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When my husband and I discovered that we were expecting our son in 2020, we both agreed that having a home birth was best for us. It was the early days of the COVID-19 pandemic and we didn’t want to be completely isolated during the prenatal and birthing processes. There was already so much that we’d have to skip out on (a baby shower, routine dates nights on the town and general in-person community care), so we clung to the little joy and control that we could salvage.
- FAQ’s on home births
- Are home births safe?
- Can anyone have a home birth?
- Am I at high risk for a home birth?
- Are home births safe for women over age 35?
- What kind of medical support do you need for a home birth?
- Do I need a doula for a home birth?
- What kind of emergency situations can happen with a home birth?
- Hospital transfer plan for home births
- How much does a home birth cost?
- Does health insurance cover the cost of a home birth?
- Is it cheaper to give birth at home?
- What are additional expenses of a home birth?
- Choosing to have a home birth
We started out going to an OBGYN because I had an infection that needed to be resolved (the visits cost $500 and $100, respectively) so we didn’t connect with our midwife until about 5 months into the pregnancy. According to Jennifer Courtney, a Louisiana-based midwife, some states also require a person looking to work with a midwife to have at least one OBGYN appointment during pregnancy.
In case you were wondering exactly what a midwife is and what they do, a midwife is the person who acts as your healthcare provider during and shortly after the pregnancy. They are separate from a doula. A doula provides emotional support and takes on more of an advocacy/comforter role.
For transparency, we’re based in Texas and our midwife charged about $4,000 for the full service. Had we come during the first trimester, it would’ve been closer to $6,000. This covered monthly, and eventually weekly, visits to her office, fetal heartbeat checks, various lab tests, blood pressure readings and the birth itself. We were also privy to her birthing pool (which is kept sanitary through cleaning and the use of a pool liner) and home visits when needed.
The cost did not include a birthing kit, which came with the items I would need during and after birth, like vaginal pads, alcohol wipes and a pool lining. It also didn’t include the midwife’s birth assistant, who charges a $400 fee for helping with the delivery. My labor was quick and I ended up delivering my son before the assistant arrived, so I didn’t have to pay that cost. If you’re looking to have a home birth, you also may want to include the cost of sonograms (roughly $100-$200), if you want to know the baby’s gender or if your due date creeps by and you want to check on the baby.
With that, it’s important to know that while there is a general range, there’s no “one price fits all” when it comes to home births. Jennifer Courtney offers a package that includes all prenatal care, lab work, labor and birth care, supplies, and postpartum care for $7800. She noted that the bulk of insurance policies don’t cover the cost of home births/midwifery, so her rate covers all needs. She also views each family individually, saying, “I offer flexible payment plans and extended payment plans for those who need them.”
She also added, “Often people compare a midwife’s fees to hospital fees, but you have to bear in mind that the hospital’s fees cover only the birth itself; prenatal care, postpartum care, labs, and pediatric care are billed separately.”
Flexibility matters, especially for families who may not be able to pay all of the costs upfront or are low-income. Transparently, my doula did not charge for her services. Malleable prices for doulas may be more common than you think.
“I offer sliding scale pricing and mostly pro bono offerings for my services,” says Opal Franklin, a doula based in Oakland, California. She conducts virtual and in-person birth education classes in Los Angeles and the Bay Area. “These services support families through a full spectrum of experiences including adoption & foster care, fertility, pregnancy & postpartum, abortion, birth, loss and otherwise,” she also says.
One final cost that expecting parents should be aware of is a hospital trip because even when you’re having a home birth, you may still need to go to the hospital. Once I began working with my midwife, I had to rush to the hospital twice; once during my second trimester due to some bleeding and in my third trimester because my amniotic fluid was leaking. I did not have health insurance during the first visit, so I had to pay for the trip out of pocket, which came to be around $3,000. So overall, I paid nearly $8,000 for my pregnancy/home birth.
With what I’ve outlined, a home birth can range from $4500 – $8000. The biggest factors include your location, how far along you are in your pregnancy when you begin working with a midwife, and if you’ll need to visit the hospital at any point. If possible, have a separate home birth account so you can pull from it as the expenses start to roll in. It’ll also help as your and your family budget for your bundle of joy.
FAQ’s on home births
To bring you the FAQ’s on home births, we reached out to Moxie, LA’s only birth center founded and operated by a midwife and obstetrician. Moxie’s experts include: Sara Howard, LM, CPM, IBCLC (Licensed Midwife & Lactation Consultant), Bente Kaiser, MD (OBGYN), and Julia Ray, DO (OBGYN).
Are home births safe?
We (the collaborative care team of midwives and OBGYNs at Moxie) are very supportive of home birth— it can be a wonderful and safe choice for people who are low-risk and don’t have any major complications in their pregnancy. There was a study published by the Midwives Alliance of North America that looked at planned home births in the US from 2004 to 2009, and the outcomes were incredibly reassuring and demonstrated that this is a safe option for those who qualify. The safety of out-of-hospital birth has also been well documented internationally.
Can anyone have a home birth?
In our opinion, out-of-hospital birth is safest when a pregnant person and their baby are low-risk. This means that they don’t have any major medical issues that could impact the pregnancy, labor or birth, and that the course of the pregnancy has been healthy. It also means that the pregnancy is full term at the time labor starts (and the baby is not premature).
Am I at high risk for a home birth?
Conditions that would make someone higher risk (and not an ideal candidate for out-of-hospital birth) would include things like hypertension (high blood pressure), uncontrolled gestational diabetes, or a fetal condition that could complicate the baby’s transition at birth (like a cardiac defect). In all of those cases, we recommend being in a hospital where specialized teams and the neonatal intensive care unit are immediately available.
Are home births safe for women over age 35?
Things that we don’t necessarily think make someone high risk include being over the age of 35 (we get asked about this a lot!), or having a thyroid issue that is well controlled with medications, etc.
What kind of medical support do you need for a home birth?
We think that having a licensed midwife, certified nurse midwife or physician attend home births increases safety for birthing people and babies. The World Health Organization has documented that having a skilled attendant present during labor and birth dramatically increases safety for everyone, all over the globe.
In California (and most other states in the US), licensed practitioners like midwives and OBGYNS who are attending out-of-hospital births carry medications, oxygen and have certification to help babies breathe in the event that they struggle when they’re born. We also offer prenatal and postpartum care, and build strong relationships with our clients that not only support and aid in the birthing process, but also improve bonding and infant feeding in the postpartum.
Most of these practitioners also see their clients multiple times in the postpartum period to support their transition into parenthood (whether it’s the first time, or again!).
Do I need a doula for a home birth?
We highly recommend that folks include a doula in their birth team— no matter where they plan to birth. Doulas offer continuous physical and emotional support to the person birthing and their family during labor, and we can’t recommend them enough for all of the skills and talents they bring to the birth process.
What kind of emergency situations can happen with a home birth?
Skilled birth attendants are prepared for major medical emergencies in labor and birth— which can include things like postpartum hemorrhage (bleeding too much after the baby is born) and neonatal resuscitation (helping a baby breathe). In most states they carry medications and tools to monitor and address many issues that can arise during labor and birth.
Hospital transfer plan for home births
Midwives and physicians who attend home births should also have a transfer plan that they have agreed on with the clients far before the birth takes place. This includes where they’ll go in the event that they need services and specialties that the hospital offers, but it is not an emergency (such as exhaustion or the birthing person is requesting pain relief medications); and how to reach emergency medical services in the event that a true emergency takes place and transport is necessary. This is very rare in low-risk, healthy and full-term pregnancies, but does happen and having a detailed plan ahead of time increases safety.
How much does a home birth cost?
Fees for home birth vary based on where you live and who the provider is. Typically, we see them between $4000 to as high as $20,000 per birth.
Does health insurance cover the cost of a home birth?
Yes! Most PPO insurance plans will reimburse for at least a portion of these fees. It is much harder to get HMOs to cover it. Some midwives, physicians, and birth centers are contracted with Medicaid (MediCal in California), but most aren’t.
Is it cheaper to give birth at home?
Most people have to pay out-of-pocket for home birth, which can make it cost prohibitive. That said, a lot of PPO insurance plans will reimburse for a certain amount of the fees, and insurance can still cover labs and ultrasounds during the prenatal care as well. Many people have a large co-insurance and deductible and end up paying a good amount to birth in the hospital as well, so it is very important to look at your own insurance plan.
What are additional expenses of a home birth?
Similar to the answer above, a lot of PPO insurance plans will reimburse for a certain amount of the fees, and insurance can still cover labs and ultrasounds during the prenatal care as well. Speak to your insurance company to determine any costs.
Choosing to have a home birth
In general, we feel that ALL practitioners should aim to provide people with evidence-based information and represent the options fairly when it comes to everything about their health and choices.
We feel that there are incredibly safe midwives out there, and also midwives making choices that we don’t see as safe. And we feel the exact same way about physicians and OBGYNs. And we have a long way to go for all practitioners to understand one another and represent each other fairly— which is why collaborative care with midwives AND physicians is so important to us at Moxie.
At the end of the day, people get to make their own choices about their bodies and their care team— and we think everyone deserves respectful, informed care, no matter where they decide to birth.