My Path to Motherhood, Part 5: Where to birth and the struggles of health insurance

In part 4, I left you in the Fall of 2021 when we just found out we were pregnant. 

Thankfully, a few days after we discovered we were pregnant, my sister and dad happened to be in town visiting, so I got to share this big news with them in person. We met up with many of our local family members over the next few days and told them the big news in person!

I called the birth center to make our first appointment. I felt so grateful and lucky that they were located only a few miles away because they were one of the last remaining birth centers in Maryland. When I called to make the appointment, I was alarmed and disappointed to find out that they were closing their doors on October 1, 2021. This news was the start of a stressful journey navigating the healthcare system. The birth center founder told me that they were transitioning from the birth center model to supporting home births and pitched the idea to me. I had never considered giving birth at home, but there were no other birth centers close by. I felt really overwhelmed as I tried to figure out who my doctor should be and where to give birth. Some of my worries were eased when my sister assured me that I didn’t have to have it all figured out immediately and that I could always switch providers over the course of my pregnancy. 

Meeting up with Andrew’s Mom for ice cream to surprise her with the big news!

One thing I decided early on was that I wanted to work with a midwife. I didn’t want any medical interventions during labor and birth, if possible, and I’d heard that midwives would be a more empowering presence, where decisions about prenatal care, labor, birth, etc. are more of a collaboration. 

So, I called a local midwifery practice who could provide prenatal care as well as labor and birth support at the local hospital. We set up our first appointment at 12 weeks and officially confirmed the birth and due date: May 20, 2022.

The next decision was to decide between a home birth and a hospital birth, so we started our research! We attended a local birth and baby fair and watched two documentaries on home birth, one of which was about OB-GYN’s who decided to give birth at home. When we were watching these films, every single time a baby was born at home or in a tub, I felt so emotional and yearned for that kind of experience. I didn’t want to be in the hospital atmosphere, with the overhead lights, cold floor, monitors, scratchy sheets, and pressure from the system to move the labor along at a faster pace than me or baby wanted.

In our research, we learned that in a hospital, you are much more likely to experience an ‘intervention’, such as Pitocin, a medication that induces labor. When you experience an intervention, you are more likely to end up needing a cesarean. We also learned that most cesareans occur at 5:00 pm and 10:00 pm, supporting the idea that cesarean deliveries are more convenient for doctors than a ‘natural’ birth and they may push for them in order to finish up the day. The hospital is a business and a system that incentivizes efficiency and I didn’t want to have my baby within this system if I could avoid it.

I wanted to birth this being in an environment that felt safe and cozy, so we started interviewing home birth midwives to find someone with the level of experience we were comfortable with. Through this process, I became aware that home birth midwives were not ‘in-network’ with my health insurance. Although the cost difference between a low-intervention hospital birth and home birth was not drastic, the cost of a home birth would not apply to our deductible and out-of-pocket maximum. As much as I didn’t want money to play a part in this decision, I was starting to feel guilty about taking this risk. If we invested in a home birth and then ended up giving birth in the hospital anyway, we’d be paying much more money than if we just went with the hospital from the start. 

At this same time, I started a new job and was no longer eligible for health insurance through Andrew’s work. I discovered that the health insurance offered through my work was much more expensive and required referrals. I compared the health insurance offered through my work to the plans offered through the Maryland Health Connection, but the cost wasn’t any better. I went ahead and signed up for the cheapest health insurance option through my work. 

We decided on a home birth midwife and found out that we may be able to get an ‘in-network exception’ so that the cost of working with this midwife would apply to my deductible and out-of-pocket maximum. To do this, I had to get a referral. I went to my primary care physician for the referral and she was, unfortunately, not supportive of home births or midwives. She said that she hated midwives and that the technology in the hospital had been invented to protect women in birth. She said that if she provided me with a referral, she could be held accountable if anything were to go wrong. After she explained all of the risks, she asked me if I was still interested in a home birth and I told her I was. I left that appointment feeling scared and frustrated by the healthcare system. I felt unsure of who to trust: I believe in the power of science and medicine, but many doctors seem quick to prescribe meds or interventions instead of taking a more holistic, root-cause approach (twice during pregnancy, I was prescribed antibiotics before test results had come back and both times, antibiotics were not needed). I was also frustrated that I needed to get my primary care physician’s ‘approval’ in order to work with the home-birth midwife in a financially-smart manner. It felt disempowering. 

In Los Angeles, I had Kaiser Permanente for my health insurance plan and loved the integration of their system. I also really liked my doctors. I traveled to the same block of buildings for my OB-GYN, primary care physician, mental health therapist, and physical therapist, and all of the providers were approachable and respectful of my values. 

After moving back to Maryland, I’ve been on Blue Cross Blue Shield, and now an HMO plan through United Healthcare and with both, I feel so unsupported: by the approach of the doctors, attitude of receptionists, longer wait times, old facilities, and lack of a whole-person approach. 

Surprisingly, I received a notification a few weeks later that the ‘in-network exception’ was approved for the home birth midwife I wanted to work with. So, we went full steam ahead with our plan to give birth at home. 

One cool experience of the home-birth approach is that we had to purchase a fetoscope, heart rate monitor, and measuring tape, so that we could measure my vitals before each of the virtual visits we had with our midwife. It felt empowering to be a full participant in my health care in this way, to know how to measure the fundal height, the baby’s heart rate, and take my own blood pressure. 

The downside that I’ve experienced is that my midwife is not a doctor. For most side effects of pregnancy that I’ve experienced (skin rashes, yeast infections), I have to go to my primary care physician for a diagnosis or referral. Another downside is that I have to buy the home birth supplies myself. It’s not very expensive, but as I tried to find some of the items for free in the community, I added on extra time and tasks. I’ve learned that when you give birth in a hospital, you receive a lot of the items there (receiving blanket, mesh underwear, diapers, etc.).

That’s all for now. Stay tuned for more details about the journey through each trimester of pregnancy.