Tuesday, December 21, 2010

When Money Talks - Homebirth vs Circumcision

In Southern Utah where I live, there are a lot of college students, most of them married, and a lot of them, even the ones out of college, are uninsured. The vast majority of families use Medicaid.

Everywhere around here are smaller towns, so the job market isn't that big, and the jobs we do have don't pay very much, so it is really hard to find affordable health insurance for families, and Medicaid is always there as a fall back, especially if they are pregnant since it covers basically everything without a copay or denial.

I was on Medicaid with my daughter, and in our first appointment they told us what was covered and what wasn't so we would know. The one thing that didn't really shock me was circumcision. This was also back when I thought it was the better thing to do, and when they said that they would not cover it since it is considered a cosmetic surgery, I didn't bat an eye. If we had a son, we would figure out how to pay for it out of pocket.

Medicaid also doesn't cover out of hospital birth except for one Birthing Center in Northern Utah, but that is the only insurance they are allowed to accept and they have a very tight licensing agreement to keep their Medicaid agreement.

Working with my midwife, I am always shocked at how many people talk about not affording a homebirth, but considering if they birth in the hospital with Medicaid, they pay absolutely nothing except a circumcision if that is what they choose to do to their son.

This last weekend I found out how much a circumcision costs a family on Medicaid.

As a bit of back story, the midwife I work with charges $900-$1500 for all of pregnancy, the birth, and postpartum. We have all the instruments needed to give you the same care you would have in the hospital, and an amazing back-up OB in case more tests are needed or if they want an ultrasound. Women on Medicaid get a discount, and she barters, so you are getting a steal for everything she covers for so little.

A circumcision if you are on Medicaid and pay out of pocket is $800-$1500 depending on your pediatrician, what anesthetics are used, and other factors.

I have yet to hear the excuse from people that they didn't circumcise their son because they couldn't afford it, yet I hear women that want a homebirth on Medicaid say they cannot afford to pay.

I find it absolutely amazing that they are able to come up with the money to cut their child without a second thought, yet money is the very first excuse they give not to birth at home when they are the same exact price.

Why do they not question cutting their child's genitals when even Medicaid considers it an elective cosmetic surgery? Do people not read the fine print or are they just going along with what they have learned their entire life, that circumcision keeps the penis clean, and foreskin is there to be removed?

Does it truly come down to money as the reason to not have a homebirth, or is it just another excuse to use?

If you had the choice to have a homebirth or cut your son's penis, which would be more important to you? Having your son look like his father, or have less infection as some people believe against the research, or having a peaceful, natural birth?

Does it come down to importance, or is it again just an excuse that we hide behind so we don't have to make the choice between the two?


Maria said... [Reply to comment]

I wouldn't cut my son if you paid ME. I'm not pregnant yet, but already figuring out how to save the $3k for a home birth. Not to sound like a broken record, but I wouldn't have another baby in a hospital even if you paid me. LOL

fearlesschef said... [Reply to comment]

I did a homebirth in Ohio and my MW charged $1090 for the birth and the 2 post-partum checks. Any visits to her, the frequency of which was determined by me, were $45. At first glance, it looked like we were going to pay more with a MW, but a friend with our same insurance (and the same MW) called the local hospital to see what the base cost of a vaginal birth is. The birth ALONE, not including even the cursory iv or the rooming costs or the actual care for the baby is $1200. But no one ever just births, they "have" to do all the other stuff as well.

A circumcision in the hospital is considered an outpatient procedure, therefore the insurance was billed well over $1000 per child. However, you do have to go to the hospital and deal with all that hoopla. Our MW told us of a Jewish rabbi who was willing to travel to non-Jewish homes to do the procedure as though it were a bris. In my opinion, if that was a deciding factor as to whether or not to do a homebirth, I would have been doing my research to see if I could find someone willing to do that for me as well. Since that wasn't a factor for our decision, I can't speak for this man, but I would have to assume that no matter what the procedure, if you have the opportunity to do it in your home where you feel safe and comfortable, that would be the way to go.

Julian@connectedmom said... [Reply to comment]

Having been born and raised with socialized medicine I can't really speak to the decisions that parents make financially.

What I can say is that the classification of circumcision as a cosmetic procedure not covered by medicare in Canada resulted in a HUGE drop in circumcision rates.

I don't know if it's just that the very thought of PAYING a doctor to do something is kind of shocking to Canadians of my generation, but having to pay just $200 (After reading this I think it should be more, I though 200 was steep, but apparently it's really cheap)for a cosmetic procedure on an infant is enough to deter most parents from having their sons cut.

Also, I love Canada! $1000 for a BIRTH!?!? I am the one doing all the work! That's what I pay taxes for.

flowers said... [Reply to comment]

I would have to say that they are using the money as an excuse and they actually feel more comfortable birthing in a medical facility.

ErinKate23 said... [Reply to comment]

Good article! You may not have heard of skipping circumcision for cost reasons (me either), but Medicaid funding of RIC is a very interesting topic. States that don't fund it have a drastically lower RIC rate. I don't know if that's for cost reasons, or if the nonpayment helps people realize that circumcision is unnecessary cosmetic surgery. Either way, the lack of medicaid funding for circumcision is pointed to as a major reason for the drop in RIC rates.

Good link here:

Kayce Pearson said... [Reply to comment]

I am loving the comments! <3

I do know that a lot of women say they want a homebirth, and use money as a huge excuse. I know that a lot of women that truly want one will pay for it even if they have to scrape together every penny from underneath the couch.

I guess the entire idea baffles me a bit since they cost the same, but people are more likely to pay for a cosmetic procedure to make their son look like daddy than paying for a birth they say they can't afford.

Sadly, Utah's circumcision rates are still higher than I would ever like them to be, which is strange since the majority of people here are LDS (Mormon) and we don't do it for religious reasons. I think it all comes down to what is most important, even though cutting your son should never even be an option.

Post a Comment