One of the longest standing battles in the birthing community is over ducats. Should we charge, and if so, how much? Are we obligated to do volunteer births, and if so, how often? Health insurance in the United States doesn’t cover doula services (although you may be eligible for reimbursement, find out more here) so these discussions will never go away. One strong argument from experienced doulas draws a parallel to sexism when it comes to doulas setting fees.
Our profession has historically been and is currently largely made up of women. We’ve been socialized to meekness, to always seek acceptance, ever offering apologies, and not wanting to rock the boat. We give of ourselves before giving to ourselves, leaving us burned out too fast and too often. Pregnant women are comfortable asking doulas to lower their fees (or to provide free service), or to throw in a few extras; seldom do women (or men, for that matter) ask this of men who provide services. No one expects their mechanic to voluntarily change their oil because they’re going through a rough patch. In fact, people would run away from a volunteer mechanic thinking, “Something’s gotta be wrong!” Part of the paralleled sexism argument is that we don’t haggle with our care providers. At least we didn’t.
According to Dr. Jeffrey Kullgren, we should try! Dr. Kullgren is, “an internist and clinical scholar at the University of Pennsylvania, [and] specializes in research on the impact of consumer-driven health care.” Now that insurance companies are cutting back on what they cover (not to mention the increase of uninsured in the US), more folks are left paying for health care out of pocket. Dr. Kullgren suggests that patients be upfront with their care providers about their financial situations, and ask for the discounted rate whenever and however they can.
Where does this leave women during the perinatal period?
Some care providers are so used to ordering tests and writing prescriptions without thinking about cost because 1) their assumption is that insurance will pay, and 2) they’re not trained to even think about the business aspect of medical care! If you have to pay a portion (or all) of your health care out of pocket, ask your provider if each ultrasound that’s ordered is necessary; or ask to be checked with a fetascope or doppler if possible. If your provider is prescribing prenatal pills, ask for the generic brand. You can also ask which over-the-counter prenatal pills or herbal supplements are recommended. If you’re facing an induction or surgical birth, find out what your insurance covers and what it doesn’t; some companies are refusing to cover elective cesarean surgery because it is so expensive.
You can also seek a midwife during pregnancy. Midwives aren’t just for home birthing families; midwives work in hospitals and birthing centers as well. A midwife’s fee is far less than an OB/GYN’s fee, and their care tends to be holistic more often than not. So there you have it, ladies – grab your ovaries with gusto and don’t shy away from speaking about finances with your OB. If you’ve come to expect volunteer or low-cost doula services, don’t let your care provider off the hook for billing you up the wazoo.
Read more from The New York Times here.