Out-of-hospital births in New Hampshire are on the rise, according to statistics from the Centers for Disease Control.
That increase is in large part, because of a 2008 law that requires health insurers to pay for midwives who work in homes or at birthing centers.
But a new bill before lawmakers proposes repealing that mandate.
And midwives are worried what that means for their livelihoods.
Enter the Birth Cottage in Milford, and you might think you’re at a country chalet.
Gentle lighting, tapestry quilts and lacey curtains create a mood that’s more comfy than clinical.
But the Birth Cottage isn’t meant for lengthy visits.
It’s a place where pregnant women can give birth naturally, and return home within 24 hours.
Adrian Feldhusen is co-owner of the Birth Cottage and chairs the New Hampshire Midwifery Council.
Feldhusen says that before 2008, far fewer women decided to give birth outside the hospital.
But that all changed four years ago when the law required state-regulated insurance companies to pay for midwifery services:
“when we passed the mandate several years ago, the response to that was overwhelming. We saw a rise of over 300 percent in our birth numbers when women were able to have their births paid for by insurance companies.”
A rise of 300 percent is more than most small businesses will see in a lifetime.
But now, Feldhusen is worried about a reversal of fortune.
“When the original law went into effect, we had to have conversations with each individual insurance company. And believe me, it was a process for each one. With the problems we had getting insurance companies to cover it in the first place, I don’t see that it’s going to continue to be covered afterwards. I think it’s going to be a fast pullout. “
Feldhusen says on average, the Birth Cottage charges between two and five thousand dollars.
In contrast, an average maternity stay at a hospital costs between nine and thirteen thousand dollars.
And these fees do not include doctors’ charges.
But State Representative John Hunt of Rindge says the issue isn’t about costs.
He’s sponsoring the legislation to repeal the mandate.
“The issue is what is the standard of care that is appropriate. And the reason why having births at home or in a birthing center is not considered standard of care is because if there is a problem, than there’s a high risk of losing the mother or the baby.”
But Feldhusen insists complications are rare.
She routinely screens for patients at risk – for example, women with diabetes, high blood pressure, or those carrying twins.
“Just because you’re having the baby out of the hospital doesn’t mean you have to sacrifice safety or monitoring or testing. We do all that. We do the standard blood work, we do the standard pap smears. We watch the baby post-partum. We watch the metabolic screening. We actually have hearing screening here.”
In contrast to certified nurse midwives, CPMs are trained to help women deliver babies outside of the hospital.
Lawlor who also owns the Monadnock Birth Center is worried what will happen if insurance companies no longer pay for midwifery services
“It would make it extremely difficult to stay open. There were two birth centers that opened in the state before the mandate and they both closed because they couldn’t get paid. “
But Paula Rogers with Anthem Blue Cross and Blue Shield, says only a small minority of New Hampshire births occur outside of a hospital when compared to those in a hospital.
She says the number of claims doesn’t amount to more than a handful.
“There might be some slight administrative cost to removing the coverage, but the reality is there are so many other things in the marketplace drawing our attention, that removing that coverage is not something we would be rushing to do.”
And it’s not clear whether other insurance companies, particularly the smaller ones, might refuse to reimburse midwives.
But Hunt says insurers have the right to decide what is medically appropriate. And sometimes that may mean that patients choose providers their insurance doesn’t cover.
“The example I give about personal choices is
I chose to put kids in the private school. We as a society have decided that, no, we should not be reimbursed to have our kids in a private school. And that’s the same thing with midwives. If you want to have your baby at home, that’s your choice. To mandate insurance to have to cover that, no, that’s not appropriate.”
Home births have been around since… birth.
It’s only in the last century that childbirth moved from homes to hospitals.
The debate over where the event takes place — and who should or should not pay for it — may end soon when the state senate votes on it later this spring.
For NHPR News, this is Sheryl Rich-Kern.