I have just spent over an hour on the phone dealing with three distinct insurance issues. One, is for our elective health and wellness rewards program, to see if our $300 individual allotment can be put towards our home birth since it can be applied to codes for a “bookstore” and “golf”. I called yesterday, and today is the follow-up to see what BCBS of VT will say – I get an absolutely it should. But what if the card denies? Oh, well then, you should find out why the card is denying. If that card denies, and it doesn’t tell me, what do I do? Do you know if Health Equity (who the debit card is through) writes checks? No, I didn’t know that, and I didn’t know to ask them since I was just checking the card’s balance to confirm that the reason the card didn’t process wasn’t a balance issue. Ok, well…Danielle, I’m going to stop you right there. I’m maxed out for today on this. I will check and see if the card can process with either midwife, and if it doesn’t, if a reason is given for denial on their Square. Bye.
The other two follow similar patterns – a constant loop around ending in an tired finale. I try to troubleshoot, and find out what I could need to know at the next step should ___ not happen as I was told. I try to avoid another call, another transfer, another conversation with “Danielle” or whomever, but it’s endless. And when I say endless, I mean that these conversations are the norm for my weeks. My daughter’s naps are spent exhaustively on these calls – why is my HRA not processing properly? Who do I need to call to confirm that payment has been received? What was the check number? And I hate it.
I hate that this is how I am spending my afternoons at 34 weeks pregnant. I wish I could just type it all out here, but there would be too many expletives to actually get out real words and sentences. It would be like listening to an Eminem song on the radio where half of it is bleeped out. I am at a 10 emotionally over this mess of an insurance company – and it’s not limited to home birth, but that’s a part of it.
So why fight? Why does this even matter? What difference does having a baby at home matter? Why not, like most women, go to a hospital?
That’s a really, really great question, and I’m glad I asked myself that again today. I opened up Instagram to post a picture of what our Bradley book sites as a normal range for gestation (Wanna take a guess? 36-44 weeks, with an AVERAGE, of 41 weeks 1/7 days.). I also came across a throwback pic of Marin, on the day she was born. Of her swaddled in my arms, with a bruise on her forehead from hitting my tailbone non-stop for hours, and resting peacefully against my chest. And a chord, that’s hit when my hormones and emotions meet at exactly the right time, led me to tears. I cried because I remember why I am fighting this fight again, more than I did with Marin, to have more insurance-covered options for me and my babe(s). And not just for me, but for other (future pregnant) women as well.
Usually, I sit back, I read Facebook posts of women whining that their baby isn’t here at 40 weeks and just roll my eyes (I didn’t claim to be super compassionate to someone complaining about being fortunate enough to have a full term pregnancy…). But today, Ms. Danielle (who in her defense is a very nice person) and her team of customer service representatives at BCBS of VT, pushed me a little over the edge. Because you know what – I had a healthy baby at 43 weeks without Pitocin and without a doctor telling me my body couldn’t do it on its own without assistance, and that I needed more Pitocin or a C-section, at home without any medical intervention. Not because I think that those interventions aren’t at times absolutely, without a doubt, completely necessary for the safety and health of mother and baby, but because I was given a chance and treated as an individual human being and so was Marin. To be clear, this isn’t a rant about why I’m awesome. This isn’t me saying I earned a gold star for having a vaginal, NATURAL birth because apparently, there’s women championing their bodies while others look down ashamed at their abdomen’s scar (and it’s really, really not ok. I’m sorry if this has happened to you.). This isn’t because I did something better, it’s because I did something different than most American women – I gave birth at home.
Ok, so you want some nitty gritty stats to support my personal thoughts? Fair. Here ya go, from my second level appeal:
“I have chosen to receive maternity, labor and postpartum care at home with Tara Kenny for the following reasons:
A· Cost: My care is more affordable for me as a patient, but also for you, my insurance provider with a home birth. The full fee for all combined prenatal, labor & delivery and postpartum care is $3,300 with Tara Kenny at Boston Community Midwifery. In 2010, a vaginal, hospital birth without any complications cost $9,683 on average and a Cesarean birth cost $20,451 on average in the state of Massachusetts (with it being plausible that both amounts have since increased). (2) Furthermore, the “World Health Organization statistics show that births attended by midwives have lower infection rates, lower Cesarean section rates, fewer complications and healthier outcomes – thus, lower, overall medical costs – than physician-attended hospital births.” (4)
B· Philosophy of care: There are two outstanding philosophies of care for women in labor and birth – that is, the techno-medical model and the midwifery model. “The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order to not be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect.” (3) Unlike the techno-medical model, the midwifery model of care is consistent with my philosophy about pregnancy, labor and delivery, and postpartum care as a natural process. The midwifery model is “uniquely nurturing, hands-on care before, during, and after birth” and it “is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics.” Most importantly, “the application of this model has been proven to reduce the incidence of birth injury, trauma and cesarean section” for women across the world. (4) Unfortunately, the techno-medical model often permeates hospitals and birth centers, including births attended by CNMs, who may be under protocol or constant pressure to practice the techno-medical model of care. (3)
C· Rate of interventions and complications: It is important to me to have a non-invasive prenatal, birth and postpartum experience with competent labor and delivery assistance for the safety of myself and my baby. The rate of c-sections, inductions, complications and other interventions is unacceptably high with in-network care providers where I live. In the state of Massachusetts, the c-section rate increased from 22.3% in 1990 to 33.6% in 2009 (5), and statistics like this, are being seen all over the nation. Fortunately, Boston Community Midwifery can provide proven low-intervention, low-complication care.
D· Safety: In a landmark study, done by the Midwives Alliance of North America (MANA) and published January, 30th, 2014, it was found that “among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies. This study, which examines nearly 17,000 courses of midwife-led care, is the largest analysis of planned home birth in the U.S. ever published.” Two particularly pertinent finds of the MANA study were that home birth mothers had “a cesarean rate of 5.2%, a remarkably low rate when compared to the U.S. national average of 31% for full-term pregnancies” and that “most importantly, their babies were born healthy and safe”. “Ninety-seven percent of babies were carried to full-term, they weighed an average of eight pounds at birth, and nearly 98% were being breastfed at the six-week postpartum visit with their midwife. Only 1% of babies required transfer to the hospital after birth, most for non-urgent conditions. Babies born to low-risk mothers had no higher risk of death in labor or the first few weeks of life than those in comparable studies of similarly low-risk pregnancies.”
E· Rate of Transfer: Boston Community Midwifery’s rate of transfer to a hospital is very low (7%) due to their complete midwifery training and continuous screening processes. Boston Community Midwifery is careful to attempt delivery of low-risk pregnancies only for the betterment of their clients and families. ”
That was a mouthful. But I’m glad I got it out. Finally. When a little voice in my head says that ‘I could just go to a hospital’, it’s absolutely right. I could go to a hospital and I could go into a different variety of options. But I’m not unless necessary because I’m deciding to birth at home regardless of what coverage, if any, we receive. I feel confident that staying at home is the safest option for our birth because I’m very fortunate to be a low-risk pregnant woman. Not every woman has that much choice or say, and I recognize that. But for those that do, I’m challenging you, not to have the birth I want or have had, but to look at the other side of the very socially acceptable interventions and policies that take place elsewhere because they have real, tangible consequences too.
With Marin, it made all the difference in the world for our outcome. If I could have won a birth superlative, it would be “Most Likely to Have a C-Section” and I didn’t want that. Just like I recognize that not every woman wants a home birth. Or a natural birth. Or even a vaginal one. I’m happy that women have those options, but I’m disappointed that my family spends 20% of our income towards an insurance plan that does not offer hospital alternatives less than 2.5 hours from where we live.
At home, there was no protocol or routines that I had to submit our birth to. There was no IV in my arm, needle in my back, or Pitocin drip causing unnaturally strong contractions. I could eat and I could drink, and I did, till the very last push. I could do squats in my hallway. I could stay at 8 centimeters, without any inclination of a problem, for AT LEAST 12 hours (I could’ve been there longer, I just didn’t get checked purposely), without someone telling me my body had failed to progress or pressuring me into another exam. Without someone rushing me to an operating room to call it quits for massive abdominal surgery. With someone constantly dripping cold water over my forehead and encouraging me. With the ability to labor in a birth tub with the pain relief equivalent of morphine. Without someone offering me any form of pain medication – with this being the best analogy, I’ve heard yet, akin to someone constantly offering you candy while you’re on a diet. Because I didn’t want an epidural, and I didn’t think I could say ‘no’ if it was offered one. I didn’t have a natural home birth because I think I am strong or stronger than someone else – I had a natural home birth because the options I had I wanted, and the options I didn’t want to have, I wanted ONLY if needed.
I had a home birth because I wanted to be treated with dignity, support, reassurance, continuity of care, and more importantly, as an individual woman and not someone’s statistic. I wanted a birth team that was for me and our birth plan, even if it failed, because I wanted the healthiest outcome for me and my child if possible with a group of women I knew and trusted. And I want a home birth again because there’s nowhere else in Boston, but my living room apparently, that those are absolutely available to me. I don’t care if my baby is born in my home, I care that my baby is born in the healthiest, safest environment we can provide – which if we’re looking at the numbers, and not personal preference, seems in the vast majority of cases, to be in the presence of CPM’s with as little intervention as possible at home.