VT Wants Insurers to Cover Midwife-Assisted Home Births

The costs associated with ongoing maternal prenatal care and the delivery of a baby keep growing every year. For many women their hospital stay to deliver their child is one of the only times they are hospitalized throughout their adult lives. In order to reduce costs of this kind of vital care, the legislature of the state of Vermont has a bill pending which would require health insurers to pay for prenatal care, delivery and after-birth care by licensed midwives.

Midwives are the primary givers of maternal care in many nations, especially in Europe. It is rare for most women in these countries to see their obstetrician except for problems; they are attended throughout their pregnancy, birth and given after-care by a midwife. Midwives are usually also certified as nurses as well, and have to go through extensive training to achieve their licensure. They normally provide lower-tech care which is proven just as effective as more expensive care by doctors, and many women feel more comfortable with a midwife.

Midwives actually perform the majority of their prenatal visits in the woman’s home and are much more flexible regarding birth plans and arrangements. Home births are the standard for midwife-overseen pregnancies, with more complicated cases being referred to a hospital where the midwife can still perform her duties while having access to emergency care if needed.

According to the available figured, this kind of care as provided by a midwife is around $3,500-$5,000 per pregnancy, including prenatal care, the delivery, and post-birth visits. Conversely, a delivery alone at a hospital averages out to almost $7,000—and this does not include any prenatal care costs or doctor fees.

Vermont is initiating a radical health insurance reform package which could make it the first single-payer health insurance system in the country. This is a logical step for the state to take in its efforts to lower costs and improve efficiency. The state wants to make sure that all its citizens have access to medical care in every area. Low-income Vermont residents have already had access to midwife-supervised home births which are covered by their state for the last several years. The state insurance paid for 60 home births overseen by midwives last year. The total cost for those births was $58,631, averaging out to less than $1,000 per birth.

Critics of the bill say that it is yet another attempt by the state to dictate policy to insurance companies. Although many insurers support the bill for its potential to radically reduce costs, they fear that the legislation could lead to women choosing a home birth even if they aren’t good candidates for it based on the cost alone. A home birth should only be done when the pregnancy has been normal and the woman is not high-risk in any way.

“We would recommend delaying the mandate until the system is improved,” said Madeleine Mongan, the insurance industry liaison with the Vermont Medical Society. She warned that enacting this mandate “would lead to increased use of a system that isn’t working safely now.”

This opinion is not shared by state officials. The Vermont Health Access Commissioner said that the state-subsidized home birth programs hadn’t had any significant problems. “A review by provider relations specialists indicated no complaints have been reported, nor have any Helpdesk issues been flagged for the lay midwife provider group,” wrote the Commissioner.