How Much is a Midwife?

This article is written by Paula Grady LM, CPM - a California licensed midwife serving Napa, Sonoma, Solano, Contra Costa and Marin counties for over 25 years. If you are are looking for natural pregnancy care in the North Bay area, you can learn more about Paula and her practice here.

How much is a midwife?  How can I pay for my natural birth?  Good questions!  In fact, these are probably the most common questions I hear from new moms considering an ‘out of hospital’ (OOH) birth plan. This article will share some useful information on finding the resources you need to have the birth you want.

Let’s begin our discussion on how much is a midwife with a couple of comparisons, and some real data.

How Much is a Midwife? The True Cost of Natural Birth.

According to the Kaiser Family Foundation (KFF), the average cost of birth in a hospital in the United States in 2021 was $18,865.  For hospital births resulting in cesarean section rather than vaginal delivery (approximately 32% of all births according to March of Dimes Peristats), the national average including hospital fees rises to $26,280.

Of course, for many of us an insurance provider plays a key role in our medical bills, particularly the overall costs we must pay out of our own pocket.  Average out of pocket costs for a birth covered by a health plan in the US are $2,854 according to KFF.

By comparison, the average natural vaginal birth attended by a licensed midwife in the US in 2021 was $4650.  In the North Bay area where I practice, that would be on the low end - the average price is closer to $8,500. Typically this is a flat fee, including all midwife services such as prenatal care, birth services and postpartum care / newborn care, including home visits and / or visits to a birthing center.

So clearly, an OOH birth for low-risk pregnancies in the US is, on average, less expensive than a hospital birth (prior to any insurance company reimbursement).

“But Paula” you may be thinking “my health insurance plan doesn’t pay for an OOH birth.  How can I possibly afford thousands of dollars in out-of-pocket costs?”

Many of my clients wrestle with this question.  I share with them the ideas and information I’m about to share with you.  But I get it – it’s not a simple question.  The price of childbirth is significant.  And the type of birth you choose, matters.

Today’s reality is: at least in the United States, natural childbirth is not (yet) considered mainstream maternity care by most healthcare providers, There is relatively little consumer demand and underwriting data to support health insurance coverage of an OOH delivery. Many private insurance companies won’t pay for home births or birth centers.

But some will.  More on that in a moment.

How to Pay for a Natural Birth

First, just a quick word about me:  As a Certified Professional Midwife, licensed by the Medical Board of California.  I have provided midwifery services for over 1500 mamas and babies over the last 25 years.

With all of that experience, in my humble opinion, I have probably seen EVERYTHING when it comes to paying for a natural childbirth.   The number one thing I have learned is:  those mothers who really want a natural childbirth, find a way to have one.

Here are the ideas I personally share with all of my clients when I am asked "how much is a midwife?"  All references to ‘midwives’ are understood to mean fully licensed and experienced professional midwives, including nurse midwives.

Know What You Want

This is first and by FAR the most important factor - there is no substitute for knowing what you want from your pregnancy and childbirth experience:  The single most important question in your personal cost equation is: “What is it worth to ME?  How determined am I to have a natural childbirth?” Again, I have found that women who truly want a natural birth find a way to have one. They often use one of the methods below…

Ask About Discounts

Many midwives offer a discount if you pay upfront, pay by cash or check, or meet certain other conditions. Some practices offer a significant discount if the account is paid in full in the first appointment.  Others offer discounts for military service members or other special circumstances.  Definitely worth asking!

Ask About a Reduced Fee

Some licensed midwives offer ‘sliding scale’ pricing, based on ability to pay.  Some offer a reduced rate to help manage the cost of a natural birth for those who qualify for MediCal or other state-sponsored programs. Some offer reduced fees for moms who are willing to come to the midwife's location vs requiring the midwife to travel.

Ask About Payment Plans

Many midwives will offer payment terms.  Sometimes their clients are in the midst of temporary financial hardship and just need the opportunity to spread the cost over time. 

Inquire About an In-Network Exception

Some insurance plans will grant an exception and cover your birth even if they do not have a contracted OB or hospital in your location. Midwives sometimes keep a billing specialist on staff, specializing securing in network exceptions and other insurance-related matters.

Be Willing to Push For What You Want

This is SO important.  No insurance plan has rules to account for every individual client and their needs. Be persistent. If you have a good argument and patiently pursue it, you may be rewarded.  If your midwife team has a billing specialist, he or she probably knows the ins and outs of negotiating with insurance plans.  Some also offer a packet of support material including examples and templates. 

Consider a Barter Arrangement

Some midwives are open to this. In my practice we once cared for the wife of a plumber who installed a separate birth tub in each room of our birth center in exchange for his wife’s midwifery care (she had a beautiful water birth).

Ask for Financial Support in Lieu of Baby Shower Gifts

The total cost of a natural childbirth for the birth parents can be much more manageable if shared by a group – particularly a group of people who love you and want you to have your perfect childbirth experience.

Set up a Crowdfunding Campaign

A crowdfunding campaign such as GoFundMe can help cover home birth cost, the cost of a birth kit, or other specific parts of your medical care.  Many moms can secure additional funding this way.

What's Next?

Now, to recap: today’s main question was "how much is a midwife?"  I hope this article has helped answer that question, but provide ideas on how to actually afford and pay for the natural birth of your dreams.  

At this stage of the discussion many mamas start to ask questions like 'how much does it really hurt?'  If that is you, please visit our page on Natural Birth Pain Management for an answer to that very question!

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