Frequently Asked Questions


What medical equipment and supplies does a midwife bring to a home birth?

I carry 2 bags and a basket. One bag is doppler (for checking fetal heart tones in labor) and respiratory equipment, including oxygen. The other bag includes medications for bleeding (all the same anti-hemorrhagics that the hospital has) as well as homeopathy, herbs and essential oils. This bag also has IV supplies, suture instruments/supplies, and supplies for cutting or burning the umbilical cord. My basket holds supplies for mom and baby assessment, including baby scale and measuring tape, BP cuff and thermometer, fetoscope, and blood draw supplies.

 


Is there a difference between a direct entry midwife and a nurse midwife?

There are differences and similarities between direct entry midwives (DEM’s)
and nurse midwives (CNM’s). The primary difference is in the educational pathway. DEM’s may have completed a formal educational program or have what is considered substantially equivalent education, which likely involves an apprenticeship with another midwife. After this they must pass the North American Registry of Midwives (NARM) written exam which is similar to the exam that CNM’s must pass for their certification. Direct entry midwives may have titles such as CPM (Certified Professional Midwife) which is an additional certification they have completed; and/or LDEM (Licensed direct entry midwife) or RM (Registered midwife) depending on whether their state’s process is licensure or registration. DEM’s are legal in many states but not all.

A CNM is usually a registered nurse first. She has also completed a master’s degree program in a medical university that specializes in midwifery. She must then pass an exam and be certified by the American Midwifery Certification Board. This grants them the title “CNM” for certified nurse midwife. They must recertify every 5 years. CNM’s practice legally in all 50 states and have prescriptive privileges. CNM’s provide pregnancy care and many provide primary care as well. They are independent health care providers in Colorado. This means they consult appropriately with other health care providers when indicated but do not require any type of supervision or collaborative practice agreement.

DEM’s work almost exclusively in homes and occasionally in birth centers. CNM’s most often work in hospitals but can work in birth centers and in homes also. There are around 200 CNM’s doing home birth in the US.

The bottom line is that CNM’s and DEM’s are all midwives. Unlike physicians, all midwives have extensive education and training in normal female life processes such as the menstrual cycle, pregnancy, birth and beyond. We can treat some of the abnormal or will refer appropriately if a concern is beyond our scope, but we specialize in keeping women and families normal and enjoying life.

Why does home birth cost so much?

Let’s compare the cost of hospital birth to the cost of home birth.

If you have your baby in a hospital you have:

1. What you pay the midwife or doctor who provides your pregnancy, birth, and postpartum care. You pay this person or practice “a global ob fee”. Along the Front Range that is typically somewhere in the $2500 or so range if you pay out of pocket. If you have insurance, your insurance company usually has some sort of contract with the health care providers so that they pay something less than that.

2. You pay the hospital for providing a place for you to have your baby, nurses to care for you and your baby, and supplies and equipment for them all to use. This usually runs in the several thousand to upwards of $10,000 or more if you have a C-section or complications. Again if you have insurance, they will pay less than you would have to pay if you are “self pay”. If baby spends anytime in the neonatal intensive care unit your bill can run in the tens to hundreds of thousands of dollars pretty quickly.

3.You pay a doctor to see your baby while he/she is in the hospital and for follow up care after going home. This is usually several hundred dollars but can be thousands of dollars if your baby needs any special care.

If you have your baby at home you pay your midwife a set fee. Along the Front Range that runs somewhere in the $3500 to $4000 range. This covers:

1.Your “global ob care” as described above provided by your primary midwife.
2.It also includes any assistant(s) who will help her with care for you and your baby during labor, birth and immediately after birth. This person(s) is usually another midwife, a nurse or a student midwife.
3.Included in this fee is also what some of us call a facility fee. We are the facility, or at least we carry the facility with us in regard to equipment and supplies. I carry IV supplies, oxygen, antihemorrhagic medications and much more for the safety and comfort of you and your baby.
4.Lastly, the fee also covers care for baby, both at birth as well as follow up for several days to 6 weeks.

Not included in this fee are any labs and ultrasounds you have. Insurance helps cover these costs.
Obviously, more cost can be incurred if any complications arise, or if you or baby is transferred to hospital care.

As the studies show, home birth generally utilizes much less intervention. So, as you see above, your initial cost is lower, and your chances of suffering some of the side effects and risks associated with those interventions, and therefore the associated financial costs, is lower as well.

Some people think of the cost of a home birth in relation to other significant costs a family may have. Many couples decide that home birth is worth more to them than their wedding that they may have spent far more on… or they think of home birth as an investment like a car or a house but much more important and much less expensive. Let me know what your questions are surrounding cost of home birth.

carolroedocker@gmail.com © 2011 Carol Roedocker