As I work in the birth world as a childbirth educator and a doula I see many women who are frustrated because they find that their options are limited.  Not because their provider does or doesn’t handle  a certain situation in a certain way but more often than you’d think, because their insurance or medical coverage plan doesn’t cover a certain option.

I spoke with a woman last weekend who would love to have a home birth but her insurance won’t cover one.  And the homebirth practice she was considering would cost her close to $7,000.  So then I asked her about going with a group of midwives who have an alternative birthing center.  She informed me that the only maternity reimbursements that her insurance provides are for MD’s.  She is healthy and low-risk and cannot even consider maternity care from a midwife.

I have heard of women whose coverage wouldn’t apply to the birth  if they were “allowed” to go past 41 weeks.  So in order to make sure that the birth was covered by their insurance they must undergo a costly, invasive, medical induction that increases their chances of a cesarean simply becasue their insurance policy arbitrarily states that it must be so.

So now we turn toward Texas where a judge recently ruled that Medicaid is not required to reimburse birthing centers for their facility fee when a woman using Medicaid gives birth there.  Medicaid will continue to reimburse hospitals (at a much higher cost) when women birth there, but the more cost effective option of the birthing center is being denied any reimbursement.  Also this ruling is not limited to Texas; it would apply nationally. Once again a medical plan is not even giving women  a choice when there exist several good options.  I’m not advocating that all low-risk women must give birth in a birthing center, only that if they have that option in their area they should be able to consider it.

If you would like to communicate your opinion about this ruling you can go here to do so: Consumer Letter to Congress

Childbirth Connection has great information on evidence-based maternity care and an excellent discussion of how current reimbursement practices actually encourage more intervention and less tolerance of supporting normal physiologic birth.  Pages 59-67 of their report Evidence-Based Maternity Care: What It Is and What it Can Achieve adress these concerns specifically.

As a childbirth educator and a doula I see my role as helping women to see the full range of options they have in various cincumstances so that they can make an informed decision about their care.  Unfortunately, the reality is that unless these women happen to be of certain means, their options are in reality much more limited than they appear at first glance.