When it comes to paying for different aspects of birth, the claim is often made that someone can't afford the cost of a service or provider they say they would otherwise choose. It's sometimes hard to stomach what look like big upfront fees when our insurance or government may offer another option "free" or much cheaper, right? Or sometimes the idea of paying for our own needs is simply foreign to us because we're so accustomed to the insurance/government run model of care.
Most often when people are saying this, they are referring to wanting to have a home birth midwife, a doula, or use a birth center but sometimes it could even be smaller things like birth classes or some extra supplies or a potentially birth-changing book (or app ;)
We want to present a few thoughts on that topic as well as ways to rethink the whole concept of "paying" for your birth.
Your pregnancy, birth, and your postpartum are an investment, in your immediate health, your longterm health, your family, your marriage, your baby's immediate health, and your baby's longterm health. The energy, time, and yes, money put into them will pay off not just now but in the future and are rarely regretted. Not only that, those things are WORTHY of our energy, time, and money. Where we direct those resources that God has given us shows much about what we believe and where our priorities lie. We know no one who regrets prioritizing those things financially but many many people who look back with regret wishing they had chosen differently.
First, we need to be honest with ourselves. Very often people say they "can't afford" one of these things when what they really mean is, "we're choosing not to prioritize that right now." They actually do have the money, or could somehow find it, but they simply don't want to pay that amount or sacrifice other things to have it. That's a legitimate choice we can make with the resources we are entrusted with. God gives us that freedom. But it's helpful to be intellectually honest and recognize that often the money could be found for those things but it's just not priority over other things we want. It's disingenuous to say that you can't afford a midwife or doula but then decide to take that trip or buy the nicer vehicle or remodel that room or pay thousands in kids' sports or activities or tuition fees.
Here are a few important questions to ask yourself (and there are not necessarily "right" or "wrong" answers here!):
Do I actually HAVE the money but I'm just not willing and don't truly want to prioritize those things?
If I have insurance what do I actually end up paying in the end? MANY parents are caught completely off guard when their birth that was "completely" covered still leaves them with several thousands of dollars in hospital bills and copays from all the different specialists that are staffed at the hospital, each of them getting to send a separate bill! If you added it all up very often, those extra charges may be close or even surpass what would have been paid out of pocket to a midwife!
Have you actually looked into what your insurance/HSA will cover? Many won't advertise it but they often MAY cover those things. (For example: We can't speak to other states but here in New York there's actually a law on the books that insurance must legally cover a home birth midwife and if there is no one in network within a certain radius, they have to cover an out of network provider! Still, despite knowing this the claim is often automatically denied by the insurance company unless a customer knows that and pushes for them to follow the law.)
Have I asked my local midwife or doula if they can accept insurance, HSA, payment plans, or other options? Many times people just assume it won't work but haven't actually done the legwork to see if they're actually right. Have you actually called to ask or see what options are?
What are the financial costs of NOT using that midwife, doula, birth center, etc.? There are many ways this could manifest. This may be extra financial costs such as the much higher bills for a cesarean that could have been prevented. It could be the extra pelvic floor therapy (that may not be covered by insurance) now necessary because your OB used forceps or performed an episiotomy that wouldn't have been used elsewhere. How about the thousands of dollars in formula that now have to be purchased because physiological birth was interrupted or your baby was induced out too early or taken to the NICU without need or you got terrible advice or breastfeeding interventions at the hospital that interfered with physiological breastfeeding? All of those things can disturb the breastfeeding relationship and cascade into now needing to spend hundreds or thousands on formula. Very often we can pay and invest now and up front, or end up paying later.
What about the emotional, mental, and spiritual costs? There are much more significant costs of devaluing your birth, compromising what you know would be more beneficial, or even of trauma or unnecessary surgery than merely finances. What about the trauma that could have been spared to you or your baby? What about the lesson it teaches your younger children, especially daughters, about prioritizing their health and emotional needs? What about the depression and anxiety and flashbacks and regret resulting from a traumatic birth? What about your future health and the repercussions of an unnecessary cesarean on future births or of incontinence that could have been prevented?
If your child was told they needed something significant for their optimal health, like surgery or a certain therapy, would you find a way to pay for it? If you could AVOID a major surgery for them by traveling further to get another opinion or trying something different or paying a bit more, would you do it? So often women compromise to make it easier on others or because they simply don't feel worth investing in. You will never get another chance to birth this baby. If you can't do it for your own self, perhaps think of the baby's perspective and what you are giving them (or protecting them from) by choosing a better provider or more support.
When you got married were you willing to pay hundreds or even thousands for that celebration? It's common and even expected for women or their family and friends to spend hundreds of dollars on flowers or bridesmaid gifts or a limo. They may pay thousands to a photographer or for that perfect dress or a venue. They often don't balk at paying a bit more to upgrade to a better venue and would be appalled if an outside company was deciding that they had to use certain flowers or only had a few approved "in-network" buildings where they could have the reception. Sure, we could get married without all the extras like a reception or honeymoon or special dress but it's such a special and important day that we are willing to put our resources toward that, right? Yet when it comes to something far more significant to their health and will have much more lasting effects on their family, their BIRTH, many mothers and fathers expect everything to be free or allow insurance CEOs to decide how it will play out.
Now, perhaps that's not you. Perhaps you really are already living bare bones, or think you are, and you just don't have extra to put toward your best and most ideal birth scenario. We recognize that that is a real thing, especially with bigger families and especially in one-income households. We've been there ourselves! Here are a few ideas to consider to possibly make it work:
First PRAY!!
If this is something you truly desire for your birth and God is leading you there, then first put it all in His hands. Ask Him to open up whatever path you need to make this work and follow His will for you. Perhaps that's one of the ideas below or perhaps He will provide supernaturally in a way you would never expect. Nothing is beyond Him, especially something like money. He cares about your birth and like a loving Father He wants to provide for us.
HSA (or other investment accounts)
Do you have a health savings account? Very often those can be used toward the costs of birth, including a midwife, doula services, and more. Look into what yours will cover! Or what about cashing out some of a retirement account?
Baby Shower or Gifts
It is COMPLETELY legitimate to ask for money or payments toward a midwife's or doula's fees if you have a baby shower! The vast majority of things gifted at a shower are not true necessities for you or your baby. A good amount you may not even use at all, or perhaps only for a few months, before they are sent to Goodwill or passed along. But a better, healthier, more supported birth is something you will BOTH take with you for the rest of your lives. Reducing the risk of a cesarean, induction, and a more physiological birth by utilizing a good midwife and doula or financing postpartum care is far more valuable than the fancy stroller or bouncy seat. Not only that but all that baby gear is easily found secondhand either at thrift stores, garage sales, or free through friends or your local Buy Nothing group, often in near perfect shape.
If people are going to spend hundreds - if not thousands - of dollars on you and your baby, put it toward the things that truly matter. You can add a note to the registry or invitation and also keep stuff on your registry bare bones to encourage people to give towards those birth costs). If you're not having a shower but parents or relatives ask what you need or say that they would like to buy a gift, be honest! Tell them you'd love money toward a doula or that you'd really like to use this midwife but need help toward the fees.
Tax Refund
If you have a tax refund coming, set it aside to use toward birth costs. Very often, these refunds or credits are coming because we may have children already so it seems appropriate to put it toward another one coming!
Selling Secondhand
What do you have in your home that you don't need or use that could bring in a few hundred dollars at least? Selling on Facebook Marketplace, consignment, EBay, or even hosting a big garage sale may cover a significant portion of your bill. It may not seem like it, but selling old books, furniture you don't need, clothes, or stuff that's been sitting in the attic or basement unused can add up quickly.
Second Job
What about you or your husband taking up a small extra source of income? Even a temporary job for a couple months would likely be enough and the investment and sacrifice of those few months may pay dividends in the form of a better birth or postpartum time. Brainstorm what small second job could work for either you or your husband to make this happen.
Cutting Out as Many Extras as Needed
Netflix, Prime, subscription services, cable bills, tickets to games, concerts, kids' sports, weekend trips, or expensive hobbies or purchases...there are SO many ways to trim smaller but unnecessary expenses that when put together add up big time. How about downgrading your internet/phone plan, cutting out all restaurant eating, meal planning and cooking from scratch and with simpler ingredients to cut your grocery bill down? The vast majority of people have ways they could find money in their budget, even if it's $100-200 a month you save, that adds up over nine months!
Push With Insurance/Submit Receipts Later
Insurance is maddening, we know. But there are many people who with lots of persistent (and hair-pulling) effort are able to get their insurance to cover their midwife. If you need to, read through the fine print on your plan. You can even consider submitting bills after the fact to see if they budge. You can also talk with a midwife about ways they can break up their services so that even some of it is covered. Some plans may have no problem covering the prenatal care, for example, but just won't cover the birth itself. If she can bill accordingly, it may at least get part of the care covered.
Consider a Health Share Plan
Health share plans, an alternative to traditional health insurance, almost always will cover midwifery care and even doula costs! They wisely know that both those things actually SAVE money long term by avoiding costly interventions, lengthy hospital stays, and reduce the risk of complications. Groups like Samaritan Ministries, Christian Healthcare Ministries, and Medishare all cover more options in birth than traditional insurance companies. Important to note that with most of these you DO need to be on the plan before you are pregnant for a certain length of time in order for the plan to cover your birth. This is understandable since the model would collapse if people simply waited to join until they were already pregnant.
Choosing a health share also means you are not participating in and contributing to things like abortion, IVF, contraceptives, gender reassignment surgeries, same sex fertility treatments, and so much more that your insurance company is covering. On a personal note, we are Samaritan members and have been incredibly happy with it, not only the more personal and Christian nature of "sharing each other's burdens" but also with the ease and lower costs than we were paying with previous insurance plans which covered far less! (P.S. If you do sign up with Samaritan Ministries feel free to use my name Mary Haseltine and we get a small credit ;)
Barter
Some midwifes and doulas are open to trading services or goods for their work. Be careful with this, though, and respect that it may not be something they can or want to do. If you have something that is truly helpful for them, it may be a great option, but as much as they might want to, they can't pay their electric bill or mortgage with your homemade crochet work. It also makes tax filing trickier. So be understanding if this is not an option for them.
Payment Plans
Nearly every midwife and doula we know is willing to work with families on payment plans. Some of them are also willing to do a sliding scale fee. If it's not in their paperwork or advertised on their site, you can still ask (sometimes it's not prudent to put that out there since sadly, people may take advantage). Like bartering, be respectful if that's not something they can offer.
Factor in SAVINGS
Like we mentioned before, you may actually be SAVING money long term by hiring this better option, or at least, you may come out equal when you factor in a high deductible, extraneous medical bills, co-pays, future pelvic floor therapy, trauma therapy, NICU bills, and more.
Credit Card or Loan
While not ideal, debt is not inherently bad. In fact, it can be a gift from God to be able to access a loan for something that is critical to our health and family. Taking out a medical loan or even credit card (if you can feasibly pay it off soon) may actually be worth considering if there are no other options. Going back to the wedding analogy, did you put part of your honeymoon on credit? Or did you take out a loan to finish college? If your child needed that surgery or therapy, would you be willing to take out a loan if need be? If those things are worthy of that sacrifice, why not your birth and your baby?
In the end, while money is important and certainly not limitless, it's just money, a gift we are given to steward well for our good and that of our family and community. Few of us remember the details of what we spent money on ten years ago. When we invest in a memory-making trip or our wedding or even a great concert, we rarely remember the exact details of costs and when we look back, we say the experience was worth it.
Is your birth worth it?
How will you look back on your birth ten years from now? Will you wish you had nickel and dimed your way to the cheapest option or will you wish you had invested that bit of extra money to have had a profoundly different outcome and experience? Ask God what He wants you to prioritize right now and ask Him to show you the way to get there.
For more encouragement and discernment points on this topic, check out this episode of Your Birth, God's Way on Apple here or on Spotify here.