08/22/2026
I know this is a hard topic for many, but money should not feel taboo. There has been a lot of conversation lately about the cost of community birth, and we think itâs a conversation worth having. Our self-pay fee at Breath of Life Midwifery is $6,000.
That is a lot of money. We know that, and we would never dismiss how difficult it can be for a family to come up with that amount, especially when they may already be paying a significant amount for health insurance that doesnât meaningfully cover the care or birth setting they actually want. But we also think there is a pretty big misunderstanding about what that $6,000 actually pays for. You arenât paying a midwife $6,000 to catch your baby. Youâre paying for an entire model of relationship-based maternity care.
What does $6,000 of midwifery care ACTUALLY pay for?
Our care begins during pregnancy and continues through the postpartum period. It includes comprehensive prenatal care, labor and birth care at home or our birth center, postpartum and newborn care, lactation support, and doula support if desired. It includes childbirth, breastfeeding, newborn care and nutrition education, prenatal yoga, birth pools and supplies, medications other than RhoGAM, newborn blood spot screening, non-stress testing when needed, and bedside ultrasound when appropriate. Our bedside ultrasound is not diagnostic imaging, but it gives us another useful tool when caring for our clients. It also means having trained assistants available for births and continually investing in the education, certifications, emergency drills, and advanced training that keep our entire team prepared.
And if something beautiful is happening and one of us happens to have a free hand, thereâs a pretty good chance youâll get some pretty decent birth photography too. We wonât pretend weâre professional birth photographers, but after attending this many births, weâve gotten pretty good at capturing the moments that matter.
There is also a whole lot that families never see. On a full-price $6,000 self-pay client, the midwife who ultimately attends the birth grosses $2,250. The other midwife grosses $1,250 for her portion of prenatal and postpartum care, shared call, coverage, and carrying responsibility for that family throughout care. Another $600 is budgeted for trained birth assistants. Newborn blood spot screening currently costs us $138 per baby, and professional birth laundry costs us $135 per birth.
That means $4,373 of the $6,000 is already allocated before we have paid for most medications, disposable birth and emergency supplies, equipment, pools and liners, the birth center, ultrasound and NST equipment, utilities, software, cleaning, insurance, continuing education, certifications, taxes, administrative expenses, and all the other things required to keep a small healthcare practice running. And those numbers are gross, not take-home pay.
Our client agreement clearly assigns individual values to many of these services as well. Birth attendance alone is valued at $4,000. Birth center use is $1,000. Individual office or telehealth visits are $300, home visits are $350, assistants are approximately $600, and supplies are approximately $400. Our $6,000 package is already discounted comprehensive pricing rather than adding up and billing every service individually.
We prefer it that way because birth is unpredictable. Sometimes we are with a family for three days or more. Sometimes we make several trips for early labor or false starts before the baby actually comes. Sometimes a long labor requires midwives and assistants to rotate so everyone can safely rest, and sometimes two clients decide to have their babies at the same time and we need additional people. Other times we are pulling into the driveway while the baby is being born, or we are still en route.
We donât charge extra for the three-day birth, and we donât refund money for the ten-minute one, because you arenât buying hours. Youâre buying our commitment to care for you through whatever birth you have. The same is true throughout pregnancy and postpartum. One family may need extra appointments, several NSTs, bedside ultrasound, frequent phone calls, additional postpartum visits, and hours of breastfeeding help. Another may have an uncomplicated pregnancy, a quick birth, a baby who latches beautifully, and very few concerns afterward. We donât keep a running meter. Our comprehensive fee allows us to ask, âWhat does this family need?â rather than âHow many billable units does this family have left?â
That is also why we donât offer a late-to-care discount. Late transfers are often more work compressed into much less time. We have records to obtain and review, labs and imaging to evaluate, gaps in care to identify, and appointments to fit into an already-full schedule, sometimes outside normal office hours. More importantly, we have to build in weeks the relationship we normally spend months developing. We arenât willing to give someone a shortened version of informed consent because she came to us at 32 weeks. We still need time to know her and for her to know us. We need to talk about her history, hopes, fears, our practice guidelines, emergencies, transfer, newborn care, informed consent and refusal, and all those âwhat ifâ conversations that ordinarily unfold gradually throughout pregnancy.
We do offer our returning families a $500 discount. There is something really special about caring for families again, and we already have an established relationship and shared history when they come back. The relationship is already built and thatâs worth its weight in gold to us.
Then there is something much harder to put on an invoice⌠AVAILABILITY!
Community midwives arenât simply on call from 37 to 42 weeks. Weâre on call pretty much every day of our professional lives. Miscarriages, preterm labor, concerning symptoms, postpartum bleeding, breastfeeding problems, and newborn concerns donât observe office hours. Our phones come on vacation. We answer messages at our childrenâs events, family dinners, and holidays. We drive separately because one of us might need to leave, and we make plans knowing they may change. Sometimes we miss milestones in our own families because someone elseâs family needs us.
We donât say that for sympathy. We chose this work, and we love it. But availability is part of the work, and our families make sacrifices for this profession too.
That is also why we cannot make up inadequate reimbursement by simply taking more clients. There are only so many families we can responsibly promise this level of care to. Every additional client isnât just another prenatal appointment. It is another birth we have promised to be available for. At some point, increasing volume means overlapping births, exhausted midwives, inadequate backup, and less time for the relationship-based care we promised in the first place. A sustainable caseload isnât a luxury. It is part of safe, relationship-based midwifery care.
We also think it is fair to put our $6,000 fee into perspective without throwing hospitals, physicians, nurses, or hospital-based midwives under the bus. We need them. We value them. They provide resources and levels of care that we cannot provide in the community, and sometimes our clients need exactly what they offer. Having respectful relationships with those providers matters tremendously to us.
But the way the two models are financed is very different. Our $6,000 is right there on the page. You see the whole number. With insured healthcare, the actual cost of care is less visible because it may be divided among premiums, employer contributions, deductibles, copays, coinsurance, insurer payments, facility charges, and separate bills from different providers. Some families have excellent insurance and pay very little out of pocket. Others pay significant premiums and then still have a substantial deductible and coinsurance when they have a baby. That makes a direct comparison surprisingly difficult.
And cost is only one part of what families are choosing. We think it is reasonable to ask what is included, what may be billed separately, what your deductible and coinsurance will be, how much time you will have with the people providing your care, whether you will know the people who may attend your birth, how accessible your team will be between appointments, and what education, postpartum, newborn, and breastfeeding support will be available to you.
There are also things that are harder to put a price on. There is value in having time to talk and knowing who will answer the phone when you are worried. There is value in continuity, in spending pregnancy developing trust, and in having informed-consent conversations before a difficult decision has to be made. There is value in choosing a team whose philosophy of birth is compatible with your own and walking into labor already knowing the people who may be beside you.
That doesnât mean choosing people who will always agree with you or who can promise you the outcome you want. It means choosing people you trust to respect your autonomy, tell you the truth, educate you well, and walk beside you when the plan has to change. That relationship has value too.
None of this changes the fact that $6,000 can be incredibly difficult for families to afford, and we try to create as much financial flexibility as we reasonably can without making the practice itself unsustainable. We accept Medicaid despite the financial loss to our practice. We provide detailed billing for health sharing programs and documentation for FSA and HSA use. We offer payment plans, accept credit cards with a 3% processing fee, and can sometimes extend payments beyond the birth for an additional fee because doing so means accepting a greater risk of not being paid. When our finances allow and someone has something we genuinely need, we sometimes barter up to half of our fee.
We would also love to establish a pay-it-forward fund so that when a family experiences a genuine financial crisis during pregnancy, our community can help carry some of that burden instead of it falling entirely on either the family or the midwife. Because we donât believe the answer to making midwifery accessible is simply asking midwives to charge less. Someone still has to pay for the care.
We would love to accept private insurance too. Unfortunately, wanting to accept insurance and being financially able to participate are two different things. Reimbursement and the additional expenses associated with participation, including malpractice coverage commonly required by insurers, can make participation financially unsustainable for a small practice.
And yes, we generally require our self-pay families to pay before the birth. That isnât greed. It is the reality of running a small healthcare practice. If we provide months of care, reserve space in a deliberately limited caseload, remain available around the clock, attend an unpredictable birth, provide postpartum and newborn care, and then hope to collect several thousand dollars afterward, sometimes we simply donât get paid. We donât have a hospital billing department or enormous financial reserves to absorb those losses.
Midwives work incredibly hard for their compensation, and we should not be ashamed to say that. But with the right to be fairly compensated comes a responsibility to be transparent about money.
Financial informed consent IS informed consent.
Before a family commits to our care, they should know what our care costs, what is included, when payments are due, what expenses are not included, and what additional expenses they could reasonably encounter. They should understand our refund and cancellation policies, what happens financially if they transfer, develop a complication that changes the plan, choose another provider, have a precipitous birth before we arrive, or ultimately give birth somewhere other than originally planned. Our agreement specifically addresses many of these circumstances because those conversations belong at the beginning of the relationship, not for the first time when something changes late in pregnancy.
We also believe there should be no shame in asking financial questions when interviewing a midwife. Ask what happens if you transfer. Ask what happens if you become ineligible for community birth. Ask what portion of your fee has already been earned as care is provided. Ask what additional labs, ultrasounds, medications, or services may cost. Ask what happens if your midwife misses your birth. Ask when your balance is due. Ask what happens if your financial circumstances change.
A good financial agreement should answer those questions before anyone signs it.
To us, that is part of relationship-based care too. Trust isnât only about what happens in the birth room. Trust means being as honest about our money and our limitations as we expect our clients to be with us about their needs.
Midwives deserve to earn a living doing this work. Our own families deserve some degree of financial security in exchange for the sacrifices this work asks of them. And our clients deserve affordable access to maternity care and a clear understanding of what they are agreeing to financially before they choose us.
Those things do not have to be in opposition.
If we genuinely believe midwives and birth centers can be part of the solution to maternity deserts and disappearing maternity services, then we also have to advocate for systems that make this care sustainable: adequate Medicaid reimbursement, reasonable private insurance reimbursement, meaningful coverage of community birth and birth center care, and policies that donât require individual families or individual midwives to carry the entire financial burden.
Because our $6,000 fee isnât the price of catching a baby. It is the prenatal visit that unexpectedly takes two hours because you need to talk, the birth center waiting for you whether you ever use it or not, the trained assistants, medications, equipment, and emergency supplies we hope we never need. It is the three-day labor that doesnât cost you extra and the precipitous birth that doesnât result in a refund. It is the phone that gets answered in the middle of the night, the postpartum visit when youâre exhausted and breastfeeding isnât going the way you hoped, and having enough room in our caseload to sit beside you instead of rushing to the next person.
It is knowing your story and knowing what matters to you. It is building enough trust throughout pregnancy that when something is wonderful, we can celebrate with you, and when something is hard, we can sit beside you and figure out what comes next together.
Our $6,000 fee isnât the price of a birth. Itâs what allows us to promise a family a comprehensive model of relationship-based maternity care.
Families deserve transparency about what that costs. Families deserve compassionate, affordable access to care. Midwives deserve fair compensation for the tremendous amount of work, responsibility, availability, education, and heart it takes to provide it. We donât think we should have to choose between those things.
Midwifery care has a cost. Midwifery care also has value. Families deserve transparency about both.
One last thought, thereâs not a midwife I know who doesnât attend births for absolutely free from time to time. We are called to this and helping those who truly need us but canât afford us is a ministry from that calling. We just canât do that for every family and still be able to care for our own families. We put faith in the promise that it will all work out.
