Breaking Down the Costs of Midwifery Care and Home Birth
Full disclosure, I am sharing the main text from an Indie Birth post where they broke down their fees back in 2017. I have made adjustments to the original posting to update with a few of my own current costs now at the end of 2022-- Deanna
Let's start with the hours invested:
● Initial Interview/Consultation – 1-2 hours
● Paperwork/Prep before appointments – 2 hours
● Prenatal Appointments – an average of 10-12 appointments that last 1.5-2 hours each – we’ll call it 20 hours. Last minute clients often suggest that we can lower the price since they didn’t have this part of care, but the truth is that we still have to make up for as much “getting to know each other” time and education as possible, and also that this lack of relationship and trust makes taking someone on at the last minute feel that much less comfortable on my end.
● Contact via phone/text/email between appointments – 1/2 an hour a week on average. Some much more, but not many that are less. If someone starts care at 16 weeks this works out to about 10 hours if I’m being conservative.
● Being on-call from 37 to 42+ weeks (that can be as much as 840 hours of on-call time) This means:
not leaving your local area because you have to be available at any moment
Traveling with 2 vehicles when you go places (I have totally left my husband at the mercy of Huddle House, and I have ditched children at the highway to meet an older sibling)
Not scheduling many personal appointments or Doctors visits (or always knowing someone’s cancellation policy).
Having all birth supplies packed and read in the car in case I'm away from home and get called
Keep the gas tank full, and of course keep drinks and snacks handy.
Not staying up too late.
Sleeping with your phone ringer and alerts turned on.
Being super responsible and working hard to stay in peak health.
Missing holidays, birthdays, and events (or at least warning that you may miss them).
I love what I do, but this part of the job is definitely stressful. There is no amount of hours or remuneration to count in this, but wanted to include it since it is a very real part of the deal.
● Around the clock Labor and Birth support once labor has begun – This usually means texts and phone calls at first (let's say 1/2 an hour worth). Then we are at the house for anywhere between 20 minutes – 48 hours before the birth. (Literally just made a precipitous birth with 20 mins to spare, and have stayed with a mom for 48-72 hours before a birth so this is totally a Mystery Time)
For the sake of this discussion lets say the most common and expected amount of time from arrival to birth is about 8 hours, though this is the most variable element for sure, and this unknown aspect adds a lot too the “cost” in my opinion.
Someone who offers almost any other service knows ahead of time when they will be needed, and can schedule and prepare accordingly. Other people who offer on-call or walk-in services are not usually doing things that are as time sensitive as birth, or they offer short sessions and can be fairly specific about their availability within the scope of the day the service is needed.
Imagine though if someone called you and said you needed to leave your house right now for 2-3 days and that you would have to possibly find your own place to sleep somewhere tucked in a corner or slumped over at a dining room table. Oh, and you would be awake for most of those two days. And you would also need to figure out your own drinks/food while gone. And you need to find someone else to watch your kids, feed your animals, etc..
What would it take for you to be able to do that?
● Immediate postpartum support – 4 hours. We rarely leave earlier than 2, its generally 3-4 hours postpartum
● Postpartum visits – an average of 6, lasting 1.5 to 2 hours each. Lets say 10 hours
● Postpartum contact outside of visits – varies widely, but an average of 1.5 hours
● Research and peer consultation – almost all clients have something come up that I have to gather additional resources, do extra research, or consult with other home birth attendants about. Again this varies widely, but lets say 3 hours, not counting the many hours I often think about clients and what is going on with them while I lay in bed awake at night, or while I’m supposed to be doing other things at home!
With these approximations, we’re looking at about 58 hours (or as much as 90+ hours per client, which is likely more accurate)
And this does not include travel time, which can be quite significant. For my apprenticeship I was traveling 68 miles/1.40 hours (one way) for office visits, averaging 2 days weekly for 5 years (some weeks were clear, others could be 4 trips weekly). Then there was travel to home visits, the birth itself, and an average of 3 postpartum visits. I was easily adding 50-60k in birth-related miles to my car yearly.
Doing less of all of this is often proposed by people who want a break in the cost, but the reality usually is that we end up doing the same amount of work since it is so important and really can’t be reduced if we want to maintain the quality of the work, and the trust level of the relationships.
● Travel (gas, car maintenance) – 15 or more trips, and many clients live 30 mins to 1.5 hours away).
Conservatively this would be about $150 for gas/car mileage for the closer clients, and more like $300 for farther ones over the entire pregnancy (factoring in gas prices is hard as much as it changes) I expect visits to be in my office now, so this would be much lower more often than not moving forward, however, I now offer in-home prenatal visits for an additional $500 fee for those that prefer that
● Printing expenses – $10-15
● All past education expenses that went into where I am now, and continuing education (books, workshops, certifications, online courses, conferences) – $3-500 a year, so let's say $50 a client.
● Taxes (12%, I really have zero idea)
● Fees for using paypal/square/Venmo and other services to accept credit card payments (3%) We also accept cash payments as well as checks as other options.
● Food while out at a labor ($25)
● Supplies throughout care that are not included in client purchased birth kit (basic meds, herbs, homeopathics etc ($40)
● Equipment – initial costs of getting all needed gear, and costs of replacing (doppler, fetoscopes, birth pool supplies, birth stool, etc, etc, etc) – gear is expensive, but luckily doesn’t need to be replaced super often ($50)
● Paying an assistant/apprentice to also be on call and to attend the birth. Highly variable depending on experience and circumstances, but between $100-400. At this time, the fee for another "real" midwife to be on call as an assist is $400-1000...a cost from my pocket, not an additional cost to the client.
Conservatively this works out to be in the vicinity of $1200 ($1600+ if it's the higher end of the assistant scale).
This isn't even including other regular business costs, such as website fees, business cards/advertising, State registration or licensing costs, business memberships, office rental and utilities, etc.
And what about other considerations that don't have a monetary tag:
● Legal risk – the possibility of being sued is always there in our line of work
● Emotional toll – this is very intense, personal work. We (almost) never show up at the birth of a stranger. We care deeply about the people we work with, and this adds a layer of complexity mentally and emotionally to our work.
● What do we pay other people that we value and are important in our lives? What do we pay chiropractors, acupuncturists, wedding photographers, caterers, massage therapists?
I'm just shooting estimates for costs:
$4000 Global Midwifery fee
-$1200 (estimated fees on my side)
$2800 ($2400 for the early pay discount...and this is not even counting the taxes, website fees, State fees, advertising, office rental, utilities etc)
Say we split that equally among the services and this is what I'm paid for each: prenatal care (33+ hours@ $28/hr), birth (8 hours as our Mystery Time@$116/hr), and postpartum care (14 hours@$67/hr)
The biggest barrier to midwifery care/home birth in our area is the perceived inability to pay out of pocket when an OB and the hospital can accept insurance . Even with insurance covering most costs, your co-pays and other out of pocket fees tend to add up equal to/more than, your midwifery/home birth fee.
We all want to make midwifery as affordable as possible for as many families as we can, but we also have to make this 24/7 life sustainable on our side.
Hands and Hearts Birth is able to offer payment arrangements after the $600 deposit is paid. If the balance is paid in full by 36 weeks, we will offer a 10%/$400 discount (making this $3000 due by 36 weeks) or leaving a balance of $3400 to be paid off by 40 weeks with *consistent payments* throughout care. Ideally, you should be paying toward your balance at each prenatal visit. Everyone's finances are different and we are always open to discussing alternate plans/options. Never be afraid to ask!
We love our clients. You are like our family by the time we reach your birth day...but your midwife cannot be more invested in your birth journey than you are.
Help us keep midwifery care and home birth sustainable and available. Recognize the value of midwifery care and the worth of your midwife. Let's talk about how wwe can work together and make your midwifery and home birth experience the best. Contact us here or at Hands and Hearts Birth & Botanical at Facebook, and let's schedule your consult soon!