Health Insurance and Homebirth---my take

The health insurance system is complicated. Obamacare has become the closest this country has come to health insurance for the masses. The Universal Healthcare, or "free healthcare" of European nations requires both higher tax input by the people and government support. This is not likely to occur in the United States, where private business and lower taxes are valued. Yet, many more people are insured under Obamacare, which is a good thing.

We all expect that our insurance plans will pay for our healthcare. Yet the paradigm of the healthcare system is that 'more is better.' Therefore, there are larger healthcare groups forming. In this 'system' we often see our providers for short visits and the care is often impersonal. Insurance companies may negotiate with a medical group that if they become in-network providers they will agree to accept a lesser fee in exchange for more 'patients.' More is considered desirable within this paradigm.

Homebirth does not fit into this systemic paradigm. We are small practices, offering personal care, where you, the 'client,' is treated as an empowered participant of your care throughout the childbearing year. Our style of care does not fit into the larger medical paradigm. Often insurances are paying less, taking longer to provide reimbursement for care, all of which makes maintaining a small homebirth practice less-than sustainable.

In some ways the personal, family-centered, and, hopefully, affirming and empowering care you seek when choosing to birth at home resembles how we mark life transitions---weddings, birthdays, anniversaries, bar mitzvahs, naming ceremonies--- rather than health 'procedures.'  In that way we must re-think how we consider payment for homebirth. If homebirth is to be sustainable in a culture that does not recognize it as a respectable and healthful option, we all need to consider how we can pay for it if insurance plans do not.

I tell this 'story' of the health insurance conundrum at each interview. I, Marcy Tardio, and now Tanya Wills, midwives of this practice, are committed to providing homebirth care for the families that seek our care. We must all continue the conversation and think outside the proverbial box when the insurance system and varied plans do not pay a sustainable fee so that homebirth remains available to all who seek this important type of care.  


Many seek a homebirth because they want a "beautiful experience." They want to trust their own bodies to lead them on this journey toward bringing new life into the world.  Yes, birth can be exquisitely beautiful, and humbling. As with the ocean, childbirth can be still, quiet, or wild, seemingly untethered. As with all potentially wild things, we must have great reverence for this bearing of life. In all facets it can evoke a state of Awe.

There is a saying: Birth has the same guarantees that life does. This saying applies when considering where the birth of your baby will occur most safely, according to your own sense of comfort. When wrestling with the choice of birth site and practitioner, one must explore all possibilities. Then----and this is my opinion as both a healthcare provider and  a healthcare consumer--- it is important to take ownership of your choices. In the hospital, yes, there are surgeons, operating rooms and monitors. There is also a greater chance of having a surgical birth, an episiotomy, being limitted in your mobility, and asking for pain medication. Your support people will likely be limitted, and there is a greater chance your baby will be taken to a nursery, even if for short periods. At home, birth can unfold in its most natural way, where you are surrounded by loving and learned people. Ultimately, everyone involved is asked to be mindful in their roles.

A midwife must be mindful and take ownership of her style of practice. A woman and her partner must be mindful and take ownership of their choices; that where they ultimately decide to give birth is the best and safest choice for them and their baby. As they explore they must take full consideration of the inherent risks and benefits within childbirth (and all of life's transitions), and within the varied birth settings: home, hospital, birth center.

As parents we must be mindful when we decide how to care for a child who may be sick. Will we elect to use homeopathy, acupuncture, herbal teas, or will we know when to seek the expertise of an allopathic care provider. In childbirth, we recognise that at home we do not have an operating room. In the best of situations we know that birth works most of the time. Transfers typically are not emergent. Yet, when there is a life-threatening problem, even if the same problem were to take place in a hospital, everyone says: you did everything you could. At home: you should have been in a hospital.

It is important to be self-reflective; to own our choices as we navigate the healthcare system: in childbirth, as parents, or caring for elder parents. As a healthcare provider, a healthcare consumer, a midwife, mother and grandmother, I must do the same.

I share this with you as food for thought. This is not a professional document. It is a subject I think about over and over again. Consider that we live in a culture of fear; fear of illness, fear of childbirth, and fear of leaving this world. As you grow your families you will be faced with many situations where you enter the healthcare system. Consider your choices with mindfulness, and, then, lay claim to your choices. It will help now, and way beyond your beautiful birth of your beautiful children.