My very first “all’s well” prenatal appointment with a nurse midwife came with a $16,000 bill. My husband and I were graduate students, which meant that we were frugal, but we were also good at research. We had priced getting pregnant beforehand. That one bill, a single cystic fibrosis test (for which I’d been quoted $180 by the lab), cost more than we expected to pay for prenatal care and the birth. Our new-baby euphoria all but fizzled as we realized we would be playing nine months of Russian roulette with medical bills.
No toys for you, baby!
Of course, I fought. Over the phone, in person, in writing, at every level. But one night, when my husband got home and found me drafting new letters to collection agencies and insurance companies, he confiscated my file folder jammed full of phone calls transcriptions, lists of names, copies of letters sent.
“You’re done,” he said.
I did not intend, however, to take my grudge against the U.S. health care system so far that our next child would not be born a U.S. citizen.
But there would be a next time, and next time, I vowed, I would not be a pawn in the game hospitals and insurance companies play with one another.
I did not intend, however, to take my grudge against the U.S. health care system so far that our next child would not be born a U.S. citizen — my husband, even keel to my crusader bent, would never be swayed into something so ridiculous. But here we are.
An interview with Viviana of Mamás y Bebés
Viviana is the woman behind the super awesome Spanish-language website Mamás y Bebés. In this interview we talk babies and compare/contrast North American and Central... Read more
In January, if all goes well, I will deliver my second baby in highland Mexico. While there are some terrifying components to this arrangement — mostly having to do with language barriers and cultural differences — I confess that I am mostly relieved.
The farther I progress in my pregnancy, and the more experiences I have with the medical culture of Mexico, the more relieved I become.
This is not because I imagine for one moment that Mexico is a paragon of modern medicine or that my experiences translate into those of Mexicans across the country, or any of that. And I could very well change my mind entirely before this whole ordeal is through. For now, I am basking in the simple one-on-one humanity that I have been met with so far.
Imagine, if you will, walking into a bright, sunlit hospital where the waiting area for a given doctor has fewer than a dozen chairs. The receptionist-nurse greets you and apologizes because the doctor will be just a minute. There are no forms.
When the minute is up, the nurse waves you over and you walk down a passageway into the doctor’s office. By office, I don’t mean exam room. I mean a room that is taken up primarily with a large wooden desk. There isn’t clutter, exactly, but the desk isn’t a sterile field either. There’s a computer, files, photographs, and a few anatomical models. It might be a professor’s desk, or a lawyer’s.
Dr. O., a man in his early forties who looks a bit like a chubby Charlie Chaplin but thankfully isn’t funny, stands up and comes around the desk to shake hands with you and your spouse. Then he gestures to the two leather chairs opposite his own.
For half an hour, sitting in chairs, all parties fully dressed and eye-level with one another, the doctor asks and answers questions, occasionally fleshing out the database form on his computer. Of course, there are language barriers, Spanish vs. English and metric vs. imperial systems, but these are patiently overcome. Only once you and the doctor are satisfied is there any move towards the exam room.
The doctor shows you the bathroom and hands you a cotton gown to put on. When you come out, the nurse who has come in for this second phase helps you onto the scale (which reports in kilograms, a blissfully meaningless number), but it is the doctor himself who takes your blood pressure and raps on your kneecaps with that little hammer. Then there is an ultrasound: the right number of everything, a strong heartbeat, oh, and it’s a boy.
A few minutes later, you are dressed again and sitting in the leather office chairs. The doctor hands you a DVD of the ultrasound, tells you to schedule your next appointment in four weeks, and shakes hands all around again. As you leave, you pay the receptionist for the appointment. 500 pesos, or about $40.
Maybe there are doctors in the US who treat patients this way, but I have never met them. I don’t doubt that a majority of doctors would like to treat patients this way, if only the system would allow it.
Of course, as tickled as I am by Dr. O.’s system in terms of how I stand to benefit from it, I can see how aspects might make Dr. O.’s life miserable.
For one, Dr. O. isn’t part of a practice.
“Of course, I will deliver your baby,” he told me during my second appointment. This made my husband and I giggle. Our first child was delivered just after a shift change at our hospital: the midwife and delivery nurses who oversaw our son’s birth had only just arrived. We learned the midwife’s name from the birth certificate.
Furthermore, while Dr. O.’s consultorio is located in a hospital, he operates independently.
“You pick the hospital,” Dr. O. explained. “Then you call me, and I will come there when you are in labor.”
So now we embark on a project to compare birth packages at various hospitals around the city. To this end we are handed glossy brochures with descriptions of rooms and their amenities, birth classes, and a la carte items — like a bed for my husband and extended stays. Our options include private and public hospitals, and we will weigh in details like proximity to our home, but it is thrilling to be able to choose.
I know Mexico is no medical utopia, not by a long shot. But it is a treat to feel like a consumer, rather than a rat in a maze.
Better still, without inexplicable medical bills to hyperventilate over, or hours lost pushing 1 for English and 3 for billing and then languishing on hold, I sure feel a whole lot healthier.
Wow! I don’t blame you for disliking the American medical system…I had home births for the same reason! I would love to know what your experience is in Mexico after you give birth!
I’m very curious about the outcome of this experience as well. I hope for a great experience and a healthy baby. I hope to see a follow-up article.
So thankful I live in Canada.
I second that!
How was the experience in canada? is it expensive?
This is a late reply, but health care in Canada in free, so no, it wouldn’t be expensive. Midwives are free as well, if you can find one (there’s a shortage). You do have to pay for drugs you buy from a pharamacy (as far as I know), but not if you’re in a hospital.
Home birth! For exactly this reason. Pregnancy is not (usually) a medical condition.
Amen! It’s not a medical condition. As a doula I despise the way the USA treats pregnancy. Being with child should be a wonderful experience yet here instead it’s a stressful experience for the most part rather than the joyful journey it should be. Instead of support based it’s about money, drugs and surgery more often than not. I sure wish it was different.
I am an American living in Sao Paulo, Brazil and will be delivering our first baby this March. Our experience here is very similar to the one you describe! People keep asking me why we aren’t coming back the the US for the birth – and I can’t think of a reason to leave! I haven’t delivered in the US, but have had a lot of experience with the medical system. What a pleasantly different experience. :o)
Right now I feel incredibly grateful for the NHS, faults and all.
That is interesting. I am due for a second baby in May, my first in the UK and so far I have not been thrilled with pre-natal care and I am dreading the birth experience with the NHS 🙁 I did not have a straightforward, vaginal birth the first time around but I did have stellar care (similar to the author’s!).
I’ll get off my wah-wah box now. But. I really was just tabulating how much it would cost me to get just the post-natal care I want (which would be half of what I got first time around) and yo. The numbers just don’t make sense for our budget 🙁
I am from Monterrey Mexico and used to getting my procedures there. My parents and sister are physitians. After moving to the US I have had no-so-great experiences wth doctors and ave now shied away form getting medican procdures asmuch as possible and lots ornatural prevention just to keep me away. Its interesting to see how fear-based my relatoinship with themedical system is here I had never experienced that when I lived back home ad most of the Doctors I worked with had at last some studies completed in the US – In Monterrey English is pretty normal tho but it is also a more expensive city. Good luck and if you ever need a second opinion let me know I will get you in contact with my mom who now works for the national department of health.
Wow, that’s pretty great! I didn’t even think of that as an option for my wife and I.
We just delivered 3 weeks ago here in the US, and though our hospital is rated as “Baby Friendly” by unicef, there was still the latent hyper-medicating vibe. The sort of assumption, “There must be something wrong with you since you’re in a hospital — Only unwell people are in the hospital.” idea cropped up a lot. (As soon as a nurse sees an IV the demeanor goes from 0: oh you’re just having a baby, to 5: there’s something wrong that needs to be managed. )
Good luck to you. It sounds like you’re getting things covered. Best wishes for a healthy baby!
I had a pregnancy scare a few weeks ago and the most terrifying part was that I had no idea how I would pay for the midwife attended homebirth I would want. It’s sad that class and privlege dictate the kind of births we have.
I’m in the seventh month of an unexpected pregnancy. My husband and I were postponing this desired step in our lives as I had recently been laid off and we were without health insurance (or jobs that paid living wages). Luckily (which is a relative term) I am able to access my state’s version of MedicAid, and even more luckily, I’ve found a midwife nearby that accepts it. All I have to pay is a $300 assistant’s fee. In reality, I’m costing the state many many thousands of dollars less than I would if I chose to give birth in a hospital (potentially up to $30,000 — my care will cost $2300 in total).
If you’re in the states, this is an option worth looking into.
Where did you find the midwife that accepts medicaid? I haven’t had any luck. Do you have a website to reference? Thank you.
Me too me too! I also want to know how you found a midwife that accepts MedicAid! And also, I really want to wish you the best. My boyfriend and I are in the same situation.
Do you live near a hospital that has Certified Nurse Midwives? When I gave birth I was on OHP (Oregon’s Medicaid) and the hospital nearest us had CNMs and also accepted OHP. There are also a few midwives around town who can accept it, but I think it’s trickier for them.
I do ALSO think there are midwives who work on a sliding scale rate or let you make payments — might be worth a Google run?
It’s funny.. a few years back I had the same thing happen (Pregnancy-scare, as we weren’t trying then and my province didn’t cover midwives). However, now my province covers midwives, and there aren’t enough to go around, so even if I had millions, I would have a very tough time getting one…. if I got one at all. That worries me a lot!
My birth was well-handled and cared for here in the US, but we were also on State-covered insurance; our son was unplanned. And that’s not all utopia and sunshine on it’s own, but I was lucky in that my OB was down-to-earth (if a bit brusque) and the hospital was laid back and not so intervention-happy.
What pisses me off about the US system is that it’s now dictating how we build our family in terms of cost. We could afford another baby, we want another baby — but because of the cost of birthing said baby, there is not another child on our horizon for some time.
I delivered at a small hospital, where my OB practiced. They fulfilled my 2 requests: have a bag of B- waiting for me and don’t let me die.
I have fast deliveries and hemorrhaged both times. I had my own nurse in the room with me for 12 hours afterward. I also had a lactation consultant that visited me 3 times a day and that gave out her home number in case I needed her again. It was a fantastic experience. It makes me really sad that not everyone can have that. The best part would be that the copay per OB visit was 10.00 and for the birth was 150.00. The “before insurance” cost for the birth was 7600.00, we are incredibly blessed to have such great insurance, but I feel everyone should have the experience they want at a decent price.
Agreed. We spent a lot of our own money on our own lactation consultant, but the actual prenatal care and (vaginal, but with epidural) delivery costs were a ONE TIME $25 copay on prenatal care and a $300 copay on labor and delivery. $325.00 — plus lactation consultant expenses. This was great for us, but it is infuriating that so many people with different or no insurance feel they cannot afford to have children they want.
And as a PS, I had five ultrasounds (due to some issues), various rounds of blood work, four non-stress tests, and the 3.5 hour gestational diabetes screening, and this was all covered by a single $25 co-pay.
Assuming you or your partner is a US citizen, your children will be US citizens no matter where they are born! You have to fill out a form to get documentation of their citizenship (this one: http://travel.state.gov/law/family_issues/birth/birth_593.html), but by law, they are natural-born US citizens.
I don’t know how Mexican citizenship laws work, but I know that since I’m a permanent resident in Australia, any kids I bear here will be dual citizens! How cool is that?
But I definitely know where you’re coming from – I’ve told my partner that if we decide to bake our own baby, we’re doing it here. Not only is the cost of birthing a baby in the US ridiculously high, but the cost of assisted conception is even more ridiculous. (It’s not exactly cheap here, but comparatively, it’s nothing!)
$16,000?! My bill before the insurance paid it was $800 for the test this past September. Just goes to show how much the costs fluctuate……..crazy.
How frustrating but great you found an alternative. I have heard all kinds of birth stories from several friends who live overseas and its not always peachy there either. I think a lot of a positive birth experience comes from being prepared, educated and informed of your choices!
I feel like that has to be a typo or we’re not getting the entire story. I’ve never heard of a single blood test costing anything like that much. The full panel that was run when I was pregnant with my first cost an unexpected $1200 because while the hospital was a participating provider with our insurance the lab wasn’t. By the time I had my second they’d worked it out so that those of us in that situation payed $50 for the panel.
i am eager to see how this turns out!
I agree with you – the US mainstream medical system is expensive and unsafe. Mexico has a c-section rate of 80% in many places. It is one of the last places I would ever choose to have a baby. Midwives are thriving in the United States. For those who are not comfortable with a homebirth, I encourage you to check out a birth center. (www.taosbirth.blogspot.com or http://www.nnmbirthcenter.org) It is inexpensive and extremely safe. Lots of luck to you!
I think it’s nuts how even people with insurance are facing insanely high costs for giving birth. DH and I are extremely lucky in that the HMO he gets though work is great. We paid a grand total of $200 out of pocket for our son’s birth. We had a $20 copay for the first visit confirming the pregnancy, no copays for any visit after that, a $30 copay for the one ultrasound, and a $150 copay for the birth and hospital stay afterward.
It’s difficult not to compare our healthcare system with those in 3rd wold countries in that only the wealthy have access to health care.
Totally true. This is how I felt with my $325.00 prenatal care and labor and delivery care. The sheer fact that we have secure affordable good health insurance makes us wealthy, even though we aren’t all that wealthy (but not poor) in a general sense.
It’s really upsetting to me that what we took for granted — I mean, I NEVER worried about the cost of HAVING the child, just the cost of raising it — is so stressful for so many people.
Holy Crap! Are you joking me, I just came back from Mexico and fell in love…I live in Colorado. People treat you like you are a person: look you in the eye, ask you how you are, what you need. it’s nearly mind-blowing. (not to mention how lovely the sun is and the sea and the sand and the sun again) I have been set on having my kids with a midwife since i was…actually a nanny for a midwife in high school. you could say I have authority issues, but i flat don’t like being told what to do and when and how by someone who does not know me at all. I also think if it doesn’t hurt that bad you don’t need to take anything for it. and if it ain’t broke, don’t mess with it!
I love your unwillingness to let the birth of your own child be dictated by this crappy system just because you are an american. I LOVE that you looked for what fit what you want instead of fitting yourself into whats offered. I hope your experience is just exactly what you were wanting it to be:o) Rock on Girl
stories like this make me so thankful to be canadian–and so aware of how like many canadians, I take our medical system for granted. i’m so sorry you have to go through this!
Me too…I always felt lucky to be Canadian, but since getting pregnant it’s intensified, hearing about the hell that American women have to go through (both with regards to health care AND mat leave policies!). I simply cannot wrap my mind around the concept of NOT having health care.
As much as I love having health care (and I do!), we Canadian have other issues. Being in Alberta, we have a midwife shortage, and many of us aren’t going to have the option of having a midwife. We are lucky, but we still could get better!
I don’t know about Alberta. In NS we have a midwife shortage too, but the hospital in Halifax is pretty awesome as far as natural birth, birth plan etc.
There’s a midwife shortage all over the country, but there are also only 3 universities in the country where one can become a midwife and the entry is incredibly difficult and competitive. The numbers (in BC at least) are on the rise however, so here’s hoping things get better in that respect.
Are you and your husband not US citizens? As long as one of you are, your baby is automatically a US citizen no matter where in the world it’s born. I lived most my life in US but am Austrian, my husband American. We are now living in Austria and about to give birth. Usually Austria only allows for one citizenship but because our child will have one US parent they legally cannot deny our child either citizenship’s and so our baby automatically gets both 🙂 You’ll just have to go to your embassy and fill out some paperwork, and viola, citizenship papers and passport for baby.
$16,000! Wow.
As an Australian I guess I’ve taken it for granted that having a baby is free, health insurance or not. I cant imagine how stressful it would be having to worry about paying for your pregnancy and birth on top of everything else babies cost.
As for pre-natal care I am finding the Australian health care system to be very laid back. Pregnancy is considered a natural process rather than a medical issue and you deal a lot more with midwives than doctors, unless there is complications.
I’m really glad you found another way of birthing your baby than dealing with a system you dont want to be in. Good luck with everything!
I would have to agree – I cannot comprehend that you would have to pay to give birth.
As a public (no insurance) patient here in Aus, I can choose from midwife teams in a natural birthing center (attached to the hospital), regular hospital care, or shared care with my usual GP. all for free. And either way midwives are a common aspect of care here.
I have chosen shared care as it means a can have most of my appointments with a doctor I already know and trust. Some of my scans I will have at the hospital for free, but some I have privately as it means less time off work (travel, waiting)… even still, these only cost me about AU$50
Subsidised medical systems may have their flaws, but it has had many, many benefits for my family, and I try not to take it for granted.
Yes!
Here in NZ, we have paid about $100 all up for pregnancy-related stuff: part co-pay on one ultrasound, a couple of prescriptions and the original appointment at my GP to confirm the pregnancy.
Our additional scans and non-stress tests will all be covered. Thank goodness.
As others have said, American citizens have the right to apply for citizenship of their children regardless of where they are born. I’ve lived in the UK since before having children and they all have the right to it if applied before their 18th birthday (I haven’t done so yet as I’m not sure the pros outweigh the cons).
Personally, I wouldn’t birth or give money to medical establishment in Mexico with the many well-known cases of sterilizations without consent, particularly to the indigenous and poorer women of the country.
From what I understand, you don’t apply as such – you’re considered a US citizen from birth no matter what! It’s just the paperwork. 😉
Wow that is such an interesting article! I really hope you will write about your experience again after the birth.
Sending you happy thoughts and good wishes!
Wow. I wonder if it depends on where you live in the U.S. I had wonderful experiences with the midwives in the medical group I visited. (I don’t know if I”m supposed to say who they are) They practice at the regular family clinics in the area, and have privileges at two of the three hospitals in the group. They would never leave at shift change if a mom was just about to give birth. My midwife even came in to the OR with me when I had to have a last minute c-section, just for support. I”m very surprised that you couldn’t find a provider you liked in the country.
Maybe I just don’t know how good I have it. Also I do have insurance and my deductible was $2500, so cost wasnt a factor, and most places are covered.
I feel really lucky — so far my experience has been overwhelmingly positive. I live in Massachusetts, in a region which is home to one of the country’s best Birth Centers. It is located on the campus of a hospital (which is where I go for ultrasounds and bloodwork) but in a separate building. The midwives are all CNMs, but as long as you’re in the center, there is no medication (if you request an epidural, you are transferred across the parking lot to the hospital). The receptionist knows my name. I can visit my midwives as much as I like — in addition to my monthly visits, I’ve dropped in for a couple of OMG I’M PANICKING visits — and I get charged no copay. I’m meeting all the midwives before the birth, and while the person actually delivering my baby will depend on who’s scheduled, I like and trust everyone so far.
I know that not everyone is lucky enough to have this kind of resource. I feel blessed that I do.
It’s lovely to see that we are not the only couple turned off by the American system. We were turned off by experiences with the American medical system to the point that neither of us really saw kids as a realistic option, until we moved to Troncones, and started to learn about and live in the system here. After a few visits to Mexican doctors, we are much more comfortable with the idea of baby-having and are planning for sometime late next year.
My family had considered moving to another country largely due to our dislike of the United States medical system (among other things.) I’m not hating on the US. I realize we have things better than a lot of places in the world but there are a lot of things that I wish were different and so far my pettitions and letters to congress haven’t changed things. I remember when I watched Micheal Moore’s Sicko for the first time. I was amazed at the quality of medical care people were recieving in other countries because we are taught by the government and media that we as Americans have the best of everything in the whole wide world. I’ve learned that isn’t always the case and therefore have begun to expand my horizions.