Many women who would have preferred to give birth at a freestanding birth center have had to choose a hospital birth due to cost. If they are covered under Medicaid, they will now have more freedom of choice, which can result in cost savings for all of us!

When I was in labor with my second daughter, I remember thinking that I'd never felt so calm and centered. Instead of being in a hospital, with an IV and straps around my belly, bright lights, and strangers poking at me every other minute, I was at home. The lights were dim, and soft music was playing all throughout the night. My older daughter was out in the living room, watching cartoons with a trusted family friend, while I labored in the bedroom. I was noisy while I was in labor, but not like the red faced shrieking women you see in movies. I was the first person to touch my daughter after she was born, and we sat still, staring quietly at each other for a while before anyone tried to weigh her or clean her or jab her with anything.

When women choose birth center births, or home births, it’s usually because they want to tell a birth story like that. Certainly many women who have their babies in hospitals have healthy babies, and good birth stories, and no one denies that for women who are at higher risks of complications, the hospital is the right place to have your baby. But for lower risk moms, all the monitoring, administration, and intrusion of the hospital setting seems to get in the way of birthing a baby. Many studies also show that low risk moms will see fewer interventions in a birth center: fewer forceps deliveries, fewer IVs, fewer epidurals, and far, far fewer C-sections.

New Changes Under Obamacare

An excellent piece of news for moms like me came in the Affordable Care Act. Effective in 2010, state Medicaid programs in states where birth centers are licensed are now required to cover maternity care and birth attendant fees at those same birth centers.

At first glance, this looks like just another cost that’s being forced on the American public through the ACA. But when you consider the rising cost of pregnancyand when you compare that to the costs of birth outside of the hospital, this benefit may actually save millions of dollars in healthcare costs yearly.

What is Homebirth Like?

The safety of births outside of a hospital setting has received a great deal of attention in the media in recent years. May people who feel that birth is only safe in a hospital point to a meta-analysis published in 2010, the authors of which said that while homebirth might be safer for women, infant mortality tripled. Others have stated that the way that analysis was conducted was flawed, since it included very small and non-scientific studies, situations where home birth was not planned, or situations where there was no birth attendant of any kind.

A study published this year in the Journal of Midwifery and Women’s Health, however, showed excellent safety for low-risk mothers and babies, giving birth in a freestanding birth center. Of the more than 15,000 women studied in 79 birth centers in 33 states, fewer than 6% had a C-section, compared with the nearly 25% of low-risk women giving birth in a hospital setting. The mortality rate for both mothers and babies was less than 1 in 1000.

Even if you just consider that the costs for a vaginal birth can be half those of a C-section, this could be mean huge savings, but going beyond that, many birth centers or home birth midwives price their services to the uninsured around $5000 for maternity care. Quite small compared to the $30,000 to $50,000 estimated for OBGYN care resulting in a hospital delivery! And also considering that almost 4 million babies were born in the US last year, and that about 40% of births are paid for by state Medicaid programs, (directly paid for with our tax dollars), we might just start seeing some savings that can be passed right back to us taxpayers!

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