How can someone afford to have a baby without health insurance?

August 2, 2008 5:03 PM

A friend of mine has 3 kids who were all delivered via caesarean section. She is pregnant again and wants to have the baby vaginally at home with a midwife. Doctors are telling her she has to have this 4th baby via caesarean section because having it vaginally could rupture her uterus. Has anyone had any experience with this? Her husband is out of work (actively looking for a job), she is a stay at home mom, and they presently have no insurance. They can't afford to have a baby in the hospital without insurance. Are there any other options they have? Is there any government help in a case like this?
posted by JPowers to health & fitness (19 comments total)

Isn't this really a question of how to pay for prenatal care? A hospital is not going to turn her away when the baby is coming. It would be illegal for a hospital to turn her away.

Plenty of poor people with no resources are popping kids out every day, in hospitals.
posted by jayder at 5:20 PM on August 2, 2008

Has she looked into Medicaid yet?
posted by dilettante at 5:20 PM on August 2, 2008

If her doctors, who have personally examined her uterus, are telling her she needs another C-section I don't think you should take the opinion of random internet strangers over the doctors' opinions.

I do know that in my state, Wisconsin, there is government assistance for pregnant women who have no support. I also know that hospitals work out payment plans and sometimes write off portions of the bill for people without insurance. It's worth making some calls to the state and the local hospital to see what can be done.

Good luck.
posted by christinetheslp at 5:23 PM on August 2, 2008 [1 favorite]

IANAD, however, I have heard before that once you have a c-section, it is usually recommended that you deliver via the same method during subsequent pregnancies. Especially if her doctor has examined her and knows her case history, then I'd be heeding his advice.

I work with health insurance at a hospital. I recommend looking into Medicaid If ineligible for Medicaid or other government programs, I'd suggest calling the Billing department of local hospital where you would likely deliver and asking if they offer financial assistance. Where I work, people can be screened to receive up to 50% discount from the total balance of the admission. As mentioned above, she absolutely cannot be turned away due to lack of insurance or inability to pay up front if she just shows up to deliver. And while in the hospital, she can ask about financial assistance and and help with applying for Medicaid. However, some due diligence on her part will give her an idea of which hospitals can offer help, and if any of them have a better rate for her than the others. This can help her decide which facility to choose.
posted by DrGirlfriend at 5:34 PM on August 2, 2008 [1 favorite]

She will need to find a midwife willing to do this, which may be difficult if not impossible. That being said, a lot of people feel that there is too much misinformation about VBAC, which is the common acronym for Vaginal Birth after Caesarian. Try this site for some more info and a personal story of someone who did a home birth after Caesarian.
posted by saffry at 5:34 PM on August 2, 2008

If this is an issue of paying hospital bills, how do they expect to pay a midwife? They certainly don't work for free.
posted by chiababe at 5:41 PM on August 2, 2008

If they are in the US, they should definitely apply for Medicaid. Pregnant women whose family income is below 133% of the Federal Poverty level are a mandatory eligibility group for Medicaid. If she qualifies, she should have prenatal care and delivery covered. Requirements vary from state to state, so she should definitely contact Health and Human Services in her state to talk to a caseworker.
Is the husband eligible for COBRA?
Some hospitals and healthcare organizations offer charity care, so they could look into that. Just contact the finance or billing department.
posted by classa at 5:54 PM on August 2, 2008

How long has he been out of work? Where do they live (welfare options vary depending on state, city, county)?
posted by Houstonian at 6:26 PM on August 2, 2008

My wife had our first child by caesarian (he was breech). She did a VBAC with our second with no problems at all. However, judging from the information we had at the time, doing a VBAC after multiple caesarian deliveries can be highly problematic.
posted by Thorzdad at 6:39 PM on August 2, 2008

He has been out of work for a couple months now and they live in Houston, Texas.
posted by JPowers at 8:10 PM on August 2, 2008

Although I have never been pregnant and am just a nursing school dropout (I wanted to be a labor-delivery nurse and am well-read on the topic), if I was going to go for a VBAC after not one but 3 Caesarians, I would at least do it in a hospital. Just because she's in a hospital doesn't mean she has to have all the interventions they offer... she needs to look into a birth plan. It's the kind of thing where she could say, for example, "No IV unless emergency" or "no episiotomy" and have them respect her wishes.

She also needs to be aware that uterine rupture can cause death to her and death or permanent disability to the baby. If her uterus ruptures and the baby is in distress, she does not want to be waiting at home for an ambulance to come get her and take her to the hospital. Being already at the hospital means they can get the baby out a lot faster should something go wrong.

That said, here's some stats that seem to indicate, if I'm reading it correctly, that 1 in 55 women who had multiple caesarians have a uterine rupture, which is 1.8%. Good odds but I'm a paranoid person who wouldn't take the risk.
posted by IndigoRain at 8:59 PM on August 2, 2008

My mother worked as a nurse in a maternity ward for nearly twenty years, and I've had many discussions with her about every sort of birth you can imagine.

There is a signifcant risk of uterine rupture in a VBAC (vaginal birth after cesarean). The risk is described as 1%. This is one couple's story about how one in a hundred really is a huge risk and not an insignificant one.

Keep that in mind when you think about the risks that you're willing to take during delivery.

As for your options for staying in the hospital, most states have programs that cover pregnant women. I know most of the women who gave birth in my mom's unit did so with state aid. I don't know what state you're in, but when I lived in Rhode Island and had a near-pregnancy experience, my doctor indicated that were I pregnant, my medical care would be covered entirely by the state.

Talk to your doctor, s/he should know about any programs that would help you out financially.
posted by grapefruitmoon at 9:12 PM on August 2, 2008

One of my numerous sisters-in-law has had two C-sections in the same hospital, three years apart. He's a farmer, she runs her own business in a dying downtown in a small city. No insurance. They just made arrangements to make monthly payments. Didn't seem to be a problem.

As to C-sections themselves, IANAD, but I have read that more doctors are encouraging women who have had C-sections to try it the other way with later babies. FWIW.
posted by bryon at 9:22 PM on August 2, 2008

I suspect that VBAC is strongly discouraged after three C-sections. My OB told me that she has operated on women who have had prior C-sections and the uterine tissue around the scar site was so thin, she could see through it. Vaginal births for these women would have been extremely dangerous.

Your friend should go to social services and apply for medicaid. It is fairly likely that she can find some sort of coverage. Hospitals usually have programs for folks without economic means as well She could also contact local churches- they are often able to find help for low income women who need pregnancy support.

And finally, midwives don't come cheap, either.
posted by mistsandrain at 10:59 PM on August 2, 2008

If he's been unemployed for less than 60 days, he can apply for COBRA, to pick up the same insurance he had before he stopped working.

She can apply for Medicaid. In Texas, she should dial 2-1-1, which is staffed to answer questions 24/7. She can also look at the Texas Health and Human Services page about Medicaid for pregnant women, and CHIP -- a program for pregnant women and her children too.

She should read the information from the Texas Dept of Insurance on this page for good information about help that is available at a federal and state level.

In Harris county, she should also look into getting a Gold Card. This is a card that allows discount for medical services within the Harris County Hospital District (that is,
Ben Taub and LBJ hospitals, and lots of clinics.
posted by Houstonian at 3:40 AM on August 3, 2008

Forgot one! She should stop by her Assistance Ministries. These are good people. They are staffed to help her through these processes, and can guide her to lots of help. I've volunteered with them, and can say they do great things and offer lots of care and concern. Don't been thrown off by the name. It's an inter-denominational non-profit, which means that many local churches, synagogues, mosques, etc., provide funds for it. The help they offer is not religious, it is just help. There's no theology involved for the people who are served; the Assistance Ministries is just a way for the local churches, etc., to pool their monies to help the community.

It's broken down into areas of town, so if she's is in the Northwest area (1960 area), she can go to NAM (Northwest Assistance Ministries); if she's in the Bear Creek area, it's Bear Creek Assistance Ministries, etc. See here to find her local one.
posted by Houstonian at 3:56 AM on August 3, 2008

No amount of money that might be saved at home with a midwife is worth the risks involved with rupturing the uterus and potentially killing mother, child, or both. Assuming either or both survived the birth, the medical costs following that would most likely dwarf those of a c-section.

For better or worse, if your friends are US citizens, and they show up at a hospital in the US, and she's in labor, she will be treated and given the c-section and hopefully everyone will live and be healthy.

That's the important part, the money part comes later.
posted by allkindsoftime at 4:10 AM on August 3, 2008

I have a close relative who had 2 C-sections, then a (successful) vaginal delivery, then another C-section. Doctors have differing opinions on this - the OB involved in the VBAC was apparently very supportive, positive and attentive wrt the VBAC, while the OB involved in the last C-section thought the VBAC OB irresponsible to allow and encourage a vaginal delivery after 2 C-sections. If you do mean to go ahead with this, you should find a midwife / OB who has a lot of experience with VBACs.
posted by aielen at 6:30 AM on August 3, 2008

For better or worse, if your friends are US citizens, and they show up at a hospital in the US, and she's in labor, she will be treated and given the c-section and hopefully everyone will live and be healthy.

Heck, it doesn't even matter if you're a US citizen. In fact it's illegal to even ask. DH used to work as a surgeon at a county hospital on the border, and a large percentage, if not the majority, of moms who delivered were from Mexico (having what they call anchor babies).
posted by texas_blissful at 8:52 AM on August 3, 2008