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Homebirth and Kaiser

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Homebirth-friendly East Bay Kaiser doc

Nov 2009

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). MB


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. Andi
hi! 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 :) Kendra


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! Good luck! veganmama
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.

Kaiser care after home birth

June 2009

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 continued coverage? 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 born in 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.

Good luck! -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 straightforward. Good luck! homebirthin' mama


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. robin
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. Kara
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! aki


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 juli

How to have a homebirth with Kaiser

February 2007

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



1. No
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 get 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 results.

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 time).

You may also want to check out the website www.birthways.org good-luck archaeomama


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. Katie


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 at Kaiser.

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. Jen


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! homebirther!

How to get Kaiser to pay for homebirth midwife?

October 2006

I have Kaiser but for various reasons plan to birth at home with a wonderful 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 healthcare person. My doctor will not say it's medically necessary for me to have a homebirth 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 suppose..)

Has anyone managed to get Kaiser to pay for all or part of a homebirth midwife's 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 probably lose.
kmom

Using Kaiser for pre-natal care for home birth

June 2004

Has anyone had experience receiving their prenatal care at Kaiser, and then switching to the home birth soon before your due date? 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. a soon-to-be-mama


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! Christina
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