A few months after my daughter’s birth, I posted a video talking about my reasons for choosing a midwife and doula. Two years later, it's still one of my most popular videos. I have gotten a lot of questions about midwives, but the number one question is always, “How much does a midwife cost?” The answer is complicated but I’m going to do my best to break it down today! There are a few factors that come into play when calculating your total out of pocket expenses.
What is a midwife?
Midwives are the traditional care providers for mothers and infants around the world. They are trained professionals with expertise and skills in supporting women to maintain healthy pregnancies and have optimum births and recoveries during the postpartum period. Midwives commonly work with pregnant women who have low-risk pregnancies and are experts in natural birth.
Type of midwife?
There are different types of midwives based on their training. According to midwifeschooling.com, a certified nurse midwife is an advanced practice registered nurse (APRN) backed by the American College of Nurse-Midwives. To become a CNM, registered nurses must graduate from a master’s or higher-level nurse-midwifery program accredited by the Accreditation Commission for Midwifery Education (ACME) and pass the national Certified Nurse-Midwife Examination through the American Midwifery Certification Board. CNMs are also required to hold state licensure and they must meet specific continuing education requirements to maintain state licensure and the CNM designation.
There are also direct-entry midwives that are not traditionally trained nurses before they start their career as a midwife. Certified midwives complete a graduate-level midwifery education program accredited by ACME and pass the national certification examination through the American Midwifery Certification Board to earn the CM designation. CMs are only recognized and licensable in a few US states. The Certified Professional Midwife (CPM) credential requires the least amount of formal education (e.g. college) but requires the holder to demonstrate knowledge (typically acquired through apprenticeship or midwifery education programs) and have experience in providing midwifery services in out-of-hospital settings. Most CPMs work in their clients’ homes and in private birthing centers, providing care to women throughout their childbearing cycle. Several states have some sort of licensing in place for CPMs.
The type of midwife is something to consider when calculating the cost, especially in the United States. Because of their medical background and licensing requirements, CNMs tend to be more sought after than direct-entry midwives in the United States. When it comes to pregnancy and birth, American people are often fearful about medical complications and will pay more money to know that they are in “safe” hands (someone capable of more medical interventions). Additionally, most insurance companies will only cover services provided by a CNM. Therefore, you might expect to pay more if you choose a CNM.
Are they covered by insurance?
If you are planning to use your health insurance plan to cover the costs of your prenatal visits, birth and postnatal care, then it is important to consider what your insurance policies cover. I’ve found that most health plans have very specific guidelines for what’s covered in maternity care, and they can be misleading. From personal experience, I’ve learned that a lot of companies state that they cover 100% of prenatal care. However, almost all of them require care to be provided by in-network providers. Some health insurance plans may include midwife services in their policy coverage, but only for services provided by a CNM. Additionally, most of the health plans only cover midwifery services that are provided in hospitals. This means that if your midwife happens to be covered by your insurance, you may not be able to give birth in a birth center or at home. Water birth has been a more common request on women's birth plan in recent years as more women find out about the pain relieving effects of warm water during labor. Unfortunately, many hospitals, even with nurse midwives, do not offer water birth as an option.
Technically, you can request a GAP exception, which allows your chosen midwife/birth setting to be covered by your insurance plan at in-network rates. However, I was unsuccessful when I tried to get my midwife and birth center covered by my insurance provider. There are very specific guidelines for when and why a company would approve this type of request. We ended up paying the full fee (which came out to $4800) out of pocket, which happens often. I recommend studying your policy closely prior to or as soon as you find out you’re pregnant to see what’s covered!
Birth location?
Midwives are usually available in multiple settings and location will affect the cost of care. CNMs can serve patients in hospitals, clinics, birth centers, and at home. CMs and CPMs are usually found in birth centers and home births. As mentioned earlier, insurance will likely dictate the cost based on setting. If you choose the traditional medical route for prenatal care and birth, private insurance will likely cover the cost of most of your care. Your out-of-pocket cost will vary depending on the type of plan (e.g. high or low deductible, copay) you have. I’ve found that most healthcare providers in the hospital setting will require an upfront payment of a few thousand dollars to cover their delivery fee, which is collected over the course of your pregnancy. This is regardless of your insurance coverage and is the doctor's own insurance policy to make sure they get paid for the birth. If insurance ends up covering the total cost, then you will be reimbursed once the baby is born. The only exception to this that I’ve seen is Medicaid or state-funded insurance plans. Patients who have low-income and use state sponsored insurance plans are typically provided maternity care at very low or no cost in the medical setting.
Midwives who serve in birth centers and in patient’s homes are rarely covered by insurance, but the trend is moving in a positive direction over time. More insurance companies are beginning to cover birth centers run by CNMs . Most midwives in either setting offer a maternity package, which includes all prenatal care, vaginal birth, postpartum care and newborn care. Some offer a discount and payment plans for patients who are paying out of pocket costs. For example, the global fee with insurance would’ve been $5400 for us. We were denied by insurance and ended up paying the discounted price of $4800 out of pocket. My midwife was incredibly flexible and worked with us to set up a payment plan (we even chose the dollar amount per month). The price varies greatly depending on the midwife, but I’ve heard and seen prices ranging from $2000-5000 for a midwife outside of the hospital setting.
One other important factor is your geographical location. The cost of living varies state to state. If you’re in a state with a generally high cost of living, expect to pay more out of pocket if you aren’t using insurance. For example, I paid $4800 for services at a birthing center in Texas. I looked up a comparable birth center in Connecticut and the maternity package was $8500.
Conclusion
Choosing a provider is already difficult enough without thinking about the cost. There are a lot of factors that go into the full cost of midwifery care. Generally, the cost will be somewhere between $2000 and $9000 across the country. In most cases, the cost of a midwife will likely be comparable to that of medical doctors unless you are on a really great insurance plan. Take your time when choosing your provider and don’t be afraid to switch if something isn’t working for you. I switched providers around 15 weeks into my pregnancy and was extremely pleased at my first visit at the birth center. At the end of the day, most births in the US will cost a few thousand dollars. I recognize that not everyone has the privilege of ignoring cost when making a decision. But, I strongly encourage you to have a plan (for pregnancy and birth) that you will be happy with and then make an informed decision about which healthcare provider will be worth the money you're spending.
I hope this was helpful! Leave a comment below and let me know what you think!
