Home Births Rose During COVID-19. But Insurance Lags Behind

tia deshazor started wondering if she wanted to give birth in a hospital when she was about six months pregnant. it was the winter of 2021 and covid-19 was still raging in new york city, where she lives. pandemic restrictions prevented her husband from attending medical 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 pain in her round ligaments was normal, although it was so intense that it was difficult for her to walk.

and she knew about the disproportionate risks for black women, like her, who give birth in the us. uu. Hospitals If tennis great Serena Williams almost died in childbirth after hospital staff initially dismissed her concerns, she believed the same thing could happen to her. “They’re not listening to me,” she remembers thinking. “I don’t want to be in labor, worry about something and get fired at an even more vulnerable time.”

Reading: What insurance covers home birth

so unshazor decided to have a home birth. but she couldn’t find a midwife who could deliver her baby at her home and who was in network with her insurer, metroplus and the medicaid plan that operates for new york city residents, including her. she would need to hire an out-of-network midwife, but her insurer told her her medicaid plan wouldn’t cover her, she says undone. (Metroplus did not respond to a request for comment on its home birth coverage policies.) deshazor and her husband scrambled to raise the $9,000 they would need for labor, prenatal and postpartum care, asking friends and family for donations. on her baby registry, applying for a home birth scholarship fund, and gradually paying off the rest. She considers herself lucky to have a supportive partner and community to make it happen, and she gave birth to a healthy baby boy in May 2021. “No one wants to worry about paying to bring their first child into the world,” she says. she undone “That’s what insurance is supposed to be for.”

the vast majority of births in the us. uu. (98%) occur in hospitals. But while home births make up only a small portion, they have become more popular during the pandemic. the percentage of home births in the united states went from 1.03% in 2019 to 1.26% in 2020, according to a report published by u.s. Centers for Disease Control and Prevention on Dec. 2021: an increase of 22%. the rise has been especially pronounced for women of color, such as unshazor, who want to avoid potentially risky outcomes in the medical setting that happen to people of color more often than white patients. from March 2020 to December 2020, the number of African-American mothers giving birth at home increased, according to the new report, from 0.5% to 0.68%, an increase of 36 %.

But home births come with unexpected costs for many new parents. Even though the average home birth in the us. uu. costs much less than the average hospital delivery using employee-sponsored insurance: $4,650 in total payments from insurers plus individuals, compared to $13,811, respectively, the sum of what is paid by insurers and families . Major insurers often reject claims to fully cover home births. , as well as the prenatal and postnatal care that accompany them. katherine baker, who handles midwife billing primarily in new york, says in her experience about 90 percent of home birth insurance coverage decisions require appeals to try to secure coverage, and the problem seems to be getting worse. “The fact that insurance companies like unitedhealthcare and aetna have policies in place to prevent women from getting coverage for home birth has become a major health issue for women, especially during this pandemic,” says baker. .

“planned home births are not covered by most aetna benefit plans (except as required by state regulations) based on guidance from medical professional societies that evaluate the safety and effectiveness of planned home births,” Aetna said in a statement sent to Time. “Our plans include coverage for home births,” unitedhealthcare said in a statement, without elaborating on what services are covered.

One of the main reasons families choose to give birth at home is that they believe it is safer than giving birth in a hospital. In a 2010 survey of 160 women who had given birth at home, the most common reasons they gave for choosing home births were safety, avoiding unnecessary interventions, and having a previous negative birthing experience in a hospital (or knowing someone who had it). Reasons like these are especially likely to push women of color to give birth at home: in the us. In the US, women who identify as black, American Indian/Alaskan Native are two to three times more likely to die from pregnancy-related causes than white women, according to a 2019 CDC report. experts attribute the disparities to unequal access to quality health care, structural racism, and disproportionate risk of chronic disease, among other factors.

having the personalized care of a midwife who understands that black mothers face greater risks and how to mitigate them makes black mothers more comfortable, says nubia earth martin, founder of birth from the earth, which provides education on the childbirth and obstetrical care for black women in new york. Martin says that she has seen a growing interest in home birth among black women, 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 been applying for a home birth financial assistance fund that she helped establish in March 2020, which has provided funding to about 50 families so far.

read more: death doulas used to be rare. the covid-19 pandemic changed that

Concerns about the pandemic have pushed many women to consider home births. some decided to give birth at home to avoid possible exposure to the virus; cumbersome restrictions like wearing a mask during labor and delivery; and limits on the number of visitors they could have. Others feared they could be separated from their babies if they tested positive for Covid-19, which the American Academy of Pediatrics (AAP) recommended early in the pandemic before changing guidelines in July 2020 to say infected mothers and their Babies can share a room if they take precautions.

ivy torres, a 34-year-old nurse from new york who previously worked in labor and delivery, said the pandemic reinforced her decision to deliver her second child at home in may 2020. torres said she feared giving positive for covid-19 after her birth, which would separate her from her newborn under hospital policies. “At the time, they were very strict about the amount of contact you would have with your baby.” there were no such rules at home; However, the Torres family largely had to pay for the delivery themselves. Her insurer, UnitedHealthcare, only paid about $700 for prenatal, postpartum and birth care, Torres says, and she was committed to the remaining $7,500.

Many insurance companies do not cover most of the costs associated with home births or do not cover home births at all. this, some say, is because scientific and professional organizations maintain that hospitals are safer. The American College of Obstetricians and Gynecologists (ACOG), which sets guidelines for health professionals in the field, and the AAP say hospitals and accredited birth centers are the safest places to give birth. aetna cited these guidelines as the reason for not covering the costs of home birth. (However, Acog adds that “every woman has the right to make a medically informed decision about childbirth,” and the AAP provides guidance for home births.)

Despite current guidelines set by professional societies, experts continue to debate the question of whether home births are significantly riskier. Some research suggests that planned home births can be performed safely and may even provide some benefits for mothers. saraswathi vedam, a professor of obstetrics at the university of british columbia, says more research is needed to understand the cultural and social benefits of home births. “Birth is a physiological process, so if you feel fear and tension, that will carry over into the course of your labor,” she says. “We are just beginning to understand the different connections between cultural safety, racial safety, and care against oppression with how it affects the body.”

Families across the country with many different insurance plans face barriers to coverage and reimbursement for home births, says Indra Lusero, an attorney and director of Circle of Elephants, a justice-focused advocacy organization. reproductive and birth. Dealing with insurers is a constant problem for midwives, who often need to hire professional billers to deal with the hassle of negotiating with insurers. “I’ve heard from people all over the country, all kinds of settings, all kinds of insurance, that there will be some barrier to getting coverage or reimbursement for a home birth with a midwife,” Lusero says. “There is a widespread culture of anti-home birth in the insurance industry in general.” Although coverage varies by state and insurer, in some states, midwives who deliver at home are often out of the insurance company’s network. That’s often by choice, because reimbursement is capped at $2,000 for delivery services and months of prenatal care that Lusero says is worth about $9,500, though coverage for hospital deliveries can be much more expensive. When families try to get their insurer to retroactively approve their claims, Lusero says they are often denied for seemingly random reasons. “Still, after all these years, I don’t understand what explains the arbitrariness,” says Lusero. “it’s a mole hit situation.”

This leaves parents in a difficult position: pay the remaining bill themselves or challenge the decision. Much of the responsibility often falls on postpartum mothers, who, if they were to fight for reimbursement, would have to balance all the effort that goes into caring for a baby and other responsibilities. “There were many, many steps. and every time i took the next step, there was another ‘no’ and a block,” says caryn davis, 39, who says she is still applying to aetna a year and a half after giving birth to her son In New York; the company provided less than $1,000 for her birth, she says. “I can’t tell you how many times I’ve been on the phone with them for more than two hours or more.”

despite financial frustration, disappointment, torres and davis have no regrets about giving birth at home. deshazor says it was worth giving birth to her baby, lexington, in her own bed, with her doula, midwife, husband and two best friends by her side. “It is intense to give birth. but I feel like it would have been more intense if I hadn’t felt safe or heard,” she says. “Bringing my son into the world was a very communal experience, rather than a scary one.”

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