From: Kathryn Newburn CNM

February 5, 2002

RE: Denial of Reimbursement by Aetna Insurance Company for home-based Midwifery Services

Click here for Aetena Email address and URLs for studies documenting the safety of planned domiciliary midwifery care

Aetna US Healthcare Denies Coverage for Home-based Birth Services, terminates CNM for providing domiciliary midwifery care  --  ACDM letter to Aetna in reponse

Dear California Nurse Midwives Association members,

I have been attending home births for selected women for the last 15 years.  I am writing to share with you a concern I have with the Aetna insurance company.  As you may have heard, Aetna has decided that Home Birth will not be covered under their policies, and they cite the ACOG Official Statement on home birth. They also refer to a home birth study done in Australia which obviously is not favorable to birth at home (in Australia!!) 

As you may know, several studies do support safety of home site delivery with skilled midwives. (USA, Netherlands, Denmark etc.,) I have included links to the abstracts of some of these studies for your review. The California Legislature has declared (SB 1479) "That childbirth is a normal process and not a disease, and that every woman has a right to choose her birth setting from the full range of safe options available in her community."

If I interpret our California Insurance Code, # 10353 correctly, I find that all perinatal services provided by nurse-midwives or nurse practitioners must be paid directly for providing these services. 

It occurred to me, that Aetna is restraining our practice by refusing to provide the usual 70% or so, coverage to 'home birth midwives' as 'out of service providers'.  However, HMO/PPO's when created (1974?) in California were not mandated to provide reimbursement to midwives. (Dept. of Corporations representative;discussion 6 years ago)

Although this may impact a small number of women overall, it certainly will effect all of us. It effects us ALL, because it is a small leap of consciousness to say that the potentially high risk nature of birth requires ONLY specialty physicians (i.e., obstetricians) to provide maternity services to ALL women. Our midwifery heritage of home birth and our credibility as safe, high quality providers is at stake here!

I would be ever so grateful if everyone would go to the Aetna link write an e-mail, call, or write to Aetna (address on the Aetna website) in support of womens  ability to determine with her care provider the safest choice of setting for her.  The exclusion of planned home birth coverage only deters qualified midwives from providing care.  In my experience, the women who really want their baby at home will chose this, even if they are unable to find a licensed midwife or nurse midwife to provide them the standard of care they require. -Kathryn Newburn CNM.  Please help keep home birth VIABLE.  Thank you.

Click here: Aetna - Leading health and related benefits organization 

J Epidemiol Community Health -- Abstracts: MacDorman and Singh 52 (5): 310


The Medical Literature on the Safety of Home Birth