CLARIFICATION: A photo that earlier appeared with this story has been removed because it depicted a family that, while planning a home birth, does not require the financial assistance described in the story.

Abiola Osibodu wanted to give birth at home, no matter what. But she couldn’t afford the full cost of a midwife.

So she pitched a novel plan to her midwife to cut her bill.

“How about you just help facilitate through FaceTime while I’m actually in labor?” she asked only half in jest.

Osibodu’s midwife, Asasiya Muhammad of Inner Circle Midwifery, had never assisted a client like that before, but she understood why Osibodu felt so strongly about the matter. “The problem is that with Black women, the rate of mortality for us is three to four times greater in the hospital,” Muhammad said.

To help expectant mothers like Osibodu, Muhammad recently started the COVID-19 Philadelphia Birth Fund with other midwives and their helpful colleagues, known as doulas. The fund set a goal of raising $50,000 to help 20 low-income patients of color give birth at home. So far, it’s raised more than $35,000.

One of the first to receive financial help from the fund was Osibodu. Now 34 weeks pregnant, she is working with Muhammad as her delivery date approaches. She was overcome when she read the message that she would receive assistance: “I cried and cried and cried when I received the email.”

While the cash will help some women, Muhammad and other midwives say a larger and more systemic problem looms: Hospital deliveries are typically covered by insurance, while at-home care from “certified professional midwives” like Muhammad is not.

Most home-birth midwives in Philadelphia offer services priced in the range of $5,500 to $7,000, which covers prenatal, delivery, and postpartum care. While far less expensive than hospital births — hospitals can charge as much as $30,000 — many potential clients still can’t afford the midwife charges.

During the COVID-19 pandemic, the demand for at-home births has skyrocketed as pregnant women seek to avoid the risks they see in hospitals. Muhammad has seen her number of monthly deliveries double, from around three to six clients. While those numbers may seem small, Muhammad says her individualized approach to care, which includes 13 hour-long prenatal and post-birth appointments, limits her number of clients.

But Muhammad has also had to turn women away for financial reasons.

“A lot of people are coming into care late, because they decided late, and it’s a deep financial burden in a short period of time,” she said.

Even when Muhammad tries to lower her price to $3,000 for clients who truly can’t afford her care, she still notes that “not a lot of people are sitting on $3,000 right now, especially with the pandemic.”

Muhammad and other home-birth midwives like Ray Rachlin of Refuge Midwifery see expanded insurance coverage as crucial to expanding their clientele.

“Women who are most at risk for bad outcomes in hospitals, Black and brown pregnant people, are not able to access home-birth care,” said Rachlin. “We’re not able to serve the people who need us most because of the current insurance structure.”

Pennsylvania is one of only 15 states that won’t license certified professional midwives, like Muhammad and Rachlin, who are credentialed by the North American Registry of Midwives, based in Georgia. (New Jersey does grant them licenses.)

Without licenses, certified professional midwives are not considered medical providers by most insurance companies and Medicaid, the federal program to provide health care to the poor, and thus are not reimbursed for their services.

The insurance industry backs the current system under which the only licensed midwives are those with nursing degrees and have completed an extra year of training in delivering babies. Such nurse-midwives rarely perform at-home births.

Midwife Ray Rachlin poses for a portrait in her office in the University City section of Philadelphia on Thursday, July 09, 2020. The pandemic has brought a rising interest and home-birth and midwifery care, but how licensure laws and insurance coverage prevent many people from being able to afford it.
HEATHER KHALIFA / Staff Photographer
Midwife Ray Rachlin poses for a portrait in her office in the University City section of Philadelphia on Thursday, July 09, 2020. The pandemic has brought a rising interest and home-birth and midwifery care, but how licensure laws and insurance coverage prevent many people from being able to afford it.

Sam Marshall, president of the trade group the Insurance Federation of Pennsylvania, said licensing had to set a high bar.

“Delivering a child is a pretty serious business,” he said. “Everybody wants to make sure that when you’re delivering a baby, it’s being done by somebody who’s qualified to deliver a baby.”

Even when some insurers offer coverage for home-birth care from certified professional midwives, Rachlin says it’s rarely enough to support her practice. Rachlin is treated as an out-of-network health-care provider —- and sometimes is paid as little as $378 by insurers.

State Rep. Morgan Cephas (D., West Philadelphia) circulated a memorandum earlier this summer urging her colleagues to support temporary licensure for certified professional midwives. She calls for the midwives to be granted licenses for the duration of the pandemic, and for six months after it ends.

Cephas said she plans to submit a bill in September and hopes that the pandemic will help persuade legislators that change is needed.

“A lot of what’s happening with COVID-19, we’re forced to create a new normal,” she said. “And I do firmly believe that a new normal in maternal health will look at how do we incorporate these other professions into the health-care continuum.”

But her proposal won’t fix everything, Cephas acknowledged. Advocates still have to fight a separate battle to get Medicaid to pay for the midwives’ services.

Until insurance money becomes available, expectant mothers who want to work with Muhammad, Rachlin, and other midwives will have to turn for help to groups like the new birth fund. So far, the fund has received 25 applications and matched 10 with midwives.

But fund-raiser and doula Megan Mauger notes that the fund requires midwives to provide care at cost for $2,500.

“They’re not making money off of these births,” she said. “So it’s not going to be sustainable for them to offer this kind of care long term.”