Fees
My current fee for comprehensive midwifery care and home birth is $8500.
A deposit of $1500 is due at the beginning of care. The remainder is paid in installments, with the balance due in full at 36 weeks of pregnancy.
Labor tub rental is included in the fee. Home birth supply kit costs approximately $120 and is purchased separately. Lab tests and ultrasounds are not included, but may be billed to insurance by the lab or technician, or may be paid directly by the client.
Fees vary for Monitrice/supplemental midwifery care and classes. Contact me to discuss your individual needs.
Insurance
PPO plans: Redwood Midwifery partners with Earthside Billing for insurance billing for PPO plans. The service begins with a Verification of Benefits with your carrier, and a call with the biller to explain your benefits and likely coverage. If you decide to contract with Earthside from there, they can file Gap Exceptions for In-Network coverage; prepare, submit and track claims; and handle follow-ups and appeals. Earthside charges a flat rate fee, with no percentage charges and no add-on fees. More information about the process and fees is available on Earthside’s website and you can get started with a Verification of Benefits here.
Alternatively, I can prepare a Super Bill receipt at the completion of care, which the client is responsible for submitting to the insurance carrier and conducting follow up. Super Bills are by request, and with no additional fee.
HMO plans, Kaiser, and MediCal do not reimburse for private midwifery services.
Questions about your individual circumstances? Contact me to discuss the details.
Fee adjustments
I am sometimes able to offer payment plans and/or reduced fees for families experiencing financial hardship who would not otherwise be able to access private midwifery care. This is determined on a case by case basis - if you need an adjustment to access care, let’s talk about it.
Please keep in mind that when folks qualify for reduced fees or pro bono care, the individual midwives are donating our time and expertise and paying for expenses related to care out of our own pocket. We do this as a way to foster community and increase access to truly comprehensive, high quality care for all. However, before asking this of the midwives, consider asking your own family and community to contribute to your care. This shows respect for your midwives, acknowledges the value of the care you will receive, and helps keep midwifery care a sustainable practice available to you and others.
Understanding the cost and Value of Private Midwifery Care
Midwife led care and home birth have much lower costs overall compared to hospital birth, as well as increased client satisfaction, and clearly proven healthy outcomes for birthing people and their babies (especially those from marginalized and oppressed groups such as BIPOC and LGBTQ people). However, out-of-hospital births represent only a tiny fraction of all births in the U.S., and the American health insurance system is not set up to recognize and reimburse this model of care appropriately.
Hospital birth and physician led care are well integrated into the insurance system, but despite that fact, families are often surprised by large, unanticipated medical bills after their care is complete. There is little to no transparency from hospitals and insurance companies about expected out of pocket costs before care is received. It is not uncommon for a family’s out of pocket cost for hospital birth after insurance to equal or exceed the average cost of midwife care and home birth.
In the private midwifery model, families are asked to pay the fee up front over the course of pregnancy, but the fee is fixed, and costs are known ahead of time. This allows for planning and budgeting, and avoids the shock of unexpected or higher than expected bills after the fact, when it is too late to consider other options or change course. The cost of midwife care can sound high at first glance, but in truth it delivers far greater value in time spent and scope of support than the standard offered in hospitals today.
I created the following lists as a reference for understanding what these two models of care offer and the associated costs. There are of course variations and exceptions. These lists represent typical care and costs.
PHYSICIAN ATTENDED BIRTH IN A HOSPITAL - Structure of Care and Costs
Approximately 10 to 13 prenatal office visits, 10-15 minutes each.
Birth attended by physician on call, frequently not the main physician seen for prenatal care. Face to face time with physician during labor and birth is typically less than one hour. Most care during labor and birth is provided by nurses on rotating shifts. Multiple doctors, nurses, and other staff members are likely to participate in care for short periods. Usually three to five or more staff members present in the room for the birth. Limited freedom of mobility. Deep water labor tubs and water birth not available.
One to two postpartum office visits (24 hours and 6 weeks postpartum), 10-15 minutes each.
No newborn or well baby follow up care is included beyond the hospital stay. The pediatrician relationship and fees are separate.
Limited to no detailed informed choice collaboration with physician.
Patient care subject to hospital and physician group standard policies, procedures and routines. Limited opportunity for individualized care. Interventions are the norm.
Large institutions are inherently slower to adapt to and implement updated evidence based care management practices.
Physician and hospital fees are billed separately, are not disclosed up front, and may be covered at different rates by insurance. Insurance typically does cover some portion, small or large, of physician and hospital care.
Total time spent face to face with the physician: approximately 2.5-4 hours
Cost of care: The average bill for a full course of care before insurance ranges from about $30,000 to $100,000 or more, depending upon the specific events of the pregnancy, birth and follow up care. Cost to families after insurance varies massively, from close to $0 up into the tens of thousands of dollars. It is not uncommon for a family’s out of pocket cost after insurance to equal or exceed the average cost of midwife care for out of hospital birth.
MIDWIFE ATTENDED BIRTH AT HOME - Structure of Care and Costs
Approximately 10 to 13 prenatal home visits, 60 minutes each.
Birth attended at your home by the same midwife/midwife team who provided prenatal care. Two midwives and possibly a student attend each birth. Face to face time with midwife during labor, birth and immediate postpartum is typically 8-16 hours or longer as needed. All hands-on care and assessments are done by the midwives. Freedom to move, eat, rest as you wish. Labor and birth in any position in any area of your home. Deep water labor tub and water birth available. If a transfer of care from home to hospital is needed, midwife provides detailed records, facilitates the transfer, accompanies the parent(s) and acts an an advisor and support person throughout the remainder of the labor and birth. Midwives may take breaks or take turns staying with the family if the birth is very long.
Six postpartum and newborn care home visits, including lactation counseling, 60-90 minutes each. Birthing person and baby are seen as linked, and are cared for in relationship to each other. Both are evaluated and supported at each visit for clinical factors as well as mental and emotional health. Newborn care through six weeks is part of midwifery scope of practice. There is no need for new parents and new babies to leave the house in the first days and weeks to access care, reducing stress, speeding recovery, enhancing breastfeeding, and reducing exposure to pathogens.
Continuity of care with same 1-2 midwives throughout the childbearing year.
24/7 direct access to midwife during due date window and early postpartum period.
Individualized care based on birthing person’s values, desires and choices.
In-depth informed choice and collaborative decision-making is ongoing. Client autonomy is central. Minimal intervention is the norm. Care is subject to some legal restrictions (Licensed Midwives in CA are legally prohibited from attending multiples and known breeches at home, and can legally only attend home births between 37 and 42 weeks gestation).
Independent providers can be very agile in updating practices and recommendations based on new evidence and research, as well as client preferences.
Cost of midwife care is fixed and is known up front. No surprise charges. Midwife fee does not increase if additional visits are needed or care becomes more complicated. (Deep water labor tub is included in midwife fee. Lab work, ultrasounds and birth supply kit are additional costs.)
No facility/hospital fees.
Payments can be planned and budgeted in advance.
No payments to make after the birth.
Insurance coverage is not guaranteed, and LMs are out of network providers for all plans. However, clients can rest assured that even if insurance does not cover midwife care, their out of pocket fees to the midwife are capped and will not exceed the predetermined retainer amount. If insurance does cover some portion of midwife care, clients may receive a refund.
If a transfer of care from home to hospital is needed, client is responsible for the additional costs.
Total time spent face to face with the midwife/midwife team: approximately 28-40 hours, or longer as needed. No time limit.
Cost of Care: When midwife care is itemized and billed to insurance, claims for the average course of care total between $10,000-$25,000. This is what would be billed to insurance, if applicable. Clients benefit from a discounted package fee of $8500 (This is my current fee. Fees for other midwives will vary.) Depending upon insurance coverage, client may receive some reimbursement, lowering their out of pocket cost for midwife care. Kit of birth supplies costs about $115, and is ordered and paid for separately by the client. Fees for lab work and ultrasounds may be billed to insurance by the lab or technician, or may be paid out of pocket by the client. Costs to the client for these services, after insurance, usually range from $0 to $1000, depending upon which services are accessed and insurance plan benefits.
If a transfer of care from home to hospital is needed or desired, client is responsible for costs related to hospital/physician care, in accordance with insurance plan benefits.
There are advantages and disadvantages, benefits and risks to both planned home birth and planned hospital birth. Each family should carefully weigh these against their own values, desires and abilities as they make important decisions about providers and planned birth locations.