February 2022 Blog

It’s no secret that at Best Start we are all about being inclusive. When we say we want all birthing people to have access to birth their way, we mean ALL. Our motto of “Your Birth, Your Way” is not conditional on you fitting a certain mold or coming from a particular background. Every birthing person’s background, story, and situation is uniquely valid and worthy.


Celebrating and honoring what makes you “YOU” is what midwifery care is fundamentally about. It’s a space that recognizes the importance of cultural birth practices. An empowerment of voices that the mainstream medical system often tries to quiet. An admiration and deep respect for the innate strength of birthing bodies.


This month and always, we want to especially stress the dire need of care that is safe and empowering for Black people, an area mainstream medicine has historically failed in. From outcome disparities in births to an unequal representation of Black people as Midwives, systemic racism is something we must continue to combat.


Unfortunately, discrimination in the birth care community comes up in more ways than one. Some insurance companies continue to uphold policies that discriminate against midwives as providers, preventing members from accessing compassionate midwifery care. Benefit plans such as Medicaid (Medi-Cal) and Tricare (federal military) respect the right to access midwifery care. However, commercial insurance plans (HMO, PPO, or employer sponsored insurance) often do NOT follow this same standard, and it is time they are held accountable.


Covering services when they’re provided by doctors, but not covering those same services when they’re provided by Certified Nurse-Midwives is in direct violation of the Harkin Amendment (2013). If you have a plan that is blocking you from receiving midwifery care in a freestanding birth center and feel compelled to help fight this injustice, you can submit a complaint to the Department of Insurance here.


What’s happening today with some commercial health insurance plans can be likened to what the real estate industry refers to as “blockbusting, steering, and redlining.” Except in this case, the group being discriminated against isn’t a specific race, it’s midwives as a whole. Some insurance plans are setting forth policies that steer members away from access to midwifery care, and unjustly favor physicians instead. The result is a plan that eliminates provider-type diversity and does not allow for midwives to even be represented as a viable option to their members.


For example, there exists a large California insurance company that will not contract with midwives for their commercial lines of business. Best Start as a FACILITY is in-network with this insurance company, but the midwives who provide the care, are not…


If you are thinking that sounds a little confusing and wrong, you’re correct. It IS confusing and it makes getting care complicated for this insurance company’s members and often involves writing multiple appeals to get professional services covered in network!


So, how’s this happening? Well, this insurance company has a policy against contracting with midwives except when required by law. This means that only members who qualify for Medi-Cal are allowed access to midwives in network because it is mandated. For commercial lines of business, they only contract with physicians in its overwhelmingly physician-centric model. So, although the insurance company is in network with Best Start Birth Center, the member may still be responsible for paying for the professional midwifery services out of pocket. Simply because this insurance company has a discriminatory blanket policy of not contracting with midwives.


Best Start will always continue to do the work to fight for coverage across insurance plans and most importantly, access for all people to birth their way, where they want, in a way that’s financially affordable. We value the importance of collaborative care that brings physicians and midwives together, not apart. We won’t give up doing our part, but we need your help to fight this too!


If you are a commercial PPO or HMO policyholder, please speak up to member services and let them know you value and desire access to care from Certified Nurse Midwives. You deserve to have all evidence-based options be financially feasible and midwives deserve to be respected for the care they provide. Together, we can make a difference.



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