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Health Law Provides No Guarantees Of Access To Midwives, Birthing Centers

WebMD News from Kaiser Health News

By Michelle Andrews

Mon, Mar 03 2014

Insurance coverage for maternity care is required in most individual and small group plans under the federal health law, extending such coverage to plans where it used to be rare. But for women who are interested in services provided by midwives and birthing centers, there are no coverage guarantees, despite the law’s provisions that prohibit insurers from discriminating against licensed medical providers.

Most women give birth in hospitals and are attended by obstetricians, but a growing number choose to deliver their babies at birth centers. The centers, typically staffed by midwives, offer women who are at low risk for complications an alternative to traditional hospital labor and delivery, eschewing common medical interventions such as drugs to induce labor and electronic fetal monitors, among other things.

In 2012, 53,635 births in the United States took place outside the hospital, or 1.36 percent of all births, according to a study released Tuesday by the Centers for Disease Control and Prevention. Twenty-nine percent--15,577 births--occurred at freestanding birth centers. (The rest were primarily home births.) Although still a tiny percentage of the nation’s total, the percentage of births at these centers increased 70 percent between 2004 and 2012, the CDC report found.

Under the health law, Medicaid programs are required to cover the services of licensed freestanding birth centers. Coverage of midwifery services had earlier been mandated by federal law.  

Birth centers and certified nurse-midwives have a good record of safety and patient satisfaction and birth outcomes,” says Cynthia Pellegrini, senior vice president for public policy and government affairs at the March of Dimes.

Birth centers are also significantly less expensive than hospitals. The average hospital charge for a vaginal birth without complications was $10,166 in 2010, compared to $2,277 for a birth center, according to data from the Agency for Healthcare Research and Quality and the American Association of Birth Centers.

Some advocates predict that coverage of birth centers in private insurance plans will become routine now that Medicaid, which pays for roughly 50 percent of all births in the United States, has embraced their use. But at this time, coverage for birth centers and for midwives, who work in a variety of settings, including hospitals, is less predictable in private insurance plans. 

When Stephanie and Sean Taylor learned they were pregnant last July, Stephanie, 30, initially planned to use an ob/gyn and deliver in a hospital near the couple’s home in Rancho Santa Margarita, Calif. But after visiting her doctor a few times she began to have misgivings about the practice’s routine use of ultrasounds, among other things, during her visits. 

“I wondered, is this really necessary?” says Stephanie. “I’m a really healthy person, and I’m not high risk. I started to question all of this.” 

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