I have had home births for my last 6 kids, so it’s fair to say I have some experience with the process. With those births, I had three different midwives, and gave birth in two different homes. I gave birth with Medicaid, MVP, CDPHP, and MVP again. I gave birth in bathrooms, a living room, and a bedroom. On a birthing stool. Labored in a tub. Cut the cord. Had my husband do it. With doulas and without. With other kids in the room and without. Gave birth with my husband by my side, and with him downstairs taking care of the other kids, thinking we still had some time before the baby came.

I have prepped my house and gone over the supply list. I have had home visits from my midwives, and I have gone to their offices. I have read birth books to prepare that left me feeling strong and ready. I’ve read birth books that terrified me, put me off, or annoyed me (and after searching for all those links, I’m sure Amazon is convinced I am pregnant again. False alarm.)

From time to time, folks who know about my experience will ask if they can give my info to a friend who is considering home birth. I always say yes. I have had overwhelmingly positive experiences with my births, and if I can encourage another person or give them the information they need to consider a home birth for themselves, I am all over it.

Recently, one such mama called me after getting my number from a mutual friend.

I asked if I could call her back at a better time, thinking we would be chatting for a little while. When I called back, the first thing she said was, “I’m on Medicaid. None of the midwives in the area will accept it. What can I do?”

Full stop as I stared into the face of my privilege.

When I had my only Medicaid birth, it was ten years ago, on Long Island. I still don’t know why the midwife accepted it; I am sure her reimbursement wasn’t great. Maybe she was of the altruistic mindset that she wanted to help anyone who wanted to have a home birth to have one, regardless of means.

All the things that made home birth amazing for me – the privacy, the choice, the control – wouldn’t matter without access.

Our conversation ended awkwardly not long after. She remarked that she would probably end up having a hospital birth because she didn’t have a choice. I counseled her, if she could, to find someone with experience with birth to be a doula for her so that she would have advocacy. I stopped short of offering to do it since I felt like that would have been over-inserting myself. But if she can’t find someone to do that for free, then my suggestion won’t even matter.

I know the internet has probably already lamented about this a million times, but for healthy moms in low risk pregnancies, for the insurance company, HOME BIRTH IS CHEAPER. So why won’t they pay enough to make it worth it for midwives to accept the reimbursement? Our last three births came with a hefty copay of $2400 which we paid for out-of-pocket with budgeting and planning. I have met other moms in the area who had to choose a different midwife because they weren’t able to pay that cost.

I love my midwife, and we have joked at our house that the reason we had so many kids is because we enjoyed working with her so much. She’s an amazing person, and bonus, an amazing photographer (she took the photo above).

It is frustrating and sad that other moms who want that experience are settling for something else because of the issue of access.

I don’t have an answer, other than the over-simplified option of all insurance companies considering a thoughtful cost analysis of home birth reimbursement vs. hospital reimbursement, hopefully with the eye to incentivizing eligible moms who are already interested in home birth to go for it and helping the midwives who serve them by paying them a reasonable wage for doing the work of ten men and women in a hospital setting.

There are many things home birth can and should be. One thing it shouldn’t be is a choice of privilege.