I just watched "The Business of Being Born", and want to learn more about midwifrey care. What do I look for in  midwife, and what kind of questions should I ask?  Thanks you.



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If you have friends who have used midwives, start there for referrals. If you don't, you could check online for some names in your area. Make some calls and set up a few consultations.
Good questions to ask what their philosophy is on pain management or relief, how many births they've attended, if they offer a childbirth prep class or can refer you to one. You will also want to know whether they are a Certified Nurse Midwife or a Certified Professional Midwife. I had both a CNM and a CPM at my first birth, and I noticed that they did basically the same thing. One difference is that the CNM could prescribe drugs and my CPM cannot. I'm sure someone else can elaborate more on the difference but both are a valid choice, IMO.
You will probably find some whose personalities you click with more than others. That is a totally personal call, more of a gut instinct. What I love about using a midwife is that you develop a relationship with her, rather than in an OB practice where you see a nurse for half the time and then spend maybe 10 minutes with the doc. Not saying that you can't develop a relationship with an OB but it is more personal with a midwife.
Thank you Mandy for sharing your wisdome with me. None of my friends have had home births, they think I'm crazy for wanting a homebirth. I clicked with one midwife by phone - she answered a lot of questions, but when it came to insurance and she mentioned that my insurance will not pay her. Her explanation was that she is recognized as a midwife in Texas, but does not have a master's degree. Does that sound right? I called my insurance and they said that they do cover midwifery care but only have one listed midwife in my area considered in network. I called her but it's more like a OB clinic - she sees you and then sends you to a hospital about 40 miles from her clinic. Weird. Anyway, do you happen to know any resources that I can look into about insurance? Not interested in buying new insurance but learning how to get this covered with the midwife I choose with the insurance I alrady have...BCBS-PPO? Thank you.
Do you know around how much the cost is? I have spoken to one midwife by phone and she charges $4,000.00. Is that about right?
There is a big range. I am using a student MW backed up by a CPM and the fee is $2,500. The CPM attended my first birth so it was a way for me to get her on a discount, because her normal fee is $3,000. That includes every service though, and no bills after the birth. My first MW was a CNM who was a BCBS preferred provider. She operates a free-standing birth center (not hospital affiliated).
If you are in the North Texas area I can tell you who I used and who I'm using now - email me: ac_hand9@yahoo.com
Hi Lylian! One thing I've heard people have done successfully is pay upfront for the midwife fees, then personally bill the insurance to be reimbursed for all or part of the cost. It's a bit of a gamble, but I've heard it often works. Unfortunately, it's no guarantee that they'll pay. Just a thought. Best of luck to you!

I too am in Texas and had the same coverage issues you are talking about w/Cigna my insurance. The only Midwifes in my network only delivered in a hospital but I wanted a Homebirth. So here is the low down...

In Texas there are 2 types of Midwives licensed to practice. 1) CPM--no Masters degree, not a nurse, but certified through Texas Midwifery Board 2) CNM--RN with a Masters degree (also called an advance practice nurse) they can also be certified to prescribe. For the most part insurance will cover CNM but not CPM. Most, but not all CNMs work out of OB offices and deliver in hospitals. Both types MUST work in consultation with, although not necessarily in the same "physical location" as a OB. for more info about licensing info and to find a midwife in Texas go to http://www.dshs.state.tx.us/midwife/default.shtm

This is how I made Cigna cover my Out of Network CNM as in network. Texas state law says that if your ins covers a physician/service but there are none in the network in your area they must allow you to see a physician/service in your area and cover them as in network--this is called a "network exception or GAP coverage. Cigna covers Birthing Centers and Midwives but the only MW in my network in my area only delivered in the hospital. The closest in network MW that did out of hospital (birthing center or homebirth) was 76 miles away.

I petitioned for and recieved a NEA for a local MW that worked out of a birthing center but also did home births. I simply told them that they cover MW & BC but had none in network in my area and I wanted an OOH birth but the local network could not provide that for me. It took lots of calls and lots of insistance (by me and the Ins Coordinator at the BC including letting them know I am aware of the state law about this) and threats to file a complaint w/the TX Ins Board, but finally it was approved and they paid for my MW & Homebirth at in network benefit levels.

So this may work for you also. I know that BCBS covers BC and MW so you should be able to push for getting a NEA or GAP coverage for a MW that does OOH births. Even if you don't use a local BC they are a great place to go for names of MW that do Home Births. Just keep telling BCBS that you want an OOH birth (don't say homebirth say out of hospital) and they dont have a local MW in network that can provide that for you. Dont take no for an answer.

Any chance you are in the Dallas area? If so I can give you lots of names of CNM that do HB.

Feel free to message me if you have any questions. My Homebirth was a beautiful experience and was worth the fight w/cigna to get it. Good Luck.



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