The Patient Protection and Affordable Care Act (ACA), also referred to as Obamacare, strives to create a streamlined, unified system of medical care across the nation. It is based on 10 key elements of minimum coverage, one of which is access to maternity care for all women in the United States. The law is new and not fully implemented yet; questions and discrepancies remain. One issue of concern to a growing number of American women is the lack of uniformity for birthing center coverage.

Insurance policy paperworkCurrently, the law is being handled differently from state to state and between private insurers, such as employer-based policies, and government-sponsored coverage plans, such as Medicaid. In all instances, hospital-based maternity care, including the use of an obstetrician, are standard and required for all but birthing centers and midwife services are not uniformly covered.

The number of American women giving birth outside the hospital setting is still small but growing significantly. According to the US Centers for Disease Control and Prevention (CDC), births occurring by choice in places other than a hospital grew 70% from 2004 to 2012. In 2012, 53,635 occurred by choice outside a hospital, a number that represents only 1.36% of all births in the US that year. Of these outside-hospital births, 29% (15,577) happened in free-standing birthing centers. Most of the remainder were at-home births.

The clinical feel of a hospital maternity ward is one reason many women cite for choosing birthing centers and home births. Another reason is cost. Data from the American Association of Birth Centers and the Agency for Healthcare Research and Quality indicates the average cost of an in-hospital vaginal birth with no complications was $10,166 in 2010 but only $2,277 in a birthing center.

Birthing centers are usually staffed by midwives, doulas, nurses, and other highly trained individuals but these centers sometimes lack the full spectrum of medical options found in the typical hospital maternity department. Women expecting no complications of childbirth often find the more comforting, familiar environment of a birthing center and midwives to be more attractive than a medical facility.

Women covered under Medicaid are allowed to use birthing centers and midwifery services as long as the center and attending midwife are certified according to federal guidelines. Private insurance providers, however, may not cover these birthing services.

If birthing centers and midwife services are covered, they must come from providers within the private insurance company’s list of providers. These services aren’t always available in a patient’s geographic service area and some private policies exclude these services altogether. Sometimes exceptions are allowed but there is no guarantee. Many soon-to-be parents must cover the cost of midwives and birthing centers as out-of-pocket, private expenses.

Source: Andrews, Michelle. “Health Law Provides No Guarantees Of Access to Birthing Centers.” NPR Shots. NPR. Mar 4, 2014. Web. Mar 11, 2014.