Money Matters

Home vs. Hospital Birth Costs – Is Home Birth With a Midwife for You?

When preparing to have a child, it is crucial to consider the financial aspects. It may not be as expensive as financing an adoption, but pregnancy and childbirth come with a financial burden. And the total cost is greatly reduced whether you choose a home birth or a hospital birth.

As parents-to-be, you naturally want to make the decision that gives your baby the best chance to survive and thrive. However, the cost of giving birth in the United States is high and health insurance plans are complicated.

While there are many personal and emotional reasons for choosing home or hospital birth, you should also consider the financial implications.

Home birth versus hospital birth costs

When deciding between giving birth at home or in a hospital, consider the cost of having a baby in either setting. There are four main factors involved: pregnancy and prenatal care, labor and delivery, hospital stay, and postpartum care.

Home Birth Cost Factors

Home birth seems like it should be less expensive than a hospital birth. But the costs can add up quickly if you’re not prepared.

Insurance coverage for home births

Some states’ insurance allows coverage for home births, but not all. As of May 2020, only 21 states covered home birth under the Medicaid program, for example. As you prepare, a couple of things are essential: ask your insurance company what types of childbirth are covered, and make sure you choose something that fits your needs.

Some insurance companies may only cover a home birth with the assistance of a certified midwife, while others may only cover a midwife if you give birth in a birthing center. Therefore, communicating clearly with your insurance provider is key. Find out what your out-of-pocket costs are for any deviations from your typical requirements.

Prenatal home birth options

Home births generally receive a similar level of prenatal care as those who have a hospital birth. However, when you decide to give birth at home, you might work closely with a midwife, a doula, or both. Each birth attendant has different roles and responsibilities.

  • A doula is a guide who provides physical and emotional support before, during and after childbirth. They may be certified doulas, but they are not necessarily medical professionals.
  • A midwife is a trained professional who assists healthy people in childbirth and provides prenatal and postnatal care. Training varies, but certified nurse midwives have completed a training program, making them the safest (and most expensive) option.

Fees for doulas and midwives vary widely based on geographic location and services provided. It is usually more expensive in cities and areas with a higher cost of living.

For example, in a large city in the Dallas-Fort Worth, Texas metropolitan area, you can find doula packages ranging from $1,600 to $2,500. But in a significantly smaller city like Abilene, Texas, they cost less than $1,000. But going to an area with an even higher cost of living like New York City can mean as little as $2,000.

The doula fee typically includes a specified number of prenatal visits, prenatal information and support, assistance during labor and delivery, and at least one postpartum visit. Prenatal vitamins, any required lab work, and any kind of hospital visit are not usually included.

Midwives are generally more expensive. Because of the wide variation in things like certification status, it’s hard to give a solid figure for midwife costs. But expect to pay at the higher end of doula costs at a minimum. But some midwives can charge $5,000 or more.

Keep in mind that doula and midwife fees may not include necessary medical tests, such as regular OB/GYN visits and ultrasounds. And they cost as much as they would for a hospital birth if they’re not included as part of your package (some midwives and doulas work with OB/GYNs).

You also need prenatal vitamins, which are relatively inexpensive. For example, many prenatal vitamins range from $0.08 to $0.48 each at Walmart . More than nine months pregnant, that’s only $20 to $130. Fortunately, you don’t need a prescription, so there’s no extra cost for a doctor’s visit.

Labor and delivery costs at home

Fortunately, if you opt for a home birth, you’re skipping one of the biggest expenses associated with childbirth: the hospital stay. That’s a huge benefit that many parents-to-be appreciate from the home birth option.

Ideally, you would not incur hospital costs. And doula and midwife packages usually include labor and delivery. A midwife will usually provide equipment such as IV lines, sterile gloves, gauze pads, a thermometer, and waterproof bed covers.

However, you may want to ask your midwife just to be sure. Doulas can provide some of this equipment, but they are not authorized to insert IVs unless they are also medical professionals.

You may also need to purchase special equipment if your doula or midwife does not provide it. Costs vary, depending on the types of supplies you need.

Even if your midwife or doula doesn’t provide them, simple items like waterproof mattress covers are under $40 on Amazon. But if you need a birthing tub, you’re looking at $100 or $200 and up at a retailer like Oasis or La Bassine. You might also consider renting one, although you may not save much money if you need to keep it for several weeks.

Fortunately, midwife and doula fees include some services that hospitals may ask you to pay for, such as facilitating skin-to-skin contact. Even if it doesn’t cost much, it’s annoying to pay to carry your own baby.

If your home birth expenses come down to a few thousand dollars paid to a midwife, it may seem like a simple financial decision.

But you must consider the safety of both the mother and the baby. The infant mortality rate for babies born at home is several times higher than the rate for babies born in hospitals, according to a 2010 to 2017 study presented in the American Journal of Obstetrics and Gynecology .

And just because you plan to give birth at home doesn’t mean it will. So plan your ideal situation and have a Plan B in case complications arise. Have enough money saved for a hospital stay for both mom and baby. If things go well, just add it to Junior’s college fund.

Postpartum care after a home birth

Most doulas and midwives include some form of postpartum care and support in their packages. Your specific agreement may vary, but it’s pretty standard to offer at least one postpartum checkup. (Babies should see a pediatrician for postpartum care.)

People with postpartum depression or psychosis should seek mental health treatment from a source other than their doula or midwife, unless they are also qualified therapists. That treatment may include talk therapy, medication, or a combination of both.

You can also seek the advice of a lactation consultant. Most midwives and doulas are trained to help, but a board-certified lactation consultant can give you more help if you need it. A home visit can cost around $200 or more per hour, depending on your location.

Insurance may cover some of these costs, but you can also get free assistance online at La Leche League.

The US Department of Agriculture also offers WIC breastfeeding support. Online resources are freely available to anyone, though you must qualify for the Special Supplemental Nutrition Program for Women, Infants, and Children to get personalized support. Your local health department may also have resources.

Cost Factors for Hospital Birth

Hospital births are often more expensive than home births, but that may not necessarily be true. In general, insurance covers hospital births more fully than home births, which means a home birth could result in higher out-of-pocket costs.

But a hospital birth costs considerably more than a home birth, unless your insurance covers most of it. Know what your insurance pays for and what it doesn’t.

Hospital delivery insurance coverage

Under the Affordable Care Act (ACA), pregnancy, maternity, and newborn care are essential benefits that qualified health plans must cover. That said, if you’re a dependent on a parent or guardian’s policy, coverage may vary, so find out as soon as possible.

Keep in mind that your essential benefit status doesn’t prevent insurers from charging copayments, coinsurance, or deductibles, so that doesn’t necessarily mean the insurance covers the full cost.

But if you’re tempted by a home birth for cost savings alone, your insurance might lower the amount for a hospital birth to a very comparable number. So check your coverage and do the math. Some policies cover prenatal care at a higher level than others. Also, high-risk pregnancies require a higher level of care and could cost more, even with insurance. But you should probably opt for a hospital birth anyway.

No matter what type of insurance coverage you have, know how much your deductible is, the length of hospital stay covered, and which doctors and hospitals are in your network for maximum coverage. Also, if you require prenatal tests that your insurance doesn’t cover, be aware that you may incur those costs and you can ask your doctor how much they cost. For example, not all plans cover genetic testing.

Fortunately, there is a limit to how much you can pay out of pocket for all medical care each year. In the most affordable Bronze-level ACA insurance plans, the maximum individual out-of-pocket cost in 2022 is $8,700 for in-network medical services for an individual ($17,400 for a family). The maximum decreases as you purchase more expensive plans.

However, your pregnancy will last about nine months, which means it could easily span two plan years, bringing the overall maximum single out-of-pocket potential on the lowest plan to $17,400. So that’s another factor to consider.

If you don’t have health coverage through an employer or your spouse, visit Healthcare.gov to see if you qualify for a special Marketplace enrollment period based on a qualifying life event, such as losing your employer-sponsored health benefits or changes of residence status.

Although pregnancy is not a qualifying life event, it can give you access to programs like Medicaid or the Children’s Health Insurance Program (commonly known as CHIP). And even if you only qualify for open enrollment toward the end of your pregnancy, it can still save you a lot of money.

Prenatal Care Options at Hospital Delivery

The Kaiser Family Foundation says prenatal care averages about $2,000, including about 12 doctor visits at $100 or $200 each if you don’t have ACA-compliant health insurance. Hospitals also often provide free childbirth and baby care classes, so take advantage of those opportunities, especially if you’re a new parent.

Your obstetrician will recommend prenatal vitamins and other preventive strategies to ensure the health of you and your baby throughout your pregnancy. Vitamins cost the same as for a home birth, about $21 to $130 for the entire pregnancy, unless your doctor prescribes something special.

When billed separately, ultrasounds range in cost from an average of $319 in New Jersey to $2,295 in Florida, according to a 2021 survey by Hospital Pricing Specialists. The national average cash price of an ultrasound was $745, so carefully research prices in your area.

General visits to your obstetrician’s office during pregnancy cost about $207 if you’re out-of-network or uninsured and $105 if you’re insured and in-network, according to Fair Health Consumer.

Prenatal care packages at hospitals and birthing centers typically spell out how many visits and ultrasounds they include and what types of extra care they offer, which can save you money on those costs. But if you have insurance, make sure your plan covers a package before you buy it.

Hospital labor and delivery costs

Despite the cost, a hospital birth has advantages. It allows you to have an epidural, even if you initially planned not to. Epidurals will put the cost of a vaginal birth in the upper range of any uninsured rate estimate.

In the hospital, you can choose a cesarean delivery if it is medically necessary (even a certified nurse midwife cannot legally perform a cesarean section).

And that’s important because the type of delivery you have can also influence the cost. For example, health care cost transparency advocate Fair Health Consumer states that the national average charge for a vaginal delivery is $12,290. The national average charge for a C-section is $16,907. (That’s as of 2018.)

But those are just averages. The actual cost varies widely depending on where you live and the services you want or need.

For example, Fair Health Consumer estimates the average uninsured cost of a vaginal delivery with pre- and postpartum care in New York City’s most expensive Manhattan ZIP code at between $12,380 and $24,666, depending on the specific care you need. But in Boise, Idaho, it’s only $4,180 to $16,269.

Note that those numbers don’t include prenatal or newborn care, which Fair Health Consumer shows costs several hundred (potentially close to $1,000) dollars per day, assuming there are no complications.

The Fair Health Consumer site can give you a rough idea of how much you’ll pay if you search based on your specific location.

Skin-to-skin contact is another aspect of the birthing experience that could lead to a charge. As silly as it sounds, after a surgical delivery, the mother may not be able to hold her baby safely, so it is necessary to have an additional nurse available to help her.

Most hospitals allow parents and babies to have skin-to-skin contact as a matter of course, but it never hurts to ask. It’s not clear what the average cost is, but the charge that went viral was $40.

Postpartum care after giving birth in the hospital

If you have chosen a hospital birth, you should have a lot of help in the area of postpartum care. Most hospital delivery packages include at least one follow-up visit soon after the baby is born. You must take the baby to a pediatrician for follow-up, which is a completely separate charge.

If you experience a high-stress delivery, such as emergency surgery, you will need more care in the days and weeks ahead. It can be as simple as having family members help you after the C-section procedure so you don’t overexert yourself. But it could be a bit more expensive.

Even if your delivery went smoothly, your OB/GYN will evaluate you for possible postpartum problems, such as postpartum depression. Postpartum depression could lead to serious expenses. Insurance should cover much of the cost of treatment, but if you don’t have insurance, rates can add up quickly.

In most areas of the country, a session with a psychologist costs between $100 and $200. It will cost you even more if you need to see a psychiatrist (a doctor who can diagnose and treat mental disorders and prescribe medication). The fees per session are similar to a psychologist, but an initial visit could cost between $300 and $500.

Postpartum care may also include physical therapy and pelvic rehabilitation to help restore your pelvic floor muscles. The cost of these can vary by location, but expect to pay between $150 and $400 for a 45- to 90-minute session. Many mothers also seek assistance with breastfeeding. You can save money in the long run if your baby breastfeeds instead of needing formula, so the investment in a consultation (about $200 an hour) can be worth it.

But you can also get a lot of help with breastfeeding through your hospital. Some offer one or more free sessions initially and fairly reasonable follow-up visits. For example, Baptist Health of Lexington, Kentucky, offers a free lactation consultation and follow-up visits for $25.

And you have the same free or low-cost options you would for a home birth, including La Leche League, WIC breastfeeding support, or your local health department.

The Verdict: Should You Choose Home Birth or Hospital Birth?

In general, the costs of home births are usually lower than those of hospital births. But the decision-making process is not as simple as looking at the numbers.

It doesn’t help if you think hospitals negotiate fees based on factors like patient insurance, paying cash, or being out-of-network. It is difficult to know the “official” cost of childbirth. But there are things you can consider to help you make the decision.

A home birth makes financial sense if…

Finances shouldn’t be the only reason you choose a home birth. But they can play an important role in your decision. A home birth makes financial sense if:

  • You need to save money. Home births are usually cheaper. But if possible, don’t let money be the only deciding factor in your birth plan. You should also consider the health and safety of you and your baby and your personal preferences.
  • You do not have any health risk factors. If you don’t have underlying risk factors, such as obesity or diabetes, that could put you or your baby in danger, a home birth is less likely to result in emergency hospital expenses. 
  • It has a Solid Backup Plan. Even if you don’t have risk factors, you should prepare for an emergency trip to the hospital. That means establishing an emergency fund. If you don’t use it, you can spend it on the baby or create a college fund.
  • You live near a hospital. Don’t plan a home birth unless you can get to a hospital quickly if something goes wrong during delivery. Emergency care will likely be more expensive than a hospital package, especially if it has to be airlifted.
  • She has a trusted midwife and an amazing support team. A doula or midwife with strong credentials (ideally a certified nurse midwife) can save you money by providing similar care for less, working with (not against) your medical team, and requesting medical intervention as soon as needed.
  • Your insurance covers home births. If your insurance covers home births, look at the numbers to see how much you can save. While home births are already cheaper than hospital births, insurance can make it even cheaper.
  • You don’t have insurance. If you don’t have insurance, a home birth can save you a lot if you’re healthy. But it’s still a gamble. Complications could land you in the hospital anyway. It may be best to see if you qualify for open enrollment or wait until you do to try to get pregnant.

A hospital birth makes financial sense if…

There are some circumstances when a hospital birth is the best option. In fact, medical professionals overwhelmingly recommend hospital births. Regardless of the cost, you must have your baby in a hospital or birthing center in the following situations.

  • Prefers the highest level of access to health care. Opting for a hospital birth means having licensed OB/GYNs available on site and the best options for treatment and surgery. Many things can affect labor and delivery, and the hospital can provide access to a C-section and pain medication as needed.
  • Your insurance has better coverage for hospital delivery. Insurance can make hospital birth competitive with home birth. And you can always have a midwife or doula with you in the delivery room.
  • You have contraindications for home births. If you have risk factors such as diabetes or obesity, are you If you have multiples, have had a previous cesarean delivery, or if there is a problem with the fetus, plan for a hospital delivery. Home birth won’t save you money if you have to go to the hospital anyway, and it’s safer to be there from the start.

Both make financial sense if…

Both home and hospital birth can be a high-quality birthing experience, as long as you have top-notch care. Choose the one that makes the most sense to you in these situations.

  • You have a High Income. If your household income is high enough that the cost difference between a home birth and a hospital birth doesn’t matter, choose your preference.
  • The cost is the same in both situations. Some people will find that the financial cost of using a midwife to facilitate a home birth is quite comparable to that of a hospital birth. If the cost is similar for both options, choose your personal preference.
  • You want the best of both worlds. A hybrid approach where you do much of the labor process at home and then move to the hospital as your labor progresses can reduce the amount of time you spend in the hospital, since early labor it can be quite a long test.

Last word

The choice between home birth and hospital birth is not purely a financial question. A home birth has other distinct advantages: the potential for greater freedom in choosing your birth plan, a more intimate experience, and a more comfortable environment to bring your baby into the world.

If you’re underinsured and concerned about the costs of a hospital birth, in some situations a home birth can be a safe alternative, especially if you’re healthy and building your emergency fund to cover unexpected hospital expenses.

On the other hand, hospital deliveries are safer and infant mortality is much lower. You have access to more advanced care and licensed doctors, which can give you immense peace of mind during what can be a very uncertain and emotional few days.

And insurance coverage can help lower hospital costs, even if you need a C-section. In general, the decision is important and personal. Review your insurance coverage to help you evaluate your options and choose the right birth plan for your family.

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