The good news about out-of-hospital birth in Washington State

Another article I wrote is up at RH Reality Check, about the much improved access to out-of-hospital birth for women in Washington State, including those on Medicaid. This piece is a follow-up the my first article about out-of-hospital birth. It’s nice to have some good news about maternity care in time for mother’s day.

Nationally, only a small portion of women give birth outside of hospitals (around 1%) and very few of those women are low-income. In a recent piece for RH Reality Check, The Cost of Being Born at Home, I painted a grim picture of the options afforded to low-income women around the country who are considering out-of-hospital birth. Few out-of-hospital childbirth providers are registered with Medicaid. Cost and physical space available at women’s homes are also significant prohibiting factors. And lack of knowledge of the practice, as well as lack of targeting from media and advocacy promoting home birth (such as the pro-home birth film The Business of Being Born), impact low-income women’s decisions about where to birth.
But there’s at least one exception to this national trend, brought up by the advocates I interviewed and by commenters responding to my original piece-Washington State. In fact, thanks to a history of expansive access to midwifery care and a number of big legislative gains, low-income women in Washington State now have more birthing options than most women around the country.
According to Audrey Levine, President of the Midwives Association of Washington State (MAWS), 2.3% of births statewide in 2007 were performed out-of-hospital. While still a low percentage, that’s more than twice the national average of 1%. What is even more impressive is the number of those births that are reimbursed by Medicaid. According to Levine, around 45% of out-of-hospital births attended by midwives in the state are Medicaid births. That mirrors the percentage of births to women on Medicaid overall in the state-also around 46-47%. (Of the 26 states that license CPMs, only 9 allow CPMs to participate in Medicaid, so this percentage is a significant departure from the situation nationally.)

Read the rest here.
Also, on Thursday I’ll be participating in a livechat at RHRC about access to out-of-hospital birth. Join in if you’re interested! More info here.

Join the Conversation

  • LoveKrystal

    for a long time now I’ve wanted to have an at home birth.. I used to watch “a baby story” on tlc and there were a number of women having babies from home and i always thought.. if i ever have a baby it will be at home.. Everyone always says how crazy that is but i think it would be a great experience .. and after seeing that mattress commercial it looks even better!

  • bifemmefatale

    It’s not crazy at all, LoveKrystal! As long as you have *good prenatal care and no risk factors*, outcomes are *better* than hospital births. Less interventions total, less severe interventions, less stress on the mother, less risk of being exposed to other peoples’ infections (most infections with MRSA are contracted in hospitals!). I successfully homebirthed my kids with a pair of midwives, one of whom was an EMT, and wouldn’t have had it any other way.
    Plus, I was a low-income, uninsured woman, and for me, homebirth was far cheaper than a hospital would have been. We paid $1200 for each birth including all prenatal visits. Besides that, all we had to pay for was the actual birthing supplies–maybe a little over $100.
    I’m really glad to see Medicaid starting to pay for homebirths.

  • MiriamCT

    What I’d love to see is for the public conversation about saving money in our health care system start addressing the fact that non-hospital birth is so much cheaper. So…better outcomes for mothers and babies and way cheaper….what’s not to love about out of hospital birth? (and yes I do understand that currently, with the way that Medicaid pays out, homebirth is often out of reach for low-income women.)

  • Tenya

    Yay! Really, a lot of the issues with home birth can be weeded out with screening during pregnancy to identify high-risk situations such as breach presentation, twins, etc. the comparison of birth rates from the past when most were done at home vs. the hospital now is really unfair, because even lay midwives do basic things like blood pressure screenings that weren’t around in the 1800s. I do find it interesting that home birth/midwives were considered not being able to afford the best care, and now it is the opposite – less economically challenged women can afford to access midwives.

  • kisekileia

    Since home birth significantly increases infant mortality, I really don’t think an increase in it is good news.