Birthing center vs. hospital costs, pros/cons

November 4, 2010 9:05 AM

Asking for a friend: (TL;DR: "We're exceptionally poor and can't figure out our best options between birthing centers and hospitals in Portland, OR with Premera Blue Cross insurance.")

"I'm nine weeks pregnant and, basically as a default, went to a hospital I've gone to in the past for my first prenatal appointment. I was pretty unimpressed with the doctor, the office, and the whole experience, and I'm now looking into other options. I very much want a natural childbirth, and money is extremely tight. I've seen data sourced from HCUPnet that vaginal delivery in birth centers is substantially cheaper than delivery in hospitals.

However, I'm confused as I attempt to research local birth centers. It looks to me as though most of them are inside hospitals? Are
they basically just hospital women's clinics that happen to be staffed by nurse-midwives? How is that different than going to a regular hospital women's clinic?

I live in Portland, OR; I have Premera Blue Cross/Blue Shield insurance; and my pregnancy is not high risk. I would love clarification on how birth centers are different than regular hospitals, and I also welcome any Portland-area birth center recommendations."

Thanks in advance.

posted by Ky to Health & Fitness (11 answers total)

Hi, I'm in Portland and will be delivering at Andaluz Waterbirth Center. I came to this decision when I was already 35 weeks pregnant (yes, seriously) because I had become so extremely disappointed in my OBGYN and the hospital where we were going to deliver. I am very excited to deliver at Andaluz; it's a free-standing birth center, all the midwives seem really nice (and you get two of them! plus their apprentices!), and the environment is SO much more conducive to a good birth experience than a hospital. In the event of an emergency you would be transferred to a hospital, of course. And though it's a waterbirth center, you don't have to deliver in the tub; you can do whatever you want (birthing stool, bed, ball, whatever helps).

I'm not familiar with Premera Blue Cross (I have Regence Blue Cross myself) but the cost difference between OBGYN + hospital delivery vs. Andaluz turned out to be about $3K cheaper at Andaluz ($4K OBGYN + $6K hospital = $10K, vs. $3600 midwife + $3K for the birth center stay = $6600). This is of course before insurance. Andaluz offers a 30% discount if you can pay in full one month before your due date, which brings the cost down even more.

Now, the only thing about Andaluz is they're out of network for me vs. the OBGYN and hospital being in-network so our out-of-pocket worked out to be about the same (actually, because I switched so late, I'm paying a lot more because I'm paying two different providers for OB care), but check your insurance to see what's what. The doctor's office or birth center will also do an insurance check and go over your benefits with you after you become a patient.

Feel free to memail me if you'd like more info.
posted by rabbitrabbit at 9:32 AM on November 4, 2010

Would your friend consider a home birth? They can be much less expensive.
posted by purenitrous at 9:44 AM on November 4, 2010

Yes, homebirths are cheaper than birth centers. My doula (who is also a midwife and has attended over 400 births) recommended Vivante Midwifery to me if I wanted to go that route.
posted by rabbitrabbit at 10:05 AM on November 4, 2010

I was born in a gentle birthing center (in California, sorry) and it was much cheaper than any of my siblings' births (in hospitals because my mom and stepmom were of "advanced" age by that point, and because my mom had a change of heart re: how natural she wanted to go.) It was a standalone center, and they only called a doctor in at the end, because of my birthmark. Mom and my dad were pretty poor at the time, and have never complained about the experience from a money standpoint. Or actually in any other way; it's literally a "high risk pregnancy" + "we're not hippies anymore" thing that had the next four births in the family at hospitals, rather than anything bad that happened.

Most notable besides the "women in charge, no MDs needed" thing and a fairly cozy atmosphere was that I was born around 3pm and we were released early enough that there are stories about the family dinner that took place that evening, which I supposedly attended. There's definitely a photograph of me next to a little sign that says "welcome to the world" that was taken that night, in my grandparents' house: I'd put the outside release time around 6 hours, though my mom swears it was more like 4, and she thinks she took no drugs that day, so perhaps she remembers accurately.

Note: this was in the freewheeling 1980s; they might not be quite so casual about letting you go home these days.
posted by SMPA at 10:09 AM on November 4, 2010

One thing to be aware of is that if everything goes fine, a home birth / birthing center experience can be great. However, if something goes wrong, there may not be the immediate medical care that may be necessary. Think of it as another form of insurance. That's not to say that hospitals and doctors don't make mistakes and there aren't problems in those environments. A friend of mine's kid is pretty messed up b/c the place she gave birth didn't have a way to monitor the oxygen the baby was getting and it turns out that the baby had been in distress for hours.
posted by reddot at 12:03 PM on November 4, 2010

Interesting answers so far.

reddot--that is definitely a major concern and why another friend of ours is pushing hospitals so heavily (granted, this other friend had a high-risk pregnancy). Between the hippie modern-medicine-is-bad-and-who-needs-to-be-licensed vs. ultra-high-tech-$$$$ hospital care, I'm thinking there has to be a balance somewhere for poor folks who want reasonable safety steps for possible problems.
posted by Ky at 12:16 PM on November 4, 2010

Some pros of birth centres:
- midwives are less likely to view pregnancy as a 'medical condition' in your check-ups and treat you like a normal woman doing a very normal thing. Most of my appointments have generally lasted less than 5 minutes - blood pressure ok? urine sample? feeling ok? great, see you next month!
- birth centres encourage 'active birth' (keeping upright and mobile as much as possible during labour) which really helps with keeping the labour going, as opposed to lying flat on your back (like in every TV show and movie you've ever seen).
- some (but by no means all) doctors are prone to interfering in labours unnecessarily, usually to speed them up. Google 'cascade of intervention'. Midwives are generally happier to let nature take its (albeit slower) course.

Some cons of birth centres:
- your pain relief options may be more limited. Epidurals, for instance were not available at the birth centre I used. If this is a first pregnancy, and you don't know what your pain tolerances are, this could be a problem. Some people just need the reassurance of having the option of an epi, even if they never use it.
- as others have said, if something requires you to transfer for, say, an emergency C-section, you need to know what your options are. I should point out that midwives are highly trained to spot potential problems before they become serious and will recommend a transfer sooner rather than later.

I'm in the UK, where home births and especially birth centres are viewed as much more mainstream than (I understand them to be) in the US. NHS midwives will attend home births if the pregnancy has been straightforward.

Most (but not all) NHS hospitals have birth centres attached - so you are able to transfer quickly (usually just to the adjacent floor) to a hospital environment if that proves necessary. It sounds from your question as though the set up for some local birth centres may be similar. This would be an ideal scenario, as far as I'm concerned.
posted by dogsbody at 1:26 PM on November 4, 2010

I'm currently working with Vivante Midwifery for a home birth, and it may be a workable blend for your friend. All the midwives are either certified nurse midwives or licensed direct-entry midwives (trained at the midwifery college in Seattle). The woman who founded the clinic also works at OHSU, so if at any point your friend wanted to transfer care, or if it became necessary to do so, she could continue working with her at OHSU.

Alma Midwifery is another midwife group that offers a freestanding birth center. Working with the certified nurse midwives at the birth centers at OHSU or Providence or Legacy can also be a great option, if that's what insurance allows. The midwife model of care generally prioritizes: 1) health of the mother and baby, 2) vaginal birth.

I would also strongly recommend that your friend get a doula, if she chooses to go the hospital route. I was trained as a doula through Mother Tree, and I know they run a program whereby women who cannot afford a doula can request a free student doula. If her most affordable option is a hospital birth, having the support of a doula may make her feel more comfortable about the whole experience and may help avoid the potentially expensive interventions.
posted by linettasky at 1:56 PM on November 4, 2010

Having a doula is great. I actually will have a Mother Tree doula attending my birth. But I want to point out that doulas aren't generally covered by insurance, and they can be spendy ($500-$900 out of pocket). If your friend can afford it, it is definitely worth it (I haven't even given birth yet and I already feel like I've gotten my money's worth by hiring my doula) but since you said your friend is "exceptionally poor" I'm not sure if that's an option or not.
posted by rabbitrabbit at 4:53 PM on November 4, 2010

Sorry, didn't see the mention of student doulas. Yes, if you can get a doula for free, DEFINITELY do it, no matter where you end up giving birth, if you can find one who clicks with you.
posted by rabbitrabbit at 4:54 PM on November 4, 2010

I have no kids, but a good friend of mine had her baby at OHSU's midwife center. She raves about her experience and another friend will deliver there next month.
posted by coolsara at 5:10 PM on November 4, 2010