Homebirth and Kaiser
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Homebirth and Kaiser
I'm pregnant w/ baby #2. We are planning a homebirth and I'd like to find an OB
who won't freak out about it. I've got Kaiser health insurance so we're limited
by that. We're in Oakland, so Kaiser Oakland would be best (unless other Bay
Area Kaiser docs would go to Kaiser Oakland if I had to transfer).
My NP at Kaiser Oakland is Rebecca Avery (sp??) and she was supportive of my
decision to have a homebirth for my second baby. I discontinued my prenatal
visits at Kaiser around month five or so. (My midwife took over my prenatal
care.) NP Avery understood and put a note in my file so I could come back for
any needed tests, ultrasounds, etc. We did end up getting an ultrasound at
Kaiser towards the end of the pregnancy to make sure the head was down, and
she was great about it.
i have dr. joanne gras at oakland kaiser.
when i went to see her i was about 6 months pregnant & told her i would only be
in occasionally to do lab tests because i was planning a home birth & was seeing
my midwife for prenatal care. she was super-chill about it (''so we're plan B?'')
& just asked what i needed.
she was also totally supportive when i saw her post-partum & it turned out that
we had a (non-emergency) transfer. absolutely no guilt that we should have
started at the hospital - just congratulations on my healthy boy.
however, who you have as your ob has NOTHING to do with who will be at your
birth (with kaiser), should you decide to go to the hospital at any point during
your labor - but that's true whether you plan to be at the hospital or at home.
i have absolutely no idea who the attending nurses or ob's were for my l&d.
as a side note - we had a really good experience delivering at kaiser - although
i do think a fair bit of that had to do with our midwife: she walked in &
immediately told the staff what we wanted & what we didn't want & coached me
through everything (everyone else was talking, but i only listened to her) - so,
make sure to find a midwife who is comfortable in the hospital setting, althoug
i hope your birth goes just the way you want it :)
I had to switch to Kaiser at the beginning of my pregnancy, and though I'm not
totally in love with their system, the doctor I chose, Rene Perry (in Oakland),
was supportive of my choice to homebirth. She gave me a list of four
recommended visits and proceedures to do at Kaiser, and otherwise has let me do
my thing with my midwife. She has answered my questions promptly via email,
though she did encourage me to do a test I didn't want to do, but ultimately I
didn't do it. The frustrating thing about Kaiser is that even though you get a
good OB, their residents do deliveries, so if you are transfered for whatever
reason and can't proceed with your homebirth, then you are with a team of
people who you've never met. They do have tours, which I haven't done
yet...Also, it's a big paperwork nightmare to get your records trasfered to
your midwife. You have to go to the records office every time you have a
proceedure there and fill out paperwork to have it transfered. I tried mailing
in this paperwork, but my midwife never got my test results. So be prepared to
waste a lot of time running between buildings and getting different stories!
I had Laura Minikel in Oakland recently for a baby due
8/09. She mentioned she had other patients who were also
doing a homebirth. I also see her for my regular gyn stuff.
My husband and I are trying to decide if we should remain with
Kaiser or change insurance providers before we conceive. We would
like to have a home birth and realize that the cost will be out of
pocket. My concern is how to record the birth, obtain proper
documentation, and care after the home birth. Since most providers
do not seem to be supportive of home births, I do not see that it
would be favorable to advise the insurance company and or the
doctor (since at Kaiser you are not guaranteed to have your doctor
deliver) of our plans.
Has anyone with Kaiser insurance had any experience having a home
birth? Are there any issues with contacting Kaiser AFTER the baby
has been born at home? Will we run risk of having them refuse
Any info is appreciated.
I would reexamine your assumption that a Kaiser doctor will not
be supportive of a home birth. Our Kaiser OB-GYN was very
supportive. (In our case, we didn't realize we wanted a
homebirth until 6 months pregnant.) We got our bloodwork,
ultrasound, check-ups etc from him and simultanously saw a
midwife. Our dr. said since it was a low-risk pregnancy that he
thought a homebirth was just fine, and that the L&D department
was there for back-up if anything went wrong (the midwife
required us to have back-up conventional care lined up). After
the (fabulous) homebirth, we called Kaiser and they got us in to
see a pediatrician for the initial baby check-up (which all
midwives require you to obtain) the next day, and it was
seamless from there. Getting the birth certificate was a bit of
a pain, however, as we had to go down to the city's records
department, in person, to get it (you'll need a letter from the
midwife but nothing from the doctor). Whereas if your baby is
the hospital, the hospital handles all the paperwork for you.
Even if you don't tell Kaiser that you are pregnant, having a
home birth, etc, I can't imagine that they would deny you
continued care for the baby, or for you, if anything goes wrong.
-have had both a home birth and a hospital birth
I can not evaluate cost differences among plans (who can these
days?), but a main advantage with Kaiser is that no doc can
refuse service to you if s/he knows you are having a homebirth,
unlike some other OBs. Before the babe is born, figure out a few
pediatricians you'd be happy with, and then after the babe is
born, you can call and get an appointment. We were lucky and had
a Pedi friend who came to our house the next day with both of
our babies, and Kaiser will not allow you to sked an appt before
the babe is born, but getting in, at least to see someone, will
not be a problem at all - esp. if you tell them you just had a
homebirth! Kaiser will not/can not refuse care, either after the
baby is born or if you need to transfer for some reason (and
neither should any other hospital)
By my second homebirth, I finally figured out what worked well
with Kaiser - they will obviously pay for an ultrasounds or
labwork you need, as well as even let you take home a Rhogam
shot, for example - the key is to bypass the wonderful nurse
practitioners, who simply have no power to order these tests -
get concurrent care with an OB - insist on it, and then s/he can
write you the scrips that your midwife recommends, so you don't
have to pay for these out of pocket.
Regarding documentation, etc. - your midwife will explain to you
how to get birth certificate, ss#, etc. It's pretty
We had a home birth with parallel Kaiser coverage for my
daughter's birth, 5 1/4 years ago. I don't know whether Kaiser's
policies or practices have changed since then, but during the
uneventful pregnancy, we saw both our midwives and our Kaiser
ob/gyn nurse-practitioner. She knew that we were planning a home
birth and mildly discouraged it, but not so much that it made us
uncomfortable. We had our tests done through Kaiser, so they
were covered by our insurance, and we got copies of the results
to share with our midwives. Our daughter was born at home, but
we had to take her to Kaiser within some short time of her birth
(72 hours?) so she could be checked by a pediatrician. Having to
do that was the only drag; otherwise the dual care worked very
well for us. Feel free to email if you have questions.
We've had three home births with Kaiser coverage and it was no
problem. Kaiser is actually great when it comes to home births
(in my opinion). They never gave us a hard time about anything -
for all three babies we brought them into the pediatrician when
they were 2-3 days old. We called right after the baby was born
to get a Kaiser number and then immediately scheduled the visit
with the pediatrician. I also did concurrent prenatal care at
Kaiser for all my home births, and it was also fine, although
some of the OBs are less supportive of home birth. Your midwife
should be able to provide you with some advice on this as well,
since there are quite a few home birthers who have Kaiser.
i have care at Kaiser Oakland and chose to birth at home with a
midwife. i received care throughout my pregnancy from both my
obgyn and midwife. i didn't like the response of my first gyn
when i mentioned i was planning a homebirth so i just switched
to a more positive one (there are several at kaiser oakland).
this doctor had no problem with my plans. just be aware that
their job is to find the worst case scenarios so while
supporting your decision, the doctor will also be concerned
about home births in a subtle way. your midwife should be
familiar with procedures with recording births, newborn tests,
etc with the various hospitals. i would suggest contacting the
bay area home birth collective www.bayareahomebirth.org which
will have a wealth of information from people's birth
experiences around the bay area.
i ended up giving birth in kaiser after all - my midwife
accompanied me but couldn't participate actively in my care once
there. (of course emotionally and spiritually, just not
medically) i don't think you have anything to worry about if
planning to give birth at home and then seeking regular care
from kaiser. it's the bay area after all.
good luck and happy home birth!
Hi , Homebirth midwives cover all your care , pre-natal, birth ,
and the first 6 weeks postpartum! for instance , our practice ,
see's you for 1 1/2 hour prenatal visits in your home , the
birth , 2 midwives are there , and then we see you( at home !) ,
for 7 visits in the 6 week post -partum period , with the bulk
in the first two weeks . if you need to access care at kaiser ,
either prenatal, birth or postpartum , it's easy . If you get an
opinion against homebirth from a caregiver at kaiser , the next
person you see will probably be supportive , it's all personal
opinion , not policy , because homebirth is legal. hope this
helps! Juli Tilsner LM , Awakenings Birth Services
Hi, I am a recent transplant to Kaiser and am trying to look into
planning for a future birth. After a very smooth first birth
experience with Alta Bates, I was hoping (really really badly)
for a homebirth for #2. But, from what I can tell, Kaiser won't
cover even one cost associated with homebirth. Any info. about
the following questions would be greatly appreciated...
1) Anyone have an experience otherwise?
2) Anyone get Kaiser to cover any homebirth costs? If so, which
ones? And how?
3) Do midwives typically (or can/do they) work with people who
use their insurance to cover most or all prenatal visits and then
start seeing them towards the end for final visits and delivery?
I don't want to short change a midwife, but I would love to have
a mix of the two, prenatals with Kaiser nurses and free co-pays,
and birth with midwife at home... Any ideas for making that a
reality are appreciated. THanks so much!
Homebirth hungry mama
2. Kaiser will not cover homebirth costs. Period.
3. Occasionally you can work out a discount arrangement with a
midwife where you get your prenatal testing and early prenatal
care done at Kaiser under your insurance and then deliver at
home. But, it is unusual. Most homebirth midwives only take on
a certain number of clients per month (e.g. four clients with an
April due date, four clients with a May due date, and so on).
Even if you don't see them on a regular basis for early prenatal
visits, they are still ''saving'' a spot for you. In other words,
you take a spot that would otherwise go for a full service/full
pay client. She will not take on ''extra'' clients to make up for
not seeing you early in the pregnancy, because this would
overload her schedule with too many births per the month of your
due date. So, giving you a discount represents a significant
income loss for a homebirth midwife. It doesn't hurt to try,
though. You can always speak to the midwives you are interested
in considering working with and ask about their policy. The
fact that you are a second time mom works in your favor since
your labor is likely to be shorter than a first timer. This may
makes some midwives more open to such an arrangement.
Another thing to consider, though, is that your plan may
diminish your experience somewhat. Having a homebirth is, in
part, so fulfulling because you have had a ''homebirth
pregnancy'' -- i.e. the quality of prenatal care that is offered
by a homebirth midwife. That is the time when you build the
relationship with a midwife that contributes so significantly to
your experience of giving birth at home. Now, many second time
mamas focus way less on the pregnancy because they are so busy
with the first child, so this may not be an issue for you. But,
I would offer that doing your prenatal visits with your midwife
offers that elusive time and space to focus on yourself a bit
and to connect with being pregnant, something that happens so
much less during a second pregnancy already.
Congrats on the new baby!- So the first thing I would do if you haven't already is
onto the BAHC (BayAreaHomebirthCollective) yahoo group list. From there you could
pose the same question you did on the BPN. Midwives, Doulas and folks who've had
their babes at home are on the list.
That out of the way- I'll give you our experience. We have Kaiser and couldn't find a
way to get insurance to pay for a midwife- as it was we were a little late in finding
one- I was around 5 or 6 mos pregnant at the time. Luckily we had a little money
saved and our midwife had a sliding scale- I think several of them do. For a time I
was doing both appointments- my kaiser ones which lasted about five minuets and
seemed pointless- and my midwife ones which were about an hour and were quite
reassuring. I would imagine less need for reassurance however with a second child. I
was able to do most of my prenatal tests at kaiser and just show the midwife the
As it turned out we ended up at the hospital after a day and a half of hard labor and
very little progress. Things were complicated and likely would have ended in an
unnecessary c-section had the midwife and my mother ( who is in the profession)
not been there.So even though it was a big expense to have the midwife and we
ended up at the hospital anyway I'm thankful she was there. (And thankful that the
doctors respected her). Also as far as the prenatal appointments- there is no
comparison. ( Although I love my kaiser OB and Nurse Prac- they just don't have the
You may also want to check out the website www.birthways.org
While I don't know of any way to get Kaiser to pay for any of
the actual homebirth costs, you can certainly *use* them
for ''parallel care''--that is, attend prenatals at Kaiser so
that you can get any lab tests done by them. You might not be
able to *tell* them that you're planning to birth at home and
receive these services, but you could check that out first in
the form of a hypothetical question.
Most midwives will not give you a break for seeking parallel
care (some may even feel threatened by it or feel that it shows
a lack of faith on your part, but if you can't give your
midwife a nice respectful eye-roll now and then, find a new
one!). Midwifery prenatals are as much about building a
relationship with you as they are checking in on the baby--so
it doesn't actually ease the midwife's job for you to attend
prenatals elsewhere. That said, tell any prospective midwife
about your money concerns and see if there's any way they can
work with you or any way that you, as a confident second-time
mom, can ease her burden.
Lastly--even though you didn't ask--money was the number one
issue for me around having a home birth. I looked at it very
realistically as giving up 2 additional months home with my
baby &/or that much more debt. I'm a tightwad. Still, I chose
the homebirth and I haven't regretted it at all. Good luck.
I have Kaiser, and I just had a homebirth for my #2 in July, so
maybe I can help. We paid for the homebirth out of pocket... I
am 100% sure that you'd never be able to get Kaiser to cover
that. Here's what happened with us... I had a decent 1st birth
experience at Summit, and was expecting to have a hospital
birth this time too. Then we started visiting hospitals. We
wanted to have a midwife at the delivery, and so we were
limited to 2 choices. Oakland was not an option because they
don't have midwives. Walnut Creek was too full and not taking
transfers, and Hayward had rules about the number of people you
could have, which would have made it impossible to have our 4-
year-old with us for the birth.
So... at 36 weeks pregnant I started looking for homebirth
midwives. So basically, most of my care was done at Kaiser,
and the last month was done by the midwives. I assumed that
would mean that the midwives' fee would be less, but they
charged me about the same as they would have done if I'd
started out with them, because taking on someone at the end of
pregnancy is more risk for them. Their fee was an all-
inclusive amount - it covered all pre- and post-natal visits as
well as the birth. (It didn't cover any supplements or tests
they did though.)
However, I don't regret switching one bit. I don't even regret
the money, even thought money is a constant struggle for us. I
am so, so glad we switched - the difference between my hospital
birth and my homebirth was so pronounced. If I get pregnant
again, there is no question in my mind which option I would
choose. I only wish that I'd been with the midwives for the
whole pregnancy because I feel like the quality of their care
was so significantly better than the quality of the care I got
Some things that may help you: when I was calling around for
midwives, money was a prime concern for me. Many midwives I
talked to were willing to significantly lower their fees for
me, just so that I could have a homebirth. So do let them know
that it's an issue for you. Also- once I was under the
midwives' care, they still had me go to Kaiser for certain
tests because I could get them for free there, but would have
to pay for them if I did the tests through the midwives' lab.
Feel free to email me. Good luck with your decision.
FYI, Kaiser does not cover homebirth costs, period. That being
said, many Kaiser folks do homebirths, and they save on any
outside costs (lab work, ultrasounds, etc.), by doing all of that
through Kaiser. But if a midwife quotes you her fee, that will be
her fee. That won't include lab work and so on. Most folks who do
homebirth choose to do as many of their labs and so forth through
their insurance. The cost of the midwife is, sadly, not covered
by HMO's. It's a pretty sad statement regarding medical choice,
and the level of care you receive with a good homebirth midwife
cannot be matched! Good luck!
I have Kaiser but for various reasons plan to birth at home with a
midwife. Several people I know with other insurances who hves used her
got part or
all of her fee reimbursed.
I called Kaiser who said they only pay for out of Kaiser care if it's an
emergency or if
my Kaiser doctor says it's medically necessary to see an out of Kaiser
person. My doctor will not say it's medically necessary for me to have a
and I doubt I could get reimbursed if I give birth at home and say 'X
happened to be
in my house when I delivered and this is her fee' (I could try I
Has anyone managed to get Kaiser to pay for all or part of a homebirth
fee? (they run from 4-6K in the Bay area so it's not cheap)
kaiser won't pay for it. period. you can try to negotiate but you will
Has anyone had experience receiving their prenatal care at
Kaiser, and then switching to the home birth soon before your
If I end up having to go to the
hospital and don't have enough time to get to a Kaiser facility,
can I trust that Kaiser will cover the costs? Thanks.
Hi - We used Certified Nurse Midwives Jennifer Hess and Beah
Haber of Motherwell Midwifery (both also at Birth Home in
Pleasanton) as midwives for our two homebirths. For the first
birth, I was a Kaiser patient, for the second, I was a high
deductible Blue Shield client. I much preferred the prenatal
care available through Kaiser - especially from a cost
perspective. We ended up paying directly for the homebirths. The
blood work and genetic testing was easy and inexpensive with
Kaiser and was a hassle and expensive with Blue Shield. Kaiser
also uses more and more midwives in their OBGYN departments, so
that was really nice.
Regarding your actual question :), we understood that in any
emergency (including labor complications), we could go to the
nearest hospital, period. If we had more time, our preference
was to go to Kaiser Walnut Creek. Our experience with Beah &
Jennifer is that they have attended thousands of births and know
very well when a situation requiring a transfer is developing,
so transfers usually occur in a non-emergency vehicle (your
car) - of course this is the homebirth policy, the Birth Home
policy might be different.
ALSO, they tend to take only low risk clients, so your chances
of transferring are something like 7% or so.
Have a wonderful birth!
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