Oregon lawmakers want to implement a new law that will expand Medicaid insurance coverage for expectant mothers who choose to give birth outside of traditional hospitals. According to recent reports, passage of the law will allow state Medicaid payments for births occurring in private homes and birthing centers. Direct Entry Midwives (DEMs) often perform birthing procedures in these unconventional settings and the Oregon Medicaid program generally does not cover their services. The reason behind the decision to withhold coverage exemplifies a common concern regarding midwives and the services they provide.
DEMs begin practicing as soon as they finish their training and certification. By comparison, nurse midwives only enter the field after obtaining a formal nursing license. Though it varies by state, most DEMs obtain Certified Professional Midwife credentials from the North American Registry of Midwives. Despite this certification, most states, including Illinois, refuse to cover their services under state funded insurance plans.
The Decision Not to Cover
In making coverage decisions, the state weighs general insurance expenditures with the cost of potential problems during delivery. Birthing complications can necessitate additional medical care for mothers, as well as infants. These safety risks significantly raise the cost to insurance companies for these specific cases.
According to the Centers for Disease Control (CDC), almost 14,000,000 births occurred in the United States between 2006 and 2009. While approximately 91% of these births were completed by hospital physicians, about 9% were delivered by nurse wives. Among all midwife births, neonatal deaths occurred at a rate of .32 per 1,000 hospital births and 1.26 per 1000 at-home births. These high death risks lead states to deny insurance coverage.
Choosing a Midwife
The medical website, WebMD, gives the following advice for choosing a midwife:
Ensure that the midwife is credentialed by an established certifying body. In addition, ask your midwife to confirm her state specific license to ensure that she has met all of the requirements for practicing in your state:
* Review the midwife’s experience in different settings. Ask whether she works with hospitals, homes or birthing centers. Also, don’t hesitate to request multiple references. Then take the time to contact each of them to inquire about their experiences with the midwife. If the provided information does not invoke your confidence, keep looking for another midwife.
*Ask questions about the actual delivery. Discuss pain management and ensure that the midwife agrees to comply with your wishes. Though it may not be comfortable, it is vital that you also discuss the things that can go wrong. Talk about the possibility of labor inducement or C-Sections. Find out which circumstances would prompt the midwife to implement these processes.
*It is extremely important to your life and the life of your baby to ensure that the midwife has an emergency back-up plan. Discuss the midwife’s affiliation with area hospitals in case an emergency procedure or neonatal unit is needed.
*Lastly, listen to your intuition. If you or your partner do not feel comfortable with a midwife, keep on searching.