Home Births Became More Popular During the Pandemic. But Many Insurers Still Don’t Cover Them

Tia DeShazor started to wonder if she really wanted to deliver her child in a hospital at six months old. In winter 2021, COVID-19 was still in full swing in New York City. Pandemic restrictions prevented her husband from attending doctors’ appointments with her, and she wasn’t even allowed to video chat with him during her ultrasound. The doctors dismissed her feelings and assured her her round ligament pain, which was severe enough that it made her unable to walk, was perfectly normal.

It was clear to her that Black women giving birth in U.S. hospitals are at disproportionate risk. Tennis is a great sport Serena WilliamsAfter the hospital initially dismissed her concerns she thought that it was possible for her to die in childbirth, but this did not happen. “They’re not listening to me,” she remembers thinking. “I don’t want to be in labor, and be concerned about something, and be dismissed at an even more vulnerable time.”
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DeShazor chose to have her baby at home. She was not able to locate a home-birthing midwife that was within her network. MetroPlus is a New York City Medicaid program. She’d need to hire an out-of-network midwife—but her insurer told her that her Medicaid plan wouldn’t cover one, DeShazor says. MetroPlus has not responded to our request for information about homebirth policies. DeShazor and her husband scrambled to get together the $9,000 they’d need for the birth, prenatal, and postpartum care—by asking friends and family for donations on their baby registry, applying to a scholarship fund for home births, and gradually paying for the rest. DeShazor considers herself fortunate to have had a support partner and community that made it possible. She gave birth in May 2021 to a healthy child. “No one wants to worry about paying for bringing their first child into the world,” DeShazor says. “That’s what insurance is supposed to be for.”

It The United States has the largest number of births—98%—happen in hospitals. Even though they make up a small percentage of births, homebirths have grown in popularity during the epidemic. According to data from ACDC, home births increased by 1.26% to 1.03% in 2019, and 1.23% in 2020. Report published by the U.S. Centers for Disease Control and Prevention in Dec. 2021—a 22% increase. This is especially true for DeShazor and other women of color who wish to avoid the potentially dangerous outcomes that can befall patients of color in medical settings. From March 2020 to December 2020 2020, the number of Black mothers giving birth at home surged, according to the new report, from 0.5% to 0.68%—a 36% increase.

For many parents, home births can come at a surprise cost. Even though the average home birth in the U.S. costs much less than the average hospital birth using employee-sponsored insurance—4650 total payments to insurers, plus individual, compares with $13,811,, the sum of what is paid by insurers and families—major insurers often deny claims to fully cover home births, as well as the prenatal and postnatal care that accompany them. Katherine Baker, a midwife based in New York who manages billing, said that about 90% home birth insurance decisions require appeals. This problem appears to be increasing. “The fact that insurance companies like UnitedHealthcare and Aetna have policies in place to keep women from obtaining coverage for home birth has become a major women’s health issue, especially during this pandemic,” says Baker.

Home Births rise during COVID-19
From left to right: Nuranisa Re, a midwife. Baby Caily. Caryn Davis. Brian Davis.Photo credit to Caryn Davies

“Most Aetna benefit plans do not cover planned home births (except as required by state regulations) based on the guidance of medical professional societies that evaluate 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 did not elaborate on what services are covered.

One of the primary reasons families choose to give birth at home is that they believe it’s safer than doing so at a hospital. You can find out more at A 2010 survey of 160 mothers who delivered their babies at home.According to the majority of respondents, safety was their main reason for opting for homebirths. They also preferred to avoid unnecessary interventions and had a bad experience with a previous birth at a hospital or knowing someone who has. This is why women of color are more likely to opt for homebirths. Women who identify as Black/Alaska Native in America are twice to three-times as likely as women who are white to succumb to pregnancy-related causes. A 2019 report of the CDC shows that there are 155 cases.. Experts blame the inequalities on structural racism, unaccessible quality healthcare and high rates of chronic diseases, as well as unequal access.

Black mothers feel more relaxed when they have one-on-one care from a midwife that understands the risks Black mothers face and can help them to minimize those risks. Martin says she’s seen growing interest in home birth among Black women, both before and during the pandemic, “because of the maternal mortality, morbidity, and race disparities.” Martin says that in recent months, more and more families have been applying to a home-birth financial-assistance fund she helped establish in March 2020, which so far has provided funds to about 50 families.

Continue reading: Death Doulas used to be rare. This was before the COVID-19 Pandemic.

Many women have started to think about home births because of concerns over the potential pandemic. To avoid possible exposure to the virus, some women chose to have their babies at home. There were also restrictions such as wearing a mask for labor and delivery and limiting the visitors that they can invite. Other mothers feared being separated from their babies, if they test positive for COVID-19. American Academy of Pediatrics recommended that the Pandemic was declared earlier by AAPBefore altering July 2020 guidelinesIt is possible for infected mothers to share a bedroom with their babies if they are careful.

Ivy Torres (a New York nurse aged 34 who had previously been in labor and deliveries) said that she was more motivated to give birth to her second child at her home, in May 2020, after the pandemic. Torres claimed that she worried about her newborn being diagnosed with COVID-19, and would be separated from him per hospital policies. “At that point, they were very stringent with the amount of contact you would then have with your baby.” There were no such rules at home; 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 either don’t cover the bulk of costs associated with home births or do not cover home births at all. Some believe this is due to the fact that hospitals are more safe than home births. Both the American College of Obstetricians and Gynecologists, which provides guidelines to health professionals working in this field, and AAP agree that hospitals and accredited centers are safer places for women to have babies. Aetna stated that these guidelines are the main reason it does not pay for home births. (However, ACOG adds that “each woman has the right to make a medically informed decision about delivery,” and the AAP This guide provides information about home births.)

Experts continue to debate whether home births pose a greater risk than those that are allowed by the professional organizations. Some ResearchIt is possible to have a planned home birth safely. This may also be a benefit for some mothers. Saraswathi Vedam is a professor of midwifery from the University of British Columbia. She believes that further research will be necessary in order to fully understand home births and their cultural and social advantages. “Birth is a physiologic process, so if you feel afraid and tense, that’s going to carry over into the course of your labor,” says Vedam. “We’re just starting to understand the different connections between cultural safety, racial safety, and anti-oppression care with how it affects the body.”

Indra Lusero is an attorney who directs the Elephant Circle advocacy group focused on reproductive justice and birth. She says that families with different insurance policies across the nation face obstacles to homebirth coverage. For midwives who have to deal regularly with insurance providers, it is often a problem. Professional billers are needed to handle the complicated negotiations with insurers. “I’ve heard from people all across the country—all kinds of scenarios, all kinds of insurance—that there will be some barrier to getting coverage or reimbursement for home birth with a midwife,” says Lusero. “There’s a broad culture of anti-home birth in the insurance industry in general.” Although coverage varies by state and insurer, in some states, midwives who deliver babies at home are typically out-of-network with insurance companies. That is often by choice, because reimbursement is capped as low as $2,000 for delivery services and months of prenatal care that Lusero says are worth about $9,500—even though coverage for hospital births can be much more expensive. When families try to get their claims approved retroactively by their insurer, Lusero says they’re often denied for seemingly random reasons. “I still, after all these years, do not understand what accounts for the arbitrariness,” Lusero says. “It’s a whack-a-mole situation.”

The parents are faced with difficult choices: pay the remainder of the bill or contest the decision. Postpartum mothers often shoulder a large portion of this responsibility. They would need to manage all the responsibilities and care for their infants if they wanted to be reimbursed. “There were just many, many steps. And every time I came to the next step, there was another ‘no’ and a block,” says Caryn Davis, 39, who says she is still appealing Aetna a year and a half after giving birth to her child 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 over two hours or more.”

Despite the financial frustration, DeShazor, Torres, and Davis don’t regret their home births. DeShazor said it was well worth it to have her child, Lexington, delivered in her own home, with her midwife, doula, husband and two closest friends. “It’s intense to give birth. But I feel like it would have been more intense if I were not feeling safe or heard,” she says. “It was a very communal experience to bring my child into the world, instead of one that’s fearful.”


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