Home births are becoming more common during the pandemic. But many insurance companies still don’t cover them

Tia DeShazor began to question whether she wanted to give birth in the hospital when she was about six months pregnant. It’s winter 2021 and COVID-19 is still raging through New York City, where she lives. Pandemic restrictions have prevented her husband from from attending doctor appointments with her, and she wasn’t even allowed to video chat with him during her ultrasound. She felt ignored by her doctors, who assured her that her round ligament pain was normal, even though it was so severe that she had difficulty walking.

And she knows about disproportionate risk to black women, like her, who gave birth in a US hospital. If tennis is great Serena Williams nearly died in childbirth after hospital staff initially dismissed her concerns, believing the same could happen to her. “They didn’t listen to me,” she recalled thinking. “I don’t want to work, worry about something and get fired at an even more vulnerable time.”
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So DeShazor decided to give birth at home. But she couldn’t find a home-based midwife who has ties to her insurance company, MetroPlus, and the Medicaid program it operates for New York City residents, including aunt. She needed to hire an out-of-network midwife — but her insurance company told her her Medicaid plan wouldn’t cover one, DeShazor said. (MetroPlus did not respond to a request for comment on their insurance policy for home births.) DeShazor and her husband scrambled to get the $9,000 they needed for birth, prenatal, and postpartum care — by asking friends and family to contribute on their newborn registry. them, enroll in a scholarship fund for home births and gradually pay for the rest. She considers herself lucky to have a partner and supportive community to make that happen, and she gave birth to a healthy baby in May 2021. “Nobody wants to worry about paying. for the birth of their first child,” DeShazor said. “That’s what insurance is for.”

The Most were born in the US—98% —occurs in the hospital. But while home births account for only a small fraction, they have become more common during the pandemic. The home birth rate in the US has increased from 1.03% in 2019 to 1.26% in 2020, according to one report announced by the US Centers for Disease Control and Prevention in December 2021 — a 22% increase. The increase is particularly dramatic for women of color, like DeShazor, who want to avoid potentially risky outcomes in medical settings that happen to people of color more often than white patients. From March 2020 to December Year 2020, According to the new report, the number of black mothers giving birth at home increased from 0.5% to 0.68% — an increase of 36%.

But home birth comes with unexpected costs for many new parents. While the average cost of a home birth in the United States is much lower than the average hospital birth using employee-sponsored insurance—Total payments were $4,650 from insurers plus individuals, compared with $13,811, respectively., the total amount paid by insurance companies and families — large insurers often deny claims to cover all home births, as well as the associated prenatal and postnatal care with them. Katherine Baker, who processes payments for midwives primarily in New York, says that in her experience, about 90% of home birth coverage decisions require appeals to try to secure insurance coverage, and the problem seems to be getting worse. “The introduction of policies by insurers such as UnitedHealthcare and Aetna to prevent women from receiving coverage for home births has become a major women’s health issue, especially during this period,” says Baker. this pandemic.

Home births increase during COVID-19
From left: Nuranisa Rae, a midwife; baby Caily; Caryn Davis; and Brian DavisPhoto courtesy of Caryn Davis

“Most Aetna benefit plans do not cover planned home births (except where required by state regulations) based on guidance from qualified medical professional associations. assess the safety and effectiveness of a planned home birth,” Aetna said in a statement to TIME. “Our plans include coverage for home births, although they do not specify what services are covered,” UnitedHealthcare said in a statement.

One of the main reasons families choose to give birth at home is that they believe it is safer than a hospital birth. In a 2010 survey of 160 women who gave birth at home, the most common reasons they gave for choosing a home birth were safety, avoiding unnecessary interventions, and a negative past experience of having a hospital birth (or knowing someone who did). Such reasons are particularly likely to motivate women of color to give birth at home: in the US, women who identify as Black, Indian/Alaska Native are at increased risk of dying from causes related associated with pregnancy two to three times higher than white women, according to the CDC’s 2019 report. Experts attribute this disparity to disparity in access to quality health care, structural racism and disproportionate risk of chronic diseases, among others. other factors.

Nubia Earth Martin, a founder of Birth From The Earth, which provides birth education and midwifery care, says: “Getting one-on-one attention from a midwife who understands that mothers-to-be Black mothers face greater risks, and ways to reduce them help Black mothers feel more comfortable. for black women in New York. Martin said she sees an increasing interest in black women giving birth at home, both before and during the pandemic, “because of maternal mortality, morbidity and racial disparities.” Martin says that in recent months more and more families have signed up for the home birth financial aid fund she helped set up in March 2020, which has so far provided funds for about 50 families.

Read more: Death Douglass used to be rare. The COVID-19 pandemic has changed that

Concerns about the pandemic have prompted many women to consider giving birth at home. Some decide to give birth at home to avoid exposure to the virus; limiting cumbersomeness such as wearing a mask during labor and delivery; and limit the number of visitors they can have. Others fear they may be separated from their children if they test positive for COVID-19, which The American Academy of Pediatrics (AAP) recommends earlier in the pandemic Before the change guide in july 2020 to say that infected mothers and their infants can share a room if they take precautions.

Ivy Torres, a 34-year-old New York nurse who has previously worked as a laborer and midwife, says the pandemic has bolstered her decision to have a second at-home baby in May 2020. Torres said she feared testing positive for COVID-19 after giving birth, which would separate her from the infant per hospital policy. “At the time, they were very strict about the amount of contact you would have with your child.” There is no such rule at home; however, the Torres family is largely self-supporting. Her insurance company, UnitedHealthcare, only paid about $700 for prenatal, postnatal, and delivery care, Torres said — and she received the remaining $7,500.

Many insurance companies either do not cover most of the costs associated with home births or do not cover home births at all. Some argue that this is because scientific and professional organizations think hospitals are safer. The American College of Obstetricians and Gynecologists (ACOG), the organization that provides guidelines for healthcare professionals in the field, and the AAP both say that hospitals and birth centers are recognized as safe places to be. best to give birth. Aetna cited these guidelines as a reason not to cover the cost of a home birth. (However, ACOG adds that “every woman has the right to make medically informed decisions about childbirth,” and the AAP provides guidance for home births.)

Despite current guidelines issued by professional organizations, the question of whether home birth is significantly riskier is still being debated by experts. Some search shows that planned childbirth can be done safely and may even offer some benefits to mothers. Saraswathi Vedam, a professor of midwifery at the University of British Columbia, says more research is needed to understand the social and cultural benefits of home birth. “Delivery is a physiological process, so if you’re feeling scared and stressed, that’ll carry over into your labor,” Vedam says. “We are only just beginning to understand the various links between cultural safety, racial safety, and anti-oppressive care and how it affects the body.”

Indra Lusero, an attorney and director of Elephant Circle, an advocacy organization focused on reproductive justice and reproductive justice around the country, is facing barriers to insurance and reimbursement for women. home births. Dealing with insurance companies is a frequent issue for midwives, who often need to hire professional dealers to deal with the hassle of negotiating with insurance companies. “I’ve heard people across the country – all situations, all types of insurance – that there will be some barrier to getting insurance or reimbursement for a home birth with a midwife,” Lusero said. . “There is a widespread anti-birth culture at home in the insurance industry at large.” While coverage varies by state and insurance company, in some states home birth midwives are generally not affiliated with insurance companies. That’s usually by choice, because reimbursement is capped at as low as $2,000 for delivery and months of prenatal care that Lusero says is worth about $9,500 – although insurance for hospital births can be much more expensive. When families try to get their insurance company retroactively approved, Lusero says they are often denied for seemingly random reasons. “After all these years, I still don’t understand what causes arbitrariness,” Lusero said. “It was a terrible situation.”

This leaves parents in a difficult position: having to pay the remaining amount themselves, or contesting the decision. Much of the responsibility usually falls on postpartum mothers, who, if they do struggle to get reimbursed, will have to balance all the efforts involved with newborn care and other responsibilities. “There are only so many steps. And every time I get to the next step, there’s another ‘no’ and another hitch,” said Caryn Davis, 39, who says she’s still calling out Aetna a year and a half after giving birth in New York. ; the company offered less than $1,000 for her delivery, she said. “I can’t tell you how many times I’ve been on the phone with them over two hours or more.”

Despite the financial disappointment, DeShazor, Torres and Davis have no regrets about their home birth. DeShazor says it was all worth it when it came to giving birth to her baby, Lexington, in her own bed, with her doula, midwife, husband and two best friends. “It was so intense having a baby. But I feel it would be more intense if I didn’t feel safe or heard,” she said. “It’s been a very general experience bringing my baby into the world, rather than a terrifying experience.”

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