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.)