Among the variety of options for pregnant women, one that seems to be gaining traction among white American women is having a home birth with a midwife. Midwifery includes prenatal, birth and post-partum care, which is typically a year’s worth of services. There is no need for doctors, nurses or hospital stays with midwifery care, as long as the pregnancy is considered low-risk. Midwives are either licensed to practice in the State of California or are nurses certified by the state.

In addition to midwifery, mothers can elect to have a doula present to provide emotional and physical support during childbirth. The clinical work of a midwife is outside the scope of care that doulas are legally allowed to provide; consider a doula as a support person or advocate who “mothers” a woman through the birthing process.

Candace Leach is a licensed midwife and certified doula based in Lakewood. Over the span of her career, she has assisted in more than 500 births. In her practice, Leach provides about a year’s worth of care for each client. As opposed to shorter prenatal visits in a physician setting, Leach’s client appointments can be an hour long to provide an opportunity for women to share their physical and emotional feelings without “feeling rushed.”

“Mom is a whole person and there are a lot of other things going on in her life that can obviously impact pregnancy and birth,” Leach said. “We want to make sure that she’s in a good place. There’s definitely a lot more time spent on nutrition and hydration and exercise; just keeping her as low-risk as possible, which is very different [from a hospital birth].”

According to Leach, a home birth in the Greater Long Beach area should cost $4,500 to around $6,000. Depending on the certification and experience, a doula can cost anywhere from $500 to $2,500 on up. Depending on whether the mother has health insurance, $4,500 out of pocket for midwifery care may be a reasonable price.

Women without insurance, who are eligible for the state-run health insurance Medi-Cal, may take advantage of the Presumptive Eligibility for Pregnant Women (PE) program. This program, according to California Department of Health Care Services Information Officer Lisa Gray, “does allow licensed midwives who are registered as Medi-Cal providers, are in good standing, and provide prenatal care that is allowed under the program, to register with the PE program as Qualified Providers.” Medi-Cal rates for services covered under the PE program are available online at Medi-Cal.ca.gov.

Some health insurance plans do reimburse for midwifery, with approval by the health provider. However, getting the insurance company to pay can sometimes pose a challenge, according to Leach. “It’s unfortunate that moms and care providers are having to contact the insurance company over and over again, and they’re just dragging their feet to reimburse,” she said. “Why do we have to keep calling to get you to reimburse for this when you didn’t have to keep calling your insured to pay the monthly premium.”

Lexie DeMaster, one of Leach’s clients, said she paid $4,500 for midwifery care for her recent pregnancy, even though she initially planned to have her baby in a hospital. DeMaster is an intensive care unit nurse at a medical center in Orange County, and her husband is a doctor.

“I had every intention of birthing at a hospital,” she said, until she went on a tour of her hospital of choice. “It didn’t feel like a loving place.” Although her healthcare coverage, plus her employee discount, would have allowed her to pay a mere $250 to have her child at a hospital, DeMaster said her need for a more spacious facility led her to realize that the best place for her to have her child was with a midwife at home.

DeMaster’s home birth was low risk and resulted in no complications. “I didn’t tear at all when the baby came out,” she said. “He didn’t even cry when he was born. I just feel like it was such a wonderful experience. I would totally recommend it and I would definitely do it again.”

Hospitals: Safe Haven For High-Risk Pregnancies

In DeMaster’s situation, her low-risk pregnancy, her health and care through her pregnancy allowed her to avoid what she felt would be an unnecessary hospital birth. But home births aren’t for everyone.

While the Centers for Disease Control and Prevention cites one in 90 babies born to non-Hispanic white women in the United States are born at home, home birth is uncommon in other developed countries like the United Kingdom, France and Japan.

In the U.S., pregnancy and childbirth account for nearly a quarter of all hospitalizations. Hospital birth is especially important for pregnant women who are considered high risk. According to Miller Children’s Hospital Long Beach, the following factors may make a pregnancy high risk:

• If you are over age 35;
• If you are under age 17;
• If you are carrying multiple babies;
• If you have chronic illness like diabetes, heart problems or blood clotting;
• If you have a history of gynecological problems;
• If you have had miscarriage, ectopic pregnancy, stillbirth or premature birth;
• If you have a sexually transmitted disease, including HIV/AIDS;
• If you used assisted reproductive technologies;
• If you had two or more second-trimester abortions;
• If you conceived with an intra-uterine device; or
• If you are the carrier of a genetic disorder.

Barbara Grimes of Huntington Beach was having her first baby at age 31 when, at her 25th week of pregnancy, she woke up in the middle of the night bleeding profusely. She was rushed to the hospital, where a perinatologist recommended she be transferred to the MemorialCare Center for Women at Miller Children’s Hospital Long Beach and Long Beach Memorial.

The center is staffed and equipped to “care for the smallest, most seriously ill newborns,” according to the hospital. Dr. Kathleen Berkowitz, medical director of Miller Children’s Hospital’s maternal transport services, said in a hospital release, “The Center for Women is rated by the State Department of Health as one of the safest places to have a baby.”

At the hospital, Grimes was found to have had a blood clot between the placenta and uterus, which was causing the placenta to separate from the uterine wall. This was the cause of the heavy bleeding, and also posed the risk of robbing the baby of oxygen and nutrients to grow. Grimes was given medicine to control her contractions and steroids to speed up the baby’s growth – all done with the intention of keeping the child in the mother’s womb. Ten days later, Grimes gave birth to a one-pound, 15-ounce baby boy she named Benjamin. “I was overwhelmingly happy,” Grimes said in the release. “Benjamin was tiny, but healthy.” Though Grimes was sent home two days later, Baby Benjamin was kept at the hospital for three and a half months until he was gradually reintroduced to his mother. In her high-risk situation, the care provided by Long Beach Memorial and Miller Children’s Hospital helped save her baby’s life.

Medical Costs And Maternity Coverage

For those with insurance, having a child at a hospital is sometimes more cost effective than going through a midwife. Anthem Blue Cross, through its small group insurance plan EmployeeElect, offers classic HMO plans with $30 office visit copays, which include obstetrician visits, and $500 per day copays for hospital visits. Any additional procedure or medication used in delivery may result in additional copays.

Kaiser Permanente’s health insurance is different from other plans. Kaiser offers all-inclusive maternity care; meaning that if someone doesn’t have Kaiser, they’re going to go to a private office, hospital, paying for pregnancy coaching classes and more, according to James Larreta-Moylan, business line director of Kaiser Permanente Southern California.

For small group medical coverage through Kaiser, there is no out-of-pocket cost for pregnancy because prenatal care is considered preventative medicine. The only time a Kaiser insured would have to pay for maternity care is if she has an individual or family plan, and didn’t choose an option with maternity coverage. Starting July 1, all individual plans will include maternity coverage as mandated by Senate Bill 222, Larreta-Moylan said.

The most popular individual plan is the $1,500 deductible plan, which does not apply to office visits or prenatal care. The deductible does apply for hospital services and delivery, and if there are complications, he said. For most plans, the out of pocket cost is capped at $3,000 to $5,000. That’s not a deductible; that’s all cost-sharing put together as it accrues, according to Larreta-Moylan. “It will never go over that,” he said. Maternity care coverage is from pregnancy to baby at 23 months. After 23 months, the mother can add the child to her plan or get family coverage.

Dr. Jamie Renslo, chief of obstetrics and gynecology at Kaiser Permanente South Bay, said that, from a clinical perspective, doctors are purposefully unaware of what a patient’s coverage is. “In terms of treating patients clinically, we’re blinded to what their individual coverage is so we focus our care on what is clinically indicated, the tests we order, the prenatal care as well as when they are admitted to the hospital,” she said.

For many women, the choice between a home birth and a hospital birth is an economical and an emotional decision. “Wherever you’re comfortable is where you should be,” DeMaster said. “If you would feel more comfortable at a hospital, then you should be at a hospital.”