Choosing to have your baby at home is a deeply personal decision, one often rooted in moral beliefs and weighed carefully against safety concerns. Cost can sometimes take a backseat to these considerations. But with few insurance policies covering home birth and prices varying dramatically across the country, expectant parents planning a home birth can’t afford to make cost an afterthought.

“It had a huge bearing on our decision,” says Jessica Goldstein, 39, a family physician, an assistant professor of family and community medicine at the Medical College of Wisconsin, and a mother of three. “I considered it for my first birth, and I think the fact that it wasn’t covered by insurance led me to say I’m not going to do it.”

Less than 1 percent of U.S. births take place in the home, according to the Centers for Disease Control and Prevention (CDC). But that percentage has been rising, climbing from 0.56 percent in 2004 to 0.92 percent in 2013.

Goldstein, who recently documented her home birth experience in the medical journal Health Affairs, said the second time around was different, in outcome if not in potential cost. “I knew it wasn’t going to be covered. But when I got pregnant again, I had more time to think about it and went, ‘You know, this is something I really want to do.’ And I talked to my husband about it, and said, ‘We’re just going to pay for it,’ and so we did.”

Cost comparison

The cost of having a baby at a hospital is far from set in stone. A 2013 study found that vaginal births produced an average of more than $32,000 in charges to employer-based insurance companies. Another study, from the University of California, San Francisco, found that charges for vaginal births ranged from $3,296 to $37,227 in California alone. 

READ MORE: How Much Does Having a Baby Cost?

Home birth costs are typically based on the price of midwifery services, as 67 percent of home births in the U.S. were attended by a midwife in 2013. In most cases, insurance aside, uncomplicated home births are cheaper, costing an average of one-third the price of a hospital birth.

“I paid $4,500 out of pocket,” Goldstein says. Working in a hospital herself, she knew it was much cheaper than the total charges for an in-hospital birth.

“We originally balked at our midwife’s total fee of $3,500,” says Frances Manfrey, 35, a small-business owner and mother of two in the San Francisco Bay Area. “That all had to come out of pocket in regular payments, but we budgeted and made it work.” 

READ MORE: Your Guide To the Price Of an Ultrasound 

Know your coverage

“Had we went with the hospital, it would have cost me about $600 out of pocket,” Goldstein says. Her insurance covers labor and delivery in a hospital, but not at home.

Manfrey was more fortunate. She made payments to her midwife throughout the pregnancy. Afterward, the midwife’s billing service filed with her insurance, and Manfrey received a check for 90 percent of the costs. 

READ MORE: Where To Find Affordable Health Insurance 

Differing state laws on the licensing of midwives, paired with differences in insurance companies and policy nuances, means there’s no single right answer to whether a home birth will be covered by your insurance.

The Affordable Care Act requires that health insurance companies offer certified midwives the opportunity to join networks, but insurers might only cover their services in a hospital or birthing center. If you have Medicaid, the ACA requires midwife coverage but not necessarily in your home. And some states don’t even recognize midwives as legal practitioners. 

READ MORE: The Pros and Cons Of Obamacare 

In short, a local midwife may be able to help you understand the laws and general practices in your state, but you’ll ultimately need to contact your insurance company.

Make an informed decision

If home birth is even a possibility, take steps to ensure your costs will be manageable:
● Talk with a local midwife about laws and limitations in your state that may affect your insurance coverage.
● Call your insurance company to find out whether your plan covers all or part of home birth costs, and whether there are any in-network midwives in your area.
● Have a plan in place so that if an emergency happens and you have to be transferred to the hospital, you are sent to a hospital in your insurance network, helping to avoid unexpected and expensive medical bills.
● If you’re uninsured, talk with your midwife about payment plans.
Finally, budget for a potential emergency transfer. “We didn’t look closely into the potential cost of a hospital transfer,” Manfrey says. “Looking back on that, I’m even more grateful for the uncomplicated births we had.”

More and more families are exercising greater choice in where they have their babies. And as these families weigh the personal and safety concerns of home births, cost should similarly be at the forefront of their minds.