A Midwife Speaks: When Birth Costs Are Too High, Health Can Be Compromised

Amie Newman

When some women are literally begging their midwife not to transfer them to a hospital because they can't afford to pay the costs associated with a hospital birth, or women must spend part of their pregnancy searching for ways to pay for prenatal care instead of actually getting the care they need, we're talking about a crisis of coverage in this country.

Rewire continues to look for and accept personal stories of women being denied coverage based on a pre-existing condition related to reproductive and sexual health issues.

As noted, the practice of denying coverage for pre-existing conditions like pregnancy, previous c-sections, or being the victim of domestic violence is not only unfair, it can be dangerous to women’s health. Yes, covering pre-existing conditions may cost the insurance companies more money (and we wouldn’t them to have to compromise profit by actually covering necessary health care costs, would we?!) but as the system is set up currently, no matter what the pre-existing condition is, we are forcing Americans to sacrifice their health to the deity of the almight dollar. 

I asked a Certified Professional Midwife, Erin Curtiss, what all this can sometimes mean for women who seek her prenatal, postpartum and out-of-hospital birth services. Does she see this denial of coverage for pregnancy frequently? What, then, do her clients do to cover the costs of the pregnancy, birth and postpartum period?

Erin says she sees couples denied coverage "several times a year" in her practice. In her words:

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Dad (or mom) gets a new job and also new insurance coverage and
pregnant mama is denied coverage because she’s pregnant and this is a
pre-existing condition so the couple either qualifies for DSHS medical
coupons or they don’t and have to pay my fee out of pocket…I haven’t ever seen a situation where an insurance
company is willing to reverse their stance on this pregnancy as a pre
existing condition thing. We all just kind of hang our heads and say,
"Well gee, this sucks, huh?". Doesn’t seem to be too much we can do
about it. I’ve had some women make phone calls and write letters but to
no avail.
Since Erin is a midwife working in Washington state, I followed up with a question about what a woman can do in this situation but the specifics apply to Washington state medicaid programs and are not necessarily the same in other states: If the pregnant woman is denied coverage and qualifies for DSHS medical coupons (Medicaid), do the coupons
cover the kind of care she would receive with insurance or are we
usually talking about a severely compromised range of services? Erin’s response:
"If she/her family makes below a certain income then she will be offered
Healthy Options pregnancy coverage (DSHS Medical Coupons) [Editor’s note: "Healthy Options" is a Washington state program]. She is
covered through her pregnancy, for her labor and delivery, and for 6
weeks postpartum. During that time she is eligible for dental, vision,
and any other emergent or routine medical event that may occur for her.
But, here’s the sh**** part, it ends COMPLETELY at 6 weeks postpartum.
I tell all my mamas in this situation to go for it and do it up now,
i.e. go to the dentist, get your vision checked, get your IUD put in
etc. and go see their primary care physician NOW because she’ll be
completely cut off a month and a half after giving birth.

So, for women who are denied health care coverage because pregnancy is considered a pre-existing condition, we’re not just talking about the lack of coverage for pregnancy and birth costs but postpartum costs as well. What if a woman suffers from post-partum anxiety and needs medication? If her symptoms are diagnosed quickly enough, prior to the 6 week cut-off date in Washington state, maybe she’ll be lucky enough to receive medication. And after 6 weeks, then what? It is not safe or advisable to stop medication or even pause medication for anxiety or depression. If a switch to a government subsidy program is necessitated, there is bound to be bureacratic red tape to wade through before obtaining coupons. If you don’t qualify, medications like these are prohibitively expensive, out-of-pocket, for many. And what about assistance with breastfeeding? Lactation consultants? Follow up visits with a midwife with breastfeeding concerns? If it falls within that 6 week time period, you’re golden. If you’re body and concerns don’t fall on a 6 week cycle in Washington state, I suppose you fall into the health care system whirlpool – spinning around, hoping to obtain coverage in some way, shape or form under which you can continue receiving similar care. Either that or you go into debt paying for these services yourself. Or, of course, you just forsake your own physical, mental or emotional health because it costs too much money to address them. 

And that is the most looming issue, according to Erin –  a woman’s health is sacrificed, while pregnant, or immediately postpartum if she suddenly finds herself without insurance coverage or needing to switch from private insurance to Medicaid. Of course, this isn’t unique to pregnancy or other reproductive health care but pregnancy brings special circumstances to the table as well. But needing to prioritize finding health care coverage, in some capacity, instead of taking the time to care for yourself while pregnant or postpartum is not just twisted; it’s dangerous, according to Erin.

Making people work so hard to get coverage costs time. Instead of
dealing with their insurance companies they should be receiving care.
Many women delay care because they are trying to get coverage. Luckily,
DSHS reimburses retroactively. If a woman does not qualify for DSHS
coverage then she pays me out of pocket. My fees for an entire course
of prenatal care, labor and delivery, and postpartum and newborn care
costs a total of $2,800.00 dollars. These women literally beg me not to
transfer them to a hospital because they wouldn’t be able to pay the
doctor/hospital/c-section bill. They literally beg me. It’s a tough
situation to be in. Of course it’s dangerous.

This is, of course, rather shocking to those of us who are not privvy to the inner workings of midwifery. Women begging not to be taken to a hospital because of the associated costs? It’s no secret that out-of-hospital birth, with a midwife, costs considerably less than an in-hospital birth with an Ob-Gyn. Hospital births can run as high as $30,000 or more, if a women needs or requests a c-section. Home birth costs fall more in the range of $2-3,000 if there are no medical interventions needed. So, it would make sense that for some women home birth is an option purely because of its economic favorability and not for any heart-felt belief in natural childbirth:

I’ve delivered women out of hospital
not because they believe in homebirth but because they can’t afford
doctor and hospital care. It’s really terrible to deliver a baby at a
beautiful homebirth only to have the woman tell you, "That was the most
painful…thing I’ve ever done. I would have had drugs in
a hospital if I could have afforded it. I felt like an animal and I’m
embarassed. I didn’t really want to do that but I had to." This very
thing has happened twice in my career and it still makes me feel icky.
I’m all for homebirth but if you want your epidural you should be able
to have one.
And yes, women have begged me not to transfer them because they
know they can’t afford the cost of a hospital delivery. Of course, I
always transfer women if that’s what they need but it’s sad. I’m not
sure how they end up paying for the bill. I think it ends up being a
sliding scale type situation or a make-payments-for-the-rest-of-your-life type situation.

Women and their families are forced to sacrifice their own health when the fear of debt outweighs concern for ones’ safety. That’s not how a healthy health care system should operate. Not at all. 




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