Facing Uninsured Pregnancy

You Can Make It Work By Johnathon Allen

Paradoxically, despite a sustained period of economic growth and low unemployment, the number of Americans without health insurance has increased rather than decreased over the last decade. The Center for Risk Management and Insurance Research at Georgia State University reported that there were 43.1 million adult Americans with no health care coverage in 1997. Considering that the average cost of a hospital birth is around $10,000 (up to $30,000 for surgical delivery), the lack of health insurance is of no small concern to expecting mothers.

"We were really thrilled when we found out that we were pregnant, but the awareness that we have no insurance weighted things down a bit," says expectant mother Kris King of Brooklyn, N.Y. "My husband and I recently started our own business so we don't have coverage through an employer, and because we have a moderately good income, we don't qualify for federal aid. We're sort of stuck in the middle ground."

"Unfortunately, the options for pregnant women who have no health coverage are pretty few in this country," says Mary Anne Curry, a professor at Oregon Health Sciences University in Portland, Ore. and longtime advocate for improving women's health care. "It's kind of pathetic. I've traveled all over the world and found that most every other country, whether developing or modern, has some form of comprehensive health coverage that assures pregnant women a safe and healthy birth experience regardless of their economic status. Medicaid is an option for mothers who meet the low-income requirements, but for middle-income families there are precious few resources available for the uninsured."

Medicaid, which consists of federal funds administered through state agencies, provides health coverage for low-income families. To qualify for Medicaid, families need to earn less than 200 percent of the federal poverty level ($31,000 annual income). Almost 60 percent of uninsured Americans live in families that may qualify to receive Medicaid benefits. Parents-to-be can find out if they qualify by contacting their state insurance department. The federal Health Care Financing Administration, which administers Medicaid, also maintains a national information number where callers can speak to a local customer service representative in English or Spanish from 8 a.m. to 4:30 p.m. local time, Monday through Friday. The number is 1-800-633-4227.

An Online Alternative
One alternative for mothers facing the looming reality of uninsured pregnancy is HealthAllies.com, an online health care marketplace. This innovative dot.com provides people with little or no health insurance access to a nationwide network of health care services at a fraction of the usual cost.

"HealthAllies is designed to help people who have to pay out of pocket to cover their medical expenses," says London, a representative of the company. "In a pregnancy situation, the first thing we would do is schedule an office visit with an OB/GYN in the mother's area. Then, when a doctor and hospital have been chosen, we would help negotiate the price and provide the mother with high-quality health care throughout her pregnancy, delivery and postpartum at a portion of the usual cost."

According to the HealthAllies online pricing system, a routine vaginal birth with a three-night hospital stay would cost an HA member just over $4,000 ($5,200 for Cesarean section). HA also has the ability to renegotiate existing hospital and medical expenses. Membership is free and sign-up is available online.

Birth the Natural Way
Home-based or "domiciliary" birth is another option open to uninsured women who are willing to take on a deeper level of participation in the birth experience. For centuries, infants were brought into the world by midwives in a natural, domestic setting. Today, in addition to being a mother's most economical birth option, home birth is an organically beautiful experience for mother and child.

"For healthy mothers experiencing normal pregnancies, home birth provides a safe form of maternity care equal to hospital-based services at one half to one-fifth the expense," says Licensed Midwife Faith Gibson of San Mateo, Calif. "The outcome is usually outstanding for both mother and child and there's no substitute for birthing in the loving environment of your own home and family."

The average expense of a midwife-managed home birth is between $1,000 and $3,000, with a notably low Cesarean rate of under 6 percent (as compared to the hospital Cesarean rate of 15 to 25 percent). In some cases, Medicaid will pay for home birth expenses, although states have varying laws regarding in-home birthing

"After reviewing our options, we decided to go with a home birth," says Jenny Johnson, a mother from Talent, Ore. "I wouldn't do it any other way. We had an excellent team of midwives and a great birth. It was just a matter of allowing the forces of nature to work themselves out."

There are a few types of midwives who can legally deliver babies in homes across the country: Certified Nurse Midwives (CNMs), Direct Entry Midwives (DEMs) and Licensed Midwives (LMs). CNMs are Registered Nurses who have advanced hospital-based Labor and Delivery training. LMs and DEMs – who facilitate the majority of in-home births in America – are midwives who entered the profession through direct experience, apprenticeship and accredited training programs. Though most states have practicing midwives, only 15 states have legal provisions allowing for in-home delivery. To view a listing of which states allow which types of midwifery practice and to contact a midwife in your area, visit the Midwives Alliance of North America.

Want to see more?

• Alone: Facing an Unexpected Pregnancy Without a Partner
• Birth in the Water, Birth at Home
• HealthAllies.com
• Pregnancy Today MomsTalk Discussion Board