastic… one more thing to worry about…

          • Daleth

            That would be yet another reason why you give birth in the HOSPITAL with DOCTORS, not in your bedroom with a crunchy midwife.

          • Stacy48918

            Or to maybe not wait an HOUR before investigating the non-appearance of the placenta? Or take mom’s HR and BP? I’m no supporter of homebirth but if we want to suppose that it could at least be made safER (though never as safe as hospital birth) there are some very simple things these midwives could be doing to make that change. Trouble is, they buck against the simplest things like active 3rd stage management, BP checks, being “hands-on” during/after labor/delivery. Ridiculous. What a tragedy for that mother to die. At least the doula “saw the light”.

          • Daleth

            Seriously. God forbid they have some objective safety standards to follow.

          • Medwife

            Yup. Gotta wait until everything becomes a screaming frantic emergency. Like acreta isn’t scary enough to deal with in the hospital.

          • Trixie

            Sounds like the doula had to call 911. Who knows how long that took.

      • Medwife

        I think MRI might be more sensitive to acreta. If we have a patient who has a history of c/s, and an anterior low-lying placenta, they get an MRI.

      • TsuDhoNimh

        ” Can placenta accreta go undiagnosed up until the moment of birth?”

        Yes. It might be spotted on ultrasound, but not always. It’s typical symptom is delayed delivery of the placenta, and an early symptom might be vaginal bleeding during pregnancy.

        it’s in the uncommon but scary category because of the massive blood loss that can happen extremely quickly before surgical interventions can attempt to fix it.

        Truly an OH CRAP! moment for L&D and blood bank staff.

      • Trixie

        Her midwife was the kind of special idiot who attends HBA4Cs. Not the kind who orders ultrasounds.

    • The Bofa, Being of the Sofa

      So what kind of smoothie was it?

      • Trixie

        I’m thinking kale/coconut oil since obviously it couldn’t have contained placenta yet.

    • Life Tip

      It’s nice of her to reassure us that this was because of the mother’s request. A little subtle victim blaming there, as per usual.

    • Forgetful Guest

      I’m surprised that even as a doula, she had no idea how serious (and, as she found out, deadly) accreta can be. All these birth junkies are supposed to be so well “informed” and do a lot of “research”… well, obviously they don’t read about possible complications much, huh? I guess the woo part of things is more important. But then we already knew that… I’m not too sure why I’m even surprised at the ignorance – I just am. Glad this person is at least aware of what she didn’t know, has since stopped attending home births and is asking herself about the “what ifs”. If only more NCB “providers” had that ability to reflect…

      • Anj Fabian

        When it comes to risks and complications, the standard hand waving is to not worry about them because they are so rare – and if anything did happen, there’s always the hospital.

        So they don’t worry, they don’t educate themselves and when something does happen, they are blindsided, shocked and often completely unprepared.

    • Guest

      Is this post still on VBACfacts FB page? I was looking for it, but couldn’t find it and was wondering if it had been deleted.

      • Smoochagator

        I assumed it would have been deleted right away. Fearmongering and all that.
        My favorite line is at the end: “Accreta is serious, I had no idea.” Really? REALLY? You had no idea? Great doula training there.

        • Trixie

          No, she even “liked” it. Cognitive dissonance.

    • Guest

      Uhhh…nevermind. Just saw it.

  • Amy M

    So far, most of the comments were in the vein of “Yeah, I like my nice safe hospitals where they clean up after you, feed you and give you painkillers.”

    Someone even directed everyone else to SOB, despite not being a fan of Dr. Amy, conceding that [Dr. Amy] had some good points about safety and the difference between CPMs and CNMs. Same poster also mentioned Hurt by Homebirth and Doula Dani. Unless that was one of you guys in disguise, in which case, very good.

  • TsuDhoNimh

    “4. You actually think that because homebirth midwives carry resuscitation equipment they know how to use it.”

    I will testify to having seen one who bragged on her skills as a midwife who had NO IDEA how to hook up a regulator to a tank of O2, or the mask to the output of the regulator.

    She had never cleared an airway, practiced intubation or taken a professional-level CPR course. Her level of first aid training was about “YMCA Babysitter Class” level.

  • Deena Chamlee

    OMG IT IS GENETIC DISCRIMINATION. If one is “sane” one is suppressed not only by the kyiarchy but by the majority of the group who are narcisstic. OMG I was booted out because I am not a gatekeeper.

    • Mom2Many

      I wish I knew what you are saying….am I the only one that is confused? Perhaps you could dumb it down for me? Thanks, and I hope you are okay, from your previous posts you sound like life has not been easy for you.

      • Deena Chamlee

        Amy knows. And life has been not only unfair it has been oppressive. discriminatory, and abusive.

        • Mom2Many

          I’m so sorry. I hope that things improve for you soon. Sometimes life can be overwhelmingly difficult. Wishing you all the best.

          • Deena Chamlee

            thank you.

        • attitude devant

          Please take care of yourself, Deena.

          • Deena Chamlee

            I will guess I am awakening at different times. What I have witnessed and experienced has definitely injured me. Beginning with homebirth deaths in Portland all the way to the horrific stalking.

          • Somewhereinthemiddle

            Stalking? By other midwives?

          • Deena Chamlee

            read previous post, yes.

      • Deena Chamlee

        The leadership in all three midwifery organization participate in a “kyiarchy”. Midwifery is largely pathologically narcisstic, thus, the leaders lead through oppression, domination and discrimination of members who are “sane”. And by getting their narcisstic supply met from others that are narcisstic and from those who remain unaware of their true idenitity. The large family of narcisstic members are oppressed by the kyiarchy but accept this because they get their narccistic supply met through mirroring and by being a part of the elitist group. The non narcissitic member are oppressed, discrimnated against and dominated by the kyiarchy and by the large family of narcissist. Bottomline is neither of the ruling groups desire change due to the need to attain narcisstic supply and the ever illusive need for power.

        The bottomline for the harmed parents by homebirth is the profession operates by malignant self love and not by what is good for you. Thus, in order to bring about change the kyiarchy must be overthrown via outsiders and justice must be sought in order for this to occur. So I say let’s all stand up against such injustice for the poor babies, the lost families and for the midwives who are sane.

  • fiftyfifty1

    “It seems not to have occurred to Ramos that these are actually among the top reasons that women choose homebirth.”

    Hmmm, I didn’t read it that way. It seemed to me that she knew that these were common reasons, but that she thought they were bad reasons unlike HER reason which was that it cost less.

    • Ennis Demeter

      It’s funny, I’ve often thought that the money issue is the one thing I can’t argue againt, although naturally, it is money well spent. Hopefully Obamacare will make this reason go away.

      • Daleth

        Seriously, HOW does it cost less? Unless you (1) have no health insurance AND (2) intend to actually pay your medical bills when they finally arrive, it can’t cost less.

        • Young CC Prof

          That’s the precise situation in which it costs less, either no insurance or insurance that offers little or no maternity coverage. It’s less common but it does exist.

          • Ennis Demeter

            Before Obamacare, insurance carriers didn’t have to cover birth control or maternity, and they could drop you at any time for any reason. A lot of the self insured were and still are the ones with incomes too high for Medicaid who end up with shitty policies

          • Stacy48918

            “A lot of the self insured were and still are the ones with incomes too high for Medicaid who end up with shitty policies””
            My family is still in this group, unfortunately. On paper I make WAY too much to qualify for any kind of subsidy or program to help lower insurance cost. However, I have 6-figure educational debt…and that is never taken into account at all. So health insurance is STILL prohibitively expensive for us.

          • Guesteleh

            Have you tried renegotiating your loan to lower your monthly payments? I think you should try. It will extend the payment period but give you better cash flow month to month.

          • Daleth

            There is no longer any such thing as insurance that doesn’t provide maternity coverage, so that’s out. And the only way you could get so little coverage that a home birth would be cheaper is if you have a catastrophic-only plan and you chose not to get a normal amount of prenatal care (which would eat into your deductible such that the actual birth would probably be partly covered even under a catastrophic plan).

          • Young CC Prof

            Yes, Obamacare, more accurately described as Obama health insurance reform, did ban those sorts of policies. So it’s mostly just the actually uninsured.

          • Daleth

            The actually uninsured who care about their credit scores and thus plan to actually pay their bills. The homebirth midwife, unlike the hospital, is probably going to ask for her several grand up front…

          • Somewhereinthemiddle

            Good point. If you don’t pay your HB midwife, she most likely will not show. In states where they aren’t recognized as legit healthcare provider, there wouldn’t be any legal ramifications for abandoning a patient for financial reasons. But the hospital and physicians/ CNMs are obligated to treat you regardless of your financial status. Never thought about that aspect of things before…

          • Liz Leyden

            One of my SILs is an unlicensed homebirth midwife in rural western NY. She has some training, but it’s not recognized by her state. She won’t move to a state where her training is recognized. She refuses to go to nursing school, or get training that her state will recognize. Most of her clients are Amish, and quite a few have skipped out without payment. Going after them in court would expose her illegal practice, so she is up a creek when her clients don’t pay her.

          • Liz Leyden

            Unfortunately, Obama has allowed some plans that don’t meet the new ACA standards, like providing maternity and prenatal care, to be grandfathered for the next year or two.

        • Stacy48918

          That was me and my husband when we were planning both homebirths. We paid everything out of pocket. First time homebirth was definitely cheaper because I successfully delivered at home. Second needed an emergent transfer for decels into the 80s…midwife’s bill PLUS about $9K for an unmedicated vaginal delivery 15 minutes after arrival and AMA check out 6 hours later. Definitely NOT cheaper. We gambled and lost. That’s what these women are doing – gambling that they won’t have an issue. If they don’t, then even a $4K CPM bill is cheaper than an unmedicated vaginal delivery in a hospital.

          • Jenny_from_da_Bloc

            $4k for a lay midwife? Good God!? I only had to pay my OB $700 up front which includes any costs associated with the new baby’s circumcision and we are expecting it to be refunded. In FL for my first sons birth by C/S with the insurance and circumcision our total out of pocket was $35 dollars for like gauze or something silly.

          • Stacy48918

            Yes, but that $700 was not the total bill, just YOUR out of pocket portion. I guarantee the insurance company was billed quite a bit more. And if you hadn’t had insurance, YOU would have received that bill. You can’t think of it just in terms of what you actually paid out of pocket at that moment. You’ve paid premiums for months/years prior, the insurance company pays a portion, and you pay a portion.

          • Guest

            This is true, but I still can’t believe how much midwives charge to deliver a baby in YOUR own house. They have no overhead, and get paid more than a lot of OBs. My OB was only paid about $2,500 for all my prenatal appointments and delivery (that’s what my insurance paid plus my copayment). Of course the hospital was paid more, but my doctor doesn’t see any of that.

          • Stacy48918

            I agree 100%. The variation is upsetting too. My CNM homebirth midwife charged $2500, labs and US extra. My friend had a CPM for her homebirth, charged $4000, labs and US extra (not that they did any…grr…). That also really upset me because they are in a much more precarious financial situation than we are so that extra money is a huge difference in their family budget. Also being 20-30 minutes from the closest hospital and having a 10# baby, oh yea and going into labor in the middle of a raging snowstorm…oy. Thankfully it wasn’t a disaster.

          • Jenny_from_da_Bloc

            Well yeah of course we pay our premiums and what not but either way we never actually saw that money because it’s deducted automatically from his salary. What I mean is our out of pocket expenses. Of course the insurance is billed quite a bit more and with our HSA we never had to touch our bank account for medical expenses. I do realize my situation is very lucky in regards to the insurance and oop. Luckily my husbands company offers very good insurance, our deductible is very, very low and they match our contribution to the HSA. I had my 3rd open spine surgery 2 years ago, the bill was well over 300k and all paid was the $500 deductible.

          • Stacy48918

            But that’s how the “homebirth is cheaper” crowd does the math. How many months have you been paying premiums x cost of premiums, plus out of pocket…compared to out of pocket homebirth midwife.

          • Jenny_from_da_Bloc

            With all my spine issues the measly $300 bucks we pay a month for premiums/HSA is a deal. I can’t imagine what we would do without insurance or having to pay 4k up front for any medical costs. Did they allow a reasonable payment plan or dis they want it all up front to provide treatment? I just took out my OB contract and she bills the insurance $3100 for prenatal care and delivery.

          • Somewhereinthemiddle

            From what I understand, most hospitals will work with you on payment plans, but I’ve never tested the theory. I do know folks who have planned self-paid hospital births who have negotiated prices ahead of time with the hospital. Obviously it wouldn’t work that way for someone who planned an out of hospital birth, but it is another pay option.

          • Stacy48918

            We paid for our homebirth transfer to the hospital out of pocket. They dropped several things just because we were a homebirth transfer and the hospital liaison said it was specifically so that transferring would not be discouraged/scary for financial reasons. After that we got a 25% cash pay discount.

            We are currently receiving bills and negotiating for cash costs for my D&C last month. We have gotten a 30% cash pay discount so far. Payment plans are an option according to the business office.

            Most hospitals/business offices are simply happy to get paid, period, since so many people DO walk away from their bills.

          • Daleth

            Stacy48914, do you not have insurance? Why? Did you look at the Obamacare website to see what subsidies you would’ve gotten? I guess I’m confused as to how it makes sense to continue going without insurance when you have personal experience with getting whacked with a $9k hospital bill.

          • Stacy48918

            Our portion ended up being a little less than half the initial $9K. We are in the young, low healthcare using demographic. Unfortunately saddled with educational debt exceeding twice the household income, but still only eligible for about $100 a month in subsidies. We know it’s math that doesn’t work forever and plan to re-evaluate November 1 when open enrollment starts again. But in the past figuring hundreds of dollars a month in premiums plus thousands of dollars in deductibles we never met against the chance that we’d have a much larger bill…it was just money we needed every month to pay Uncle Sam. My initial loan payments (since into IBR) were more than our rent each month.

          • Daleth

            When you reevaluate, definitely check out the HMO policies. They tend to have very low deductibles and very low premiums. In exchange you get a smaller network (although actual emergencies that end with you in some out-of-network emergency room are, to my knowledge, covered like you were in-network–they certainly are in my state and the one other state I’ve looked at plans in, and I think that’s just generally true everywhere).

            When you’re of childbearing age, have kids, etc., high-deductible plans don’t generally make sense unless you have a lot of spare cash you’re putting into an HSA, which of course it doesn’t sound like is the case for you. And the cheapest low-deductible plans are the HMO ones.

            Best of luck.

          • Box of Salt

            I am compelled to add re: “the young, low healthcare using demographic” vs “childbearing age and have kids, you can’t count on being a low healthcare user ”

            When we had to research individual health insurance plans, the premiums we were quoted were higher than expected partly due to the fact one of my children was prone to ear infections.

          • Daleth

            When did you research individual plans? Pre-Obamacare, I’m guessing? I don’t see how the kid’s ear infections would come up at all when researching Obamacare (ACA exchange) plans. The only health-related question they ask in Obamacare applications is whether you smoke.

          • Stacy48918

            Both times my homebirth CNMs wanted the bill paid in full by 32 weeks or so. How we decided to break it up was up to us.

          • Guest

            I looked at mine too. My doctor charged $3,200, and actually was only paid about $2,200 between insurance and my copayment. I wish midwives in my area would post their fees on their websites, I don’t actually know anyone here who has used a homebirth midwife. Everyone I know that has used a CPM has been in a different area. But I’m willing to bet it’s more than $2,200.

          • Daleth

            Of course you can think of it just in terms of what you actually paid out of pocket. This is health insurance we’re talking about, not “labor and delivery insurance.” It covers everything, and that’s what you’re paying the premiums for: not just labor and delivery, but cancer, strep throat, broken bones, car accidents, etc.

            Maybe I’m misunderstanding but it sounds almost like you’re counting the entire cost of your insurance policy as somehow being the cost of giving birth in a hospital.

          • Stacy48918

            I realize that and I’m not saying the 2 are equivalent but these are the financial decisions that many Americans – not just myself – are faced with. Balancing their monthly bills with the likelihood of needing medical care. It’s been a decade since I’ve been to the doctor for an illness of any kind (and that was minor and self-resolving). I recognize that won’t go on forever, and we’re not philosophically opposed to health insurance that’s just my experience so far that has formed our decisions.

      • anonymous

        Obviously, this is not true for people on shitty health insurance who have to pay for deliveries themselves, but I was on Medicaid for pregnant women, which would have covered a hospital birth, and used our savings to pay about 3000 dollars for our homebirth (which thankfully went well). Had I read this blog before,I could have saved myself those dollars, which would have been nice for our family.

        • AmyP

          It’s terrible that a midwife would see your family’s conditions and take your 3,000 when you could have had a Medicaid hospital birth. Oh my goodness–so unethical. $3k pays for a lot of diapers.

    • Anna T

      If she was truly forced to choose homebirth because of money, I feel very sorry that a woman in the US has to make such a choice. But what would happen if she just walked into a hospital in labor, having no insurance? Would she get a bill later?

      • Young CC Prof

        Yes. And you generally can’t find out how big the bill will be in advance. You can negotiate a payment plan, maybe reduce the total, but you can’t make the bill go away unless you declare bankruptcy.

        • Anna T

          This sounds totally skewed.

          So thankful not to have this consideration. Money is tight for us right now, and I’d hate to compromise on subpar maternity care because of it.

          • anion

            It’s just been explained to you by several different people that you wouldn’t have to “compromise on subpar maternity care” because of a lack of funds, and that any hospital would be obligated to treat you (and treat you exactly the same as other patients, to a basic standard of care higher than many countries–frex, women in US maternity wards are not placed in single beds in huge wards with dozens of other women and no phones/TVs/privacy/shower/private toilet/ability to control the lights and thus when they sleep or wake up, unlike every hospital ward I’ve ever seen in the UK) and that low-income pregnant women can receive all kinds of insurance. I’m not sure why you’re not getting that?

            I’m not saying the system is perfect but I’m very, very tired of the idea that if you’re poor and pregnant in the US you’ll end up giving birth in an alley while cigar-smoking fatcats point and laugh.

          • Stacy48918

            Yes and no. Obviously prenatal care starting in the first trimester dramatically improves outcomes for mothers and babies. While a woman with no insurance can definitely walk into the labor ward in labor and receive top notch care…try that with all your prenatal visits. No insurance and no intent to pay…much less likely to fly. Hospitals are legally obligated to care for women in labor regardless of finances…I don’t think that OBs are legally obligated to provide prenatal care regardless of ability to pay. So yes she might get labor care…but she and her baby might be much sicker than they otherwise may have been.

          • Cobalt

            Exactly. Labor and delivery and emergency care they have to give you. Until then, you’re on your own. And Medicaid availability varies widely state to state, depends on your state’s rules, which get modified by politicians to suit the current voter situation.

            So no, you don’t have to deliver in an alley somewhere. You just may not have medical care before labor. Makes the cheap midwife clinics look good, certainly seems better than nothing at all.

          • Somewhereinthemiddle

            Do most community health clinics offer some sort of prenatal care option? Like county health offices or something like that? I haven’t needed those services in a looong time, but used them when I was younger for contraception and STI testing.

          • fiftyfifty1

            I worked at a community health clinic for my first few years after residency and ours CNMs and docs provided a lot of free or almost free prenatal care.

          • Somewhereinthemiddle

            I’m just curious as to why this option isn’t mentioned more often for prenatal care in discussions about mother who are uninsured. Are there many communities where there are no free/ low cost health clinics or there is a clinic but they don’t offer prenatal care? Obviously a free clinic isn’t the first choice for uninsured, low-income mothers, but isn’t some form of medical care better than nothing?

          • Somewhereinthemiddle

            Are they utilized that often for prenatal care or not really? I’m questioning specifically about the US since I know lots of folks here aren’t in the US.

          • Jenny_from_da_Bloc

            Medicaid is a federally funded program administered by each state individually, the rules and administration of the program vary by state. Where I live in Ohio there are community health clinics that provide medical care based on a sliding fee scale for the services required by the patient. These clinics can be accessed by low-income families and those without insurance for free or a fee based on income.

            There are also prenatal clinics for pregnant Medicaid patients. These clinics are staffed by CNMs and OB/GYNs. They see most of the Medicaid patients in our area because many of the private practice OBs do not accept Medicaid patients. A friend of mine had her pre-natal care with this clinic and was very happy with her treatment and the hospital she delivered at is the best in our area and everything was pretty much the same for both types of patients at the hospital.

            However, in FL most OBs accept Medicaid and see these patients in their offices, just like the patients with private insurance.They deliver at whatever hospital the doctor has privileges at just like the private insurance patients, so not much of a difference in FL. I had my first son in FL and I would never have known who had Medicaid and who did not, though most of the woman in the waiting room would freely tell you they were using Medicaid.

            In regards to the hospital in FL, another friend who had Medicaid and used the same doctor as me had a completely different type of room than I did at the same hospital and shared a recovery room with another patient. I’m assuming they cut out the perks for Medicaid patients because the hospital is paid less by Medicaid. She said everything that my room had and what we were given and had access to was completely different than her, even the food.

          • Life Tip

            In my experience, a low-income woman who lives in a major city probably has more options for prenatal care. But even for those living in a city with resources, many women do not know how to access the care that might be available. I work with immigrants, and I see many people who fall through the cracks because they aren’t sure how our system works, fear authorities or simply don’t have the English language skills.

            So, yes, help exists. But it doesn’t magically appear on a pregnant woman’s doorstep, and it’s not always easy to access.

          • Somewhereinthemiddle

            I figured that awareness of that as an option, accessibility, availability, transportation, and cultural/ language barriers would be an issue. My question was inspired by several discussions being had above where people where discussing the gaps in insurance and Medicaid and how a woman would have care for delivery but not prenatal care.
            I guess I was wondering if a free/ low cost clinic *is* a available and/or a viable option in most communities and it sounds like the answer isn’t all that simple.

          • anion

            They don’t know how to access it because of the persistent myth that the American medical establishment will let you die if you can’t pay your bill. The more people repeat this myth as fact, the more women assume it’s true and that there are no services out there for them.

            Walk into any public hospital in the US and tell them you’re pregnant and uninsured and would like help. They will find you help.

          • Bombshellrisa

            They also can help direct you to where to find other services like WIC and help with utilities and make sure you have transportation to your doctors appointments.

          • fiftyfifty1

            “I don’t think that OBs are legally obligated to provide prenatal care regardless of ability to pay.”

            No they are not legally obligated to provide it, but most do. “Insurance Pending” is a common designation among prenatal patients, sometimes for the entire 9 months.

            It’s an imperfect system, and I can’t wait to have it change, but saying you went with a homebirth midwife because you couldn’t afford anything else is just an excuse.

          • Stacy48918

            “saying you went with a homebirth midwife because you couldn’t afford anything else is just an excuse.”
            Right. The real reason is somewhere between “I didn’t want a heplock” and “I want to eat in labor”. It’s the experience they’re after, not the cost factor.

          • fiftyfifty1

            “Obviously prenatal care starting in the first trimester dramatically improves outcomes for mothers and babies.”

            Or at least is dramatically *correlated* with better outcomes.

          • Bombshellrisa

            Exactly-if you have no insurance you can pay out of pocket and get a small discount but you have to pay at time of service. When you go with Medicaid, you are limited (at least in my state) because clinics only take patients from certain zip codes, which Means you WILL get care but you may not to be able to go to the closest practice and that will determine what hospital you deliver at (for example if you are getting your medical through Seattle Indian Health Board, you will end up at a teaching hospital all of which are amazing but some people don’t want to go to a teaching hospital).

          • Life Tip

            It’s not just the delivery though. Many women do compromise prenatal/maternity care because of lack of funds. Even with insurance, I know people who have tried to wait out a problem at home rather than go to the ER, skipped the epidural/medicine in the hospital and left the hospital early AMA because they knew they couldn’t afford the bills.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            Birth is completely free in Israel. In fact, the mother gets a small monetary grant so she can buy baby supplies.

          • Anna T

            However some tests which are done during pregnancy are not entirely free. Basic OB care is, but there are certain tests/scans you have to pay for out of pocket if you want them, unless you have upgraded insurance.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            I was speaking of in-hospital care. Do I think Israeli women are “over-tested”? Sometimes yes, sometimes no. A good part of my job was dissuading women from having every test in the book. As for being time-consuming, it can be difficult; many ultrasound labs work until late in the night because the birth rate is high and it is difficult to squeeze everyone in. But we rarely hear complaints. As for cost, it is really very inexpensive compared to US costs, and the health funds do cover the usual antenatal tests most of the time. But if you want weekly ultrasounds, without a good medical reason, you’re going to have to pay.

            Defensive medicine is increasing in Israel because the Israeli public has begun to take a leaf from the US book, and are definitely more eager to sue than they were a generation ago.

          • Anna T

            I do realize that part of the extensive testing in Israel is defensive medicine; I’ve also heard opinions that it’s the “neurotic Jewish mother” syndrome. All of this leaves me wondering which tests/scans, if pressed for time, I can in good conscience skip without feeling as though I’m compromising my prenatal care.

          • http://www.antigonos.blogspot.com/ Antigonos CNM

            Write to me at meir dot cnm at gmail dot com and I’ll advise you. Let me know [1] your age, and [2] what baby this is, and [3] whether you have any medical or ob history that I should know about. And which kupah you belong to.

          • Anna T

            When I say “maternity care” I don’t only mean the delivery itself. What about during pregnancy? I’m only 16 weeks along and already had several OB appointments and 4 scans, out of which 2 were funded through upgraded health insurance. Having little to no care during pregnancy and then just arriving at the hospital doesn’t seem like a very lucrative prospect to me.

            I do not live in the US, never visited the US, and am not sure how exactly things work there. I do, however, hope that every pregnant woman has access to good care.

          • jenny

            When I got pregnant with my second, I went to a clinic and they helped me apply for medicaid. This was actually one of the reasons I planned a hospital birth for her. The home birth midwife also accepted medicaid but she didn’t have a social worker in her office to help me apply for it. Our health system is flawed but it’s not always a complete failure.

        • Guesteleh

          Yes, but…reality is that people walk away from their hospital bills all the time with very little consequence other than a bad credit record, which if you can’t afford to pay your hospital bill chances are good that your credit wasn’t good to begin with.

          I think a bigger factor in quality of care and access to care is whether you’re in a rural or urban area. Poor women in urban areas can and do get outstanding care at hospitals with Level 3 NICUs. If you’re poor in a rural area without a car or reliable public transportation, you are screwed. Even if you do have a car, making a two hour drive every time you have an OB appointment can be a huge barrier to receiving care.

          • Young CC Prof

            Yup. If you don’t have any money or credit record, it doesn’t do much more harm. It’s people who have some money, not a lot, and no insurance who are more obligated to pay.

        • Daleth

          Or you can just ignore the bill. Doing so will trash your credit but otherwise have no effect.

          • Stacy48918

            And since so many people already have bad credit, the idea of “trashing their credit” isn’t really a concern.

            One benefit to being in the veterinary world and not the human medical world – if you don’t have enough money to pay me now, up front, today, before you walk out – no treatment for Fluffy. If Fluffy is DYING, I’ll euthanize for low cost or free…otherwise, see ya later. There’s no treat first and stiffing me for the bill.

          • OlyS

            Ouch. I always pay my vet the day of service but I don’t think I’d visit your clinic.

          • Stacy48918

            Well I’m an ER vet so it’s not typically a shop around kind of service. But – what would you have me do? Treat everyone for free? How exactly am I to pay my staff/lights/water/bills? I feel bad for the dog with a cut/fleas/vomiting/diarrhea/PPQ, but am I supposed to treat them for free? I work within people’s financial means as I’m able but I have some people bring me animals and they literally have NOTHING.

            If a dog or cat is suffering and the owners have no money I will euthanize the animal for free – had one of those last week. But that cat needed a minimum of $1500 of treatment. He had a VERY treatable condition and I likely could have saved his life. But am *I* supposed to pay for it?

          • Somewhereinthemiddle

            A friend told me a about a friend of hers who had a stray kitten show up on their doorstep. The guy was not a cat fan, but made a deal with the cat that it could stay as long as it didn’t cost more than $100 at the vet. The cat lived for something like 15 years before it started having health problems. The guy took the cat to the vet and it was going to be something like $1000 to treat the cat. True to his word, he put the cat to sleep that day. Honestly, I think that is way more humane than dragging out the lives of suffering animals paying through the nose for it. But I am just not a very sentimental person about animals…

            And, no, I don’t think vets should shoulder the financial responsibility for treating sick animals for whoever walks through the door. That would be like suggesting that restaurants should be responsible for feeding people who can’t afford to dine out. That’s insane.

          • Stacy48918

            I meet folks like that too and I respect that. Everyone’s relationship with their pet is different and everyone’s finances are different.

            But the clients that want me to shoulder the blame/guilt/responsibility for their pet’s illness or their irresponsibility? Yea, no way.

          • Mishimoo

            Speaking of vet stuff, did you see the rant on VBB today? It was perfect!

          • Stacy48918

            I did and it is! I am ALWAYS wary sending a client out the door with a written script to fill at a human pharmacy. I have encountered most every one of those, the NPI one repeatedly. What part of “it’s ILLEGAL for me to have an NPI number” don’t you understand? Makes me very worried about filling my OWN prescriptions sometimes…

          • Mishimoo

            It makes me grateful that my local pharmacists appear to be competent. As far as I know, over here the only meds that vets get their clients to fill at a pharmacy are OTC ones for those reasons (along with legal ones, presumably). I don’t know if you have MIMS over there, but the veterinary annual handbook is very popular here. My old boss was beaming all day when the new one arrived. (~40 years of veterinary practice, he’s usually pretty reserved.)

          • The Bofa, Being of the Sofa

            If the owner had a cat for 15 years without paying $100 at the vet, he is a very lousy owner, it seems to me.

            What about vaccinations?

          • Stacy48918

            Yes, I thought that too. Likely the cat went with minimal preventive care all it’s life just to keep up with the guy’s deal.

            Irritating, but I understand that pets are important to people, even if they can’t provide a lot of care of their lives. As long as they don’t get to 15, get sick and the owners get mad at me that it costs a lot now to treat their cat for a condition that would have cost less if they’d addressed it earlier – eh. I’m not going to chastise them for it.

          • Somewhereinthemiddle

            Geez, let’s not overreact. $100/annual visit. My friend told me this story in 2005, so close to 10 years ago, the cat had been dead for a couple of years, and it was a 15 year old cat. I think that well explains how someone could care well for an animal for that amount of money/ year. And even now there are low cost vax options.

      • fiftyfifty1

        There is almost always coverage for pregnant women. Medicaid (free government insurance) cutoffs are much more generous for pregnant women. Rarely a woman will not qualify for this and if she doesn’t there are often a number of charity programs that will. For instance many areas have Catholic Charities where the un-insured or under-insured who make too much money for Medicaid can pay a nominal fee to be covered. The residency program I trained in had a partnership with just such a program and the entire fee was $2,000 for all the prenatal visits, labor, delivery, hospital fees and aftercare. Now that was 15 years ago, but even if it were doubled in price it would still be comparable to homebirth fees or even cheaper. And yes, a woman can also just walk in off the streets. She will supposedly be billed, but you can work out a payment plan with the hospital. They waive the majority of the charge and have a policy of never turning anyone in to collections as long as they continue to pay $5 per month toward their bill, or call and explain each month why they can’t.

      • Jenny_from_da_Bloc

        She would most likely get emergency Medicaid and there is also a program called HCAP which gives people without insurance free, basic medical care. It is usually written off by the hospital, paid for by the hospitals foundation or the state reimburses the hospital. When you walk.into an American hospital there are signs everywhere stating that women in labor cannot be turned away due to inability to pay for treatment or anybody needing emergency treatment for that matter

  • The Computer Ate My Nym

    Yup, all indigenous peoples give birth in plastic kiddie pools in their living rooms.

    Thanks. Now I have to clean my monitor and I have this image in my head of a “primitive” village full of “simple” people who live in grass huts, use clay pottery, and hunt with spears–and all have plastic kiddie pools taking up approximately 80% of the room inside their grass huts. Plus, probably, wifi.

    • Smoochagator

      And webcams so they can live-stream their “natural birth experience.”

      • yugaya

        I live in a place with large autochtone Roma population. You can imagine how irritating all those ‘gipsy’ mommas of the internet are to people like myself who actually know how much the real “Gipsy” women appreciate proper medical care in pregnancy and being able to give birth in a hospital – something a lot of them still do not have access to.

        • Smoochagator

          It’s the same thing with vaccinations. All over the world people are begging for vaccines to protect their kids from devastating illnesses, and in America we’re like, “Nah, we’ll pass, ‘natural’ immunity is better.” No, it’s not.

  • The Bofa, Being of the Sofa

    Glad you posted this, because then I can make a comment that is not as far off-topic.

    3. You trust birth

    7. You think waterbirth is “natural” even though primates don’t give birth in water

    Speaking of primates….

    Recall last week I mentioned the elephant who died as a result of complications due to childbirth that was on “Sex in the Wild.” Last night the topic was orangutans. Orangutans are really cool (my kids are on an orangutan kick (they didn’t watch the show, it was after their bedtime)), and they are, in fact, very similar to humans. Among the things that they do that is uncommon even for primates is that they have a monthly menses, and don’t signal fertility.

    I could imagine that NCBers watching the show would be drooling over some of the comparisons, and be anxious to say, “They can do it, so can we!” For example, orangutans give birth by themselves in their nests, 100 ft up in the tree tops. However, the show was clear to point out, the reason is because their anatomies are different from humans, and it is a result of our bipedalism. So no, that orangutans give birth relatively easily in the wild does not mean it’s a good idea for us.

    But they don’t always work out so easily. They also told the story of the orangutan who’s delivery got complicated by the placenta getting in the way. It was in a sanctuary in England, so they called in an OB to do a c-section, hoping that he would be able to recognize enough. The baby was born not breathing, but the resuscitation team got him going, and he turned out ok. Because of the c-section.

    But that’s not the important part of the story. The question is, what happened after the c-section. There was a concern that, since the mother was anesthetized through the process, that she would not recognize the baby nor accept him. However, they showed the video of when the mother was introduced to the baby after she woke up. She ran to him and grabbed him! Absolutely no problems with bonding at all.

    So if we can look to apes for models of birth, they show us that bonding after a c-section is not a problem. And since they don’t use birthing pools and do it in the water, I think the big lesson is that orangutans have just been brainwashed by the Western medicine establishment to not give birth the right way.

    • MamaBear

      I bet the other orangutans didn’t shame the one who needed the C-section. I also willing to be the C-Section isn’t out trying to have a “healing birth”.

      • The Bofa, Being of the Sofa

        I also willing to be the C-Section isn’t out trying to have a “healing birth”.

        Actually, she went into menopause before she would be up for having another (orangutans take 8 years to raise their baby to independence and don’t have another until the first is gone).

        Interestingly, she is the first known example of an orangutan to go through menopause. They aren’t believed to do it in the wild, but that’s because they die before they get to that point (humans had that stage in evolutionary development, too).

        Of course, I’m sure the whackos would just claim that the c-section caused her to have premature menopause. See? It”s evil!

    • Mel

      A few weeks ago, I was writing a lesson plan involving changing population dynamics in moose and white-tailed deer in Michigan in response to climate change. Since moose have been re-introduced into Michigan in the 1980′s, a small, but not insignificant cause of mortality has been complications during or after birthing a calf.

      Yet another example of how evolution – even in a truly free-ranging animal – does not protect against death in child birth.

      • Amy M

        And this has always been the case for all mammals, but its a lot more fun to believe that everything in nature is perfect and only humans, with all their modern inventions mess everything up. *huge eyeroll*

      • fiftyfifty1

        “A few weeks ago, I was writing a lesson plan involving changing population dynamics in moose and white-tailed deer in Michigan in response to climate change.”

        Sounds like a good lecture. Cool.

    • Stacy48918

      There was a gorilla at the San Diego Zoo earlier this year that also required a C-section and didn’t see the baby for 2 days after the birth, if I remember correctly. They also have video of her running to the baby, scooping it up and nursing it immediately upon reintroduction.

      • The Bofa, Being of the Sofa

        I meant to ask about her. Thanks for providing that.

      • Certified Hamster Midwife

        The baby had a hat on, too.

    • Cobalt

      Orangutan emergency cesarean? Non-veterinary OB? Live baby with good outcome? That’s awesome.

    • Young CC Prof

      “they called in an OB to do a c-section, hoping that he would be able to recognize enough.”

      Clearly he did, but I’d LOVE to hear his thoughts on the whole thing.

      • The Bofa, Being of the Sofa

        He didn’t say much afterward, although he was the one they brought in for her exam 8 years later.

        The cooler part IMO was the resuscitation. See the comment above about MWs carrying oxygen and not knowing what to do with it. This resuscitation team knew what they were doing.

        • Somewhereinthemiddle

          Of course he didn’t say anything. Hello, HIPAA violation! ;)

          • The Bofa, Being of the Sofa

            They asked him, and he could not even verify that she was an organgutan…

          • Young CC Prof

            If the orangutang wants her records, she can request disclosure in writing at least five business days in advance.

          • Jennifer2

            She will need to separately indicate whether she releases records of mental health, substance abuse and/or HIV/AIDS testing.

          • Liz Leyden

            Plus sexual abuse/assault, psychiatric history, counseling sessions with an LICSW, Hep C status, STI history (separate from HIV and Hep C) . . .

    • Anna T

      Many species will bond with young that aren’t even theirs (chickens will “steal” chicks from another hen), and/or even young that belong to different species.

      • An Actual Attorney

        And a good time to note there are children’s books about this: http://goo.gl/nClpj6

    • AmyP

      And sometimes animal mothers that have a natural birth will be confused by the presence of a baby.

      My family ranches, and every so often there’s a mama cow (especially a first time mother) that doesn’t realize that the baby calf is hers. Or a mama cow will have twins and then cold-shoulder one of the twins. One of the tricky ranching tasks is to persuade the twin mama to accept both twins–if it doesn’t work, the rejected twin will probably die. (I bottle fed a baby calf as a tween–poor thing died despite a lot of TLC from humans.)

  • Stacy48918

    A great update of the “12 foolish things” post. Love it!