Backing at-home births
House passes bill broadening insurance coverage for moms
By Margot Sanger-KatzMonitor staff
January 17. 2008 12:43AM
Parents pushing strollers and toting bottles came to the State House yesterday to show their support for a law that might affect where they deliver their next baby.
Yesterday, the house passed a bill that would require insurance companies to reimburse mothers who chose to deliver their children with a midwife at home rather than with a doctor in a hospital. The measure, which already passed the Senate, won legislators' support by a sizeable margin, 226-111.
The bill builds on New Hampshire 's long history of supporting alternatives to hospital birth. For more than 20 years, the state has permitted "lay midwives" who do not have medical or nursing degrees to practice in the state once they obtain proper training. Two years ago, it approved a measure that required health insurers to pay for deliveries in birthing centers run by midwives.
The newest bill does not change much other than the range of places where a woman can deliver her baby, but that choice is critical, many of the bill's advocates said.
"This gives women a real choice," said Rep. Jim Martin of Sanbornville, a Republican who was one of the bill's sponsors.
Midwives who supported the measure said that they treat many women who would prefer to deliver their children at home but opt for a birthing center or hospital because they find it too expensive to pay for a midwife's services out of pocket. According to Martin's testimony yesterday, a midwife's services generally cost $3,000 to $4,000 for prenatal and delivery care, while prenatal care and an uncomplicated hospital delivery generally cost between $12,000 and $15,000. But for women with health insurance, the choice is not between a $4,000 and a $15,000 price tag, it's between a $4,000 price tag and an insurance deductible.
Because of slight differences in amendments to the bill, it will not go directly to the governor's desk. Colin Manning, the spokesman for Gov. John Lynch, said his office could not comment on the bill yesterday because of the discrepancy.
"That bill was amended today, so the governor is going to need to look at the changes that were made," he said.
New Hampshire has long been a leader on midwifery issues. As of last year, 11 states ban lay midwifery altogether, according to Midwives Alliance of North America, a professional organization. In New Hampshire , the state has not only allowed for formal endorsement of midwives' work since the 1980s, but also requires Medicaid coverage for midwifery services.
Carol Leonard, a midwife and longtime advocate for her group's cause at the State House, said that since the Legislature began requiring insurance payment for birthing center births, the number of babies delivered at such centers increased by 600 percent.
Critics of yesterday's bill expressed concerns yesterday that endorsing home births might increase the dangers to pregnant women and their children. Accidents or unforeseen medical emergencies could be more difficult to treat outside of a professional setting, they said.
"We just do not know the risk of home births," said Rep. Mathew Houde of Plainfield . "We do not know how accessible a home will be if there is an emergency."
And despite the apparent cost savings, the state's health insurers opposed the bill, according to legislators.
But advocates of the bill said that the fear of complications was overblown and pointed out that the state already allows midwives to deliver babies at home, a measure the legislature has long supported. Existing law aims to protect against bad outcomes by requiring midwives to transfer any high-risk pregnancies, like multiples or breach infants, to obstetricians. The system has worked well, Leonard said. About 8 percent of midwives' cases here end up referred to medical professionals at some point in the pregnancy, and no midwife in the state has ever been sued for malpractice.
"This is not about the practice of midwifery," said Rep. Martha McLeod of Franconia , a Democrat who testified in favor of the bill. "This is a bill about the business of midwifery."
Matt and Heather Moran, who visited the state house yesterday with their children, Piper, 8 months, and Laela, 3, said they'd had wonderful experiences delivering in a birthing center.
"We're here to represent the out-of-hospital birth," Heather said, as Laela and midwife Jeanne Brown exchanged memories of the family's recent visits to the center. "We'd do a home birth the third time."
Yesterday, the midwives and their clients formed a visible block in the State House lobby, as they handed out yellow sheets asking House members to vote their way, and, in one case, breastfed an infant.
Surrounded by a few of her supporters yesterday morning, Leonard expressed concern that debate about other bills would push the discussion of theirs into the afternoon.
"I hope it's not too long," she said. "They get so crabby."
She was talking about the legislators.
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By MARGOT SANGER-KATZ
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