Home births became more popular during the pandemic. But many insurers still don’t cover them

Tia DeShazor started to wonder if she wanted to give birth in a hospital when she was about six months pregnant. It was winter 2021 and COVID-19 was still raging through New York City, where she lives. Pandemic restrictions prevented her husband from attending doctor’s 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 she was having trouble walking.

And she knew about the disproportionate risks to black women, like her, who give birth in American hospitals. If tennis player Serena Williams nearly died in childbirth after hospital staff initially dismissed her concerns, she believed the same could happen to her. “They don’t listen to me,” she recalls. “I don’t want to be in labor, worry about something and be fired at an even more vulnerable time.”
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So DeShazor decided to give birth at home. But she was unable to find a midwife who could deliver her baby at home who was in-network with her insurer, MetroPlus, and the Medicaid plan they run for New York City residents, including her. She should hire an out-of-network obstetrician, but her insurer told her her Medicaid plan wouldn’t cover one, DeShazor says. (MetroPlus did not respond to a request for comment about their home birth coverage policies.) DeShazor and her husband made an effort to raise the $9,000 they needed for birth, prenatal and postpartum care — through friends and family to support donations on their baby registry, apply to a home birth scholarship fund, and pay gradually for the rest. She considers herself fortunate to have a supportive partner and community to make it happen, and she gave birth to a healthy baby in May 2021. “Nobody wants to worry about paying to bring their first child into the world,” DeShazor says. “That’s what insurance is for.”

The vast majority of births in the US – 98% – take place in hospitals. But while home births are only a small part, they have become more popular during the pandemic. The rate of home births in the U.S. rose from 1.03% in 2019 to 1.26% in 2020, according to a report published in December 2021 by the U.S. Centers for Disease Control and Prevention — a 22% increase. The rise has been especially strong for women of color, like DeShazor, who want to avoid potential risky outcomes in the medical environment that happen to people of color more often than white patients. From March 2020 to December 2020 the number of black mothers giving birth at home rose from 0.5% to 0.68% — a 36% increase, according to the new report.

But home births come with surprise costs for many new parents. While the average home birth in the US costs much less than the average hospital birth with 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 Significantly, insurers often deny claims to fully cover home births, as well as the prenatal and postnatal care associated with them. Katherine Baker, who handles billing for midwives based primarily in New York, says that in her experience, about 90% of home birth insurance decisions require appeals to get coverage, and the problem appears 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 births has become a major health concern for women, especially during this pandemic,” Baker says.

Home births on the rise during COVID-19
From left: Nuranisa Rae, a midwife; baby Caily; Caryn Davis; and Brian Davis Photo Courtesy of Caryn Davis

“Most Aetna benefit plans do not cover planned home births (except as required by state regulations) based on the guidelines of medical professional associations evaluating the safety and effectiveness of planned home births,” Aetna said in a statement to TIME. “Our plans include coverage for home births,” UnitedHealthcare said in a statement, though they don’t elaborate 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 in a hospital. In a 2010 study of 160 women who had had a baby at home, the most common reasons they gave for choosing home births were safety, avoiding unnecessary interventions, and having a negative previous birth experience in a hospital (or know someone who did). Reasons like these will especially push women of color to give birth at home: In the U.S., women who identify as Black, American Indian/Alaska Native are two to three times more likely to die from pregnancy-related causes than white women, according to a report from 2019 from the CDC. Experts attribute the differences to, among other things, unequal access to quality healthcare, structural racism and a disproportionate risk of chronic conditions.

One-on-one attention from a midwife who understands that black mothers are at greater risks and how to reduce them puts black mothers more at ease, says Nubia Earth Martin, a founder of Birth From The Earth, which provides childbirth education and midwifery care. offers for black women in New York. Martin says she has seen a growing interest in home births among black women, both before and during the pandemic, “because of maternal mortality, morbidity and racial differences.” Martin says in recent months more and more families have applied for a financial support for home births fund that she helped set up in March 2020, which has helped about 50 families to date.

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

Concern about the pandemic has prompted many women to consider home births. Some decided to give birth at home to avoid possible exposure to the virus; cumbersome restrictions such as wearing a mask during labor and delivery; and limits on the number of visitors they could have. Others feared they would be separated from their babies if they tested positive for COVID-19, which the American Academy of Pediatrics (AAP) recommended earlier in the pandemic before changing guidelines in July 2020 to say that infected mothers and their babies 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 strengthened her decision to give birth to her second child at home in May 2020. Torres said she was afraid of testing positive for COVID-19 after her birth, which would separate her from her newborn under hospital policy. “At the time, they were very strict about the amount of contact you would have with your baby.” At home there were no such rules; however, Torres’ family largely had to pay for the birth themselves. Her insurer, UnitedHealthcare, only paid about $700 for prenatal, postpartum and birth care, Torres says — and she was on the hook for the remaining $7,500.

Many insurance companies do not cover most of the cost of home births or do not cover home births at all. Some say this is because scientific and professional organizations believe that hospitals are safer. The American College of Obstetricians and Gynecologists (ACOG), which sets guidelines for health care professionals in the field, and the AAP both say hospitals and accredited birth centers are the safest place to give birth. Aetna cited these guidelines as a reason not to cover the costs of home births. (ACOG adds, however, that “every woman has the right to make a medically informed decision about childbirth,” and the AAP provides guidelines for home births.)

Despite current guidelines established by professional associations, whether home births are significantly more risky remains the subject of debate by experts. Some research suggests that planned home births can be done 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. “Giving birth is a physiological process, so if you’re scared and tense, that will carry over into the course of your labour,” Vedam says. “We’re just beginning to understand the different links between cultural security, racial security, and concern for oppression and how it affects the body.”

Families across the country with many different insurance plans face barriers to home birth coverage and reimbursement, said Indra Lusero, a lawyer and director of the Elephant Circle, an advocacy organization focused on birth and reproductive justice. Dealing with insurers is a constant problem for midwives, who often have to hire professional account holders to solve the hassle of negotiating with insurers. “I’ve heard from people across the country — all kinds of scenarios, all kinds of insurance — that there will be a barrier to getting coverage or reimbursement for a home birth with a midwife,” says Lusero. “There is a broad culture of anti-home birth in the insurance industry in general.” While coverage varies by state and insurer, in some states, midwives who deliver babies at home are usually outside the insurance carrier network. That’s often of her own volition, as reimbursement is capped at $2,000 for delivery services and months of prenatal care that Lusero says are worth about $9,500, although hospital birth coverage can be much more expensive. When families try to get their claims retroactively approved by their insurer, Lusero says they’re often rejected for seemingly arbitrary reasons. “After all these years, I still don’t understand what explains the randomness,” says Lusero. “It’s a whack-a-mole situation.”

This puts parents in a difficult position: to pay the remaining bill themselves, or to challenge the decision. Much of the responsibility often rests with postpartum mothers, who, if they were to fight for reimbursement, would have to weigh up all the effort involved in caring for a baby and other responsibilities. “There were just a lot of stairs. And every time I got to the next step, there was another ‘no’ and a blockade,” said Caryn Davis, 39, who says she is still appealing a year and a half after the birth of her child in New York. aetna; 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 the financial frustration, DeShazor, Torres and Davis have no regrets about their home birth. DeShazor says it was all worth it to give birth to her baby, Lexington, in her own bed, with her doula, midwife, husband and two best friends by her side. “It’s tough to give birth. But I feel like it would have been more intense if I hadn’t felt safe or heard,” she says. “It was a very communal experience to bring my child into the world, rather than a fearful one.”

This post Home births became more popular during the pandemic. But many insurers still don’t cover them

was original published at “https://time.com/6145726/home-births-insurance-coverage/”