Last week, we started crowdsourcing the cost of childbirth.
In a blog post introducing this next phase of our #PriceCheck project, I pointed out the huge variation in average charge prices between a vaginal birth in a birthing center in California in 2010 ($1,980) and an uncomplicated vaginal birth in a hospital ($15,760).
That led me to wonder: Why would the charged price in a birthing center be so much cheaper than in a hospital? Keeping in mind that charged prices are often extremely inflated, I also wondered: Once insurance is factored in, is it cost-effective for women to give birth in birthing centers?
'A safe option'
I asked the American College of Obstetrics and Gynecology for its opinion on birthing centers, and I was referred to Dr. Sarah Kilpatrick, a maternal-fetal medicine specialist at Cedars-Sinai Medical Center. She says accredited birthing centers using licensed midwives can be a good option for healthy women with low-risk pregnancies who want a low-intervention birth in a home-like setting.
"I think it's a very safe option, if you're low-risk and if your risk status has been carefully assessed by your care provider, which typically is a midwife in this scenario," Kilpatrick says.
She says birth centers can also save the health care system a lot of money: When women have babies at birth centers, they avoid long hospital stays and receive fewer medical interventions. The recent National Birth Center Study finds that 94 percent of women who entered labor planning a birth center birth had a vaginal birth; just 6 percent got a Cesarean section.
But do those savings trickle down to the patient? It's a trickier question than I realized.
Supporting low-risk birth
I visited GraceFull, a birthing center in the Silverlake neighborhood of Los Angeles. (It's licensed by the Commission on the Accreditation of Birth Centers, as is recommended by ACOG.)
Owner Elizabeth Bachner, a licensed midwife and acupuncturist, gave me a tour of the facility. It's tucked into a shopping center and has two birthing rooms. They're warm in temperature and are designed to feel safe and comforting: Bachner tells me the walls of the rooms are covered with prayers and inscriptions from the community; that writing is covered with wallpaper that I recognize from Anthropologie.
Inside each room are a bed and a tub. There's also a hammock-like swing hanging from the ceiling, and a birthing stool that's shaped like a toilet seat.
"This room was created from the ground up to support the transition of the mother-child relationship from inside the body to outside into the world," Bachner says. "Everything here is to support low-risk childbirth, for the baby to come out safely."
A birth with GraceFull costs $6,400. That includes prenatal care, midwifery and nurse care during labor and delivery, along with postpartum care.
While Bachner maintains that she and other midwives provide cost-effective care for low-risk pregnant women, she concedes that using a birthing center doesn't always prove to be the cheapest route. GraceFull is considered an out-of-network provider; mothers can try to have their insurance cover a portion of the bill. The facility's billing expert tells me that when clients go through their insurance company, the women pay on average about $4,000, but that can vary based on their out-of-network deductible.
Things can get expensive if a woman needs to be transported to a hospital. The mom will then be responsible for the out-of-network costs of the birthing center and any cost-sharing (like deductibles, copays, or coinsurance) associated with an in-network hospital.
Bachner shares a speech she often gives to families when addressing this issue of cost: "If we should transport, you, as a woman, are going to have to mourn the loss of that home birth that you wanted, with the candles and the water, and un-medicated," she says. "But you as a mother are going to be so happy to have your child in your arms, and you're going to be so grateful for that hospital."
"And then, dads, you as a father, you're going to be so grateful that the woman you love is safe and your child is safe," she continues. "But you as a man, you're going to be so pissed off at the extra cost that you're going to incur, and we're just not in charge of that.”
Whether giving birth in a birth center is cost-effective for a particular woman comes down to a major factor: Insurance.
As I reported last week, most of childbirth should be covered by insurance, but women could be responsible for a portion of their bill, depending on the terms of their individual plan. They could be on the hook for larger bills, too, if they're treated by out-of-network providers while at the hospital.
I've said it before and I'll say it again: It's really important to understand your insurance plan. If you're healthy and your pregnancy is considered low-risk, and you're interested in giving birth outside of a hospital, it's critical that you speak with your insurance company to find out how much of the bill you'd be responsible for, both at the birthing center and if you have to transfer to the hospital.
Whether you had your baby at a birthing center or a hospital, we want to hear from you: Share your childbirth costs here with our #PriceCheck project. If something shocked you about your bill, you can also e-mail me at Impatient@scpr.org. And please spread the word about #PriceCheck on social media!