In the US..?

[misspriss]

How do I do this? I am seriously leaning toward homebirth.

I already have my first appointment with an OB, which I plan to go to. Do I go to the OB for my care, or after this appointment do I do the rest with a midwife? Should I say anything to the OB? I want to keep my relationship with the OB in case things don't go well and I need a hospital birth.

I have been in contact with a direct entry midwife, but insurance doesn't cover them, only CNMs. I would have to pay out of pocket. I am not sure if I want to go with her, I have never met her just emails. There are other direct entry midwives in the area I could contact, as well as ONE CNM. Should I try to contact the CNM, whom my insurance will cover? Do they do homebirths?

I'm so confused on what to do next! This is all so new to me!

 

[gryphongrl]

It differs a lot by state. In my state, only a direct entry midwife will attend a home birth, and a CNM will not. However, you can have a birth at a "birthing center" and have a CNM. (Side note, my insurance DOES cover direct entry midwives.)

I googled the Arkansas regulations and found
"The practice of midwifery related to home births is governed by the Arkansas Department of Health. In addition to seeing the midwife for prenatal care, the mother must also see a physician or health clinic for two visits, and must file a back-up plan with the Health Department."

So, you'd HAVE to see your OB still for a couple of appointments, but it seems like the direct entry midwife should have gone over all of that...

I can tell you, I've been to both an OB and a midwife and the care I get from the midwife is by far and away superior to the care I get from the OB. At our monthly appointment she talks to me and about me for at least an hour and usually longer, covering diet, exercise, state of mind, relationship with DH (because it can change a lot through pregnancy), becoming a mother, etc, besides the usual physical examination (weight, blood pressure, urine, fundal height, so forth).

 

[Cails]

First of all, congrats on pursuing a home birth. I am hoping for my first home birth any time now!

I can tell you that in California CNM's do home births. I would recommend doing a home birth with a CNM or at least a REALLY experienced direct-entry midwife. Midwives are amazing and the care really is exceptional compared to an OBs care.

You need to find out what your OB's opinion on home birth is. Some doc's support it and some are just really against it. You need to find an OB who supports home birth. If you do end up needing a hospital birth you don't want a doctor telling you "I told you so".

Any good midwife that does home births will have a good relationship with an OB nearby. Then if you do end up needing a hospital transfer the OB and midwife will work together.

As far as my experience goes, I saw my midwives once a month and they were amazing! They spend an hour with me every appointment. Then I went, at 16 weeks, and met the OB that my midwives work with. He was great, he did a check up and told me what would happen if I did have to transfer into his care. THEN at about 18 weeks I went to his partner to get a detailed ultrasound (optional) and those were my two experiences with the docs.

I recommend that you go interview a few midwives and see how it works in your state and who you're most comfortable with. If CNMs only do birthing center births in your state, then that can be a great option too. Just be sure to make sure it is a real birth center with minimal interventions and not a "faux birth center" that really operates as a hospital would.

Good luck. I hope I have been of some help.

 

[misspriss]

Thanks you guys!

I still plan to keep my OB appointment Tuesday. I will see how I like this OB. One of the midwife groups that has a website recommends the entire clinic (no specific docotors) but I found a lot of recommendations for my doctor being in support of natural, intervention-free birth, so hopefully if he supports natural birth he is cool with homebirth. We will see.

Then I will set up some consultations with midwives. The problem is that I work full time and I have NO sick time, so even making my doctors appointments are tough. I don't know when I could meet with midwives.

There are NO birthing centers in my area, at all. There is only ONE CNM in my part of the state. I can call my insurance company, they may cover more than the little one-liner on their website.

 

[MindUtopia]

I'm originally from the U.S. so this would have been our approach if we'd been still stuck living there when I was pregnant, and I've had many friends have home births. I'd definitely keep your OB appointment, while you research and interview midwives. I'd contact every midwife you can find in your area and have an initial meeting with all of them (they should do this for free), so you can pick the person whose experience and personality is the best fit for you. If you do choose a midwife, they'll handle all your medical care from that point on and refer you out if you need any testing or ultrasounds that they can't do. What you tell your OB if you do choose a midwife is up to you. I'd just maybe say you've decided to go with someone else who has more to offer for birth, but that you're looking forward to maintaining your relationship in the future for all your gyn care. You don't have to tell them anything to be honest, but if you do, I'd leave it at that. If you start talking home birth with them, you may provoke some unpleasant reactions that might not be what you need. Once you return after your birth, if they ask, you can tell them then. As for which midwife to go with, if you can afford to pay out of pocket, I'd go with whoever you feel most comfortable with (assuming they have plenty of experience). As the other ladies have said, it varies so much by state and by insurance company, who is allowed to practice where and what is reimbursable. You'd have to find out specifically what's the case for your situation (midwives themselves would be great people to ask) and then also just go with your gut.

 

[ace28]

I'm in Indiana, and we originally had gone with an OB, intending to go the standard OB/hospital route. However, the care we received with the OB was so atrocious it drove us to look for other options... and when I googled around, I found a midwife practice in my area that served women looking for home births. The practice has both a CPM and a CNM working for it, as well as several apprentices. However, other practices in the area I looked into had only CPMs or CNMs. I think it just depends on where you go- keep looking! I also think it's definitely worth a try to contact the CNM- tell her what you're looking for, and if nothing else she can help point you in the right direction even if she can't help you directly.

 

[misspriss]

I'm in Indiana, and we originally had gone with an OB, intending to go the standard OB/hospital route. However, the care we received with the OB was so atrocious it drove us to look for other options... and when I googled around, I found a midwife practice in my area that served women looking for home births. The practice has both a CPM and a CNM working for it, as well as several apprentices. However, other practices in the area I looked into had only CPMs or CNMs. I think it just depends on where you go- keep looking! I also think it's definitely worth a try to contact the CNM- tell her what you're looking for, and if nothing else she can help point you in the right direction even if she can't help you directly.

Well I met my OB and I really like him and the practice, but I definitely doubt the level of one-on-one care I would get. He was delivering 5 babies the day of my appointment, and keeping up with regular appointments!

I want to call my insurance company and get the details about it, and meet with the CPMs too. I called the CNM and the CPMs on my lunch break Friday, but no one answered. Since I haven't told anyone at work, and I can't have I can't talk to them while they are open! How on earth am I supposed to do something?

See if I go the OB and hospital route, it should cost me no more than $1500 out of pocket. The CPM's midwife care in my area is $2600 out of pocket. If I go for midwife care, and pay $2600 out of pocket, $1100 more than the hospital birth, and then have to be transferred to the hospital, I am then looking at $2600 + $1500! I can't afford that, and how can I justify it when I know it is only going to be $1500 at the hospital?!?

It's frustrating. But I have to talk to the CPMs, they are CPMs, licensed in my state, and some of them are RN's, so I feel like perhaps they can order my care from the insurance sine they are RNs? I just don't understand the difference between a CNM and a CPM/LM who is also an RN? If my insurance will cover the homebirth? I will probably go for it!

 

[ace28]

I'm in Indiana, and we originally had gone with an OB, intending to go the standard OB/hospital route. However, the care we received with the OB was so atrocious it drove us to look for other options... and when I googled around, I found a midwife practice in my area that served women looking for home births. The practice has both a CPM and a CNM working for it, as well as several apprentices. However, other practices in the area I looked into had only CPMs or CNMs. I think it just depends on where you go- keep looking! I also think it's definitely worth a try to contact the CNM- tell her what you're looking for, and if nothing else she can help point you in the right direction even if she can't help you directly.

Well I met my OB and I really like him and the practice, but I definitely doubt the level of one-on-one care I would get. He was delivering 5 babies the day of my appointment, and keeping up with regular appointments!

I want to call my insurance company and get the details about it, and meet with the CPMs too. I called the CNM and the CPMs on my lunch break Friday, but no one answered. Since I haven't told anyone at work, and I can't have I can't talk to them while they are open! How on earth am I supposed to do something?

See if I go the OB and hospital route, it should cost me no more than $1500 out of pocket. The CPM's midwife care in my area is $2600 out of pocket. If I go for midwife care, and pay $2600 out of pocket, $1100 more than the hospital birth, and then have to be transferred to the hospital, I am then looking at $2600 + $1500! I can't afford that, and how can I justify it when I know it is only going to be $1500 at the hospital?!?

It's frustrating. But I have to talk to the CPMs, they are CPMs, licensed in my state, and some of them are RN's, so I feel like perhaps they can order my care from the insurance sine they are RNs? I just don't understand the difference between a CNM and a CPM/LM who is also an RN? If my insurance will cover the homebirth? I will probably go for it!

I definitely understand about the money! Believe it or not, it would have only been a $100 copay for me to deliver at the hospital vs the $2400 we're paying the midwife, none of which is covered by insurance. One reason its worth it to us, monetarily, is because A) like I said we really really really hate the hospital that my insurance covers and B) We're going to use it as a tax write off and ultimately get the money back. Could this be something you could look into, to help justify the cost?

Also, as far as you being at work and hours and such for contacting midwives, I've found that most midwives operate on a different schedule than a typical "office", since they have to schedule around home births, home visits, as well as see their regular patients. A lot of times they're open earlier/later than a normal doctor office and also a lot of the ones in my area are available via email. Hopefully someone will get back to you!

 

[PommyMommy]

How would you use it as a tax write off?

 

[NaturalMomma]

You can tell your Ob or not, you can also go to your OB and your MW. If you're going to have a homebirth your MW should be your primary care giver.

Most inusrances do not pay for homebirth MWs. I paid out of pocket with ds2 and will with this baby as well. You can contact others, but it's likely you'll pay out of pocket.

 

[gryphongrl]

How would you use it as a tax write off?

That's a good question. You can only write off medical expenses if they are more than 7.5% of your adjusted gross income. So by my math if your midwife charges $2500 and your AGI is more than $33,333 you cannot write off the expense. Plus, in order to write off this expense, you'd have to use line item deductions across the board and not take the standard deductions.

You could use a flexible spending account or a health saving account to save paying taxes on the $2500, if you anticipate the expenditure and have enough time to sock away money into the account. I'm pretty sure you can only adjust your FSA or HSA contributions once a year at open enrollment with your employer, so if you didn't anticipate the upcoming medical expenses, you probably wouldn't have that much in your account to begin with.

 

[misspriss]

Well I met with a midwife today and it turns out that she....DELIVERED ME!!!! Can you believe it!

She charges $3000 and will bill my insurance if they will cover it, but if not, I am cool with it. All of a sudden, it doesn't matter. The interview went so well, I am so happy to have her deliver my baby, it could cost $5000 and I would find a way to pay it. It means a lot to me to have the birth that I want, and if she was someone my mother would choose and trusted for me and my sister (my sister in the hospital and me at home) then I feel I can trust her.

 

[aliss]

Well I met with a midwife today and it turns out that she....DELIVERED ME!!!! Can you believe it!

She charges $3000 and will bill my insurance if they will cover it, but if not, I am cool with it. All of a sudden, it doesn't matter. The interview went so well, I am so happy to have her deliver my baby, it could cost $5000 and I would find a way to pay it. It means a lot to me to have the birth that I want, and if she was someone my mother would choose and trusted for me and my sister (my sister in the hospital and me at home) then I feel I can trust her.

Wow that is so amazing!!!

 

[misspriss]

I know, right? I found it hard to believe, the first midwife I met was the one that caught me!

 

[gryphongrl]

I know, right? I found it hard to believe, the first midwife I met was the one that caught me!

That's truly amazing and sounds like it was meant to be!

 

[angel2010]

Well I met with a midwife today and it turns out that she....DELIVERED ME!!!! Can you believe it!

That is so amazing!!!