A non-refundable deposit of $2000 to reserve your place in care is due at the beginning of care. The remainder is paid in installments, with the balance due in full at 36 weeks of pregnancy. I accept cash, personal checks and Zelle. I am happy to consider trade and payment plans.

“As a seasoned birth doula in San Francisco, I can tell you with unwavering confidence that Michelle was worth every single out of pocket penny we paid for her outstanding midwifery services. Even though I decided to transfer after a very long labor, we are forever grateful for her support and would hire her again in a heartbeat. Thank you, Michelle, for going above and beyond in every way possible. You’ll forever be a part of our family.  Your care is truly a gift to the birth community.”

~Love, Heather, Jeremy & Wilder

PPO Plans

I partner with Innovative Medical Billing Inc. for insurance billing for PPO plans. Your first step is to sign up for a Verification of Benefits‍ with IMBI for $55, to better understand your benefits and likely coverage. If you decide to contract with Innovative Medical Billing Inc. at the end of care, I will submit your chart to them and they will handle everything from there: applying for Gap Exceptions and/or In-Network coverage; preparing, submitting and tracking claims, managing follow-ups and appeals. IMBI fees are a percentage of what they get back for you. I highly recommend working with a biller. I consistently find that those who work with a biller get the best reimbursements. 

Alternatively, I can prepare a Superbill receipt for you at the completion of care, and you will be responsible for submitting it to your insurance carrier and conducting all follow up. Superbills are by request, and with no additional fee.

HMOs, EPOs, Kaiser, and MediCal

HMOs, EPOs, Kaiser, and MediCal do not reimburse for private midwifery services but typically these plans have far lower monthly fees than PPOs and often the reduction of monthly fees compared to a PPO ends up making them a better deal even when paying for your midwifery care out of pocket.

FSA/HSA plans

If you have an FSA (flexible spending account) or an HSA (health savings account) you can use it to pay for midwifery care. I can provide you with a statement for reimbursement from these plans.

Everyone wants a discount! The Bay Area is expensive! I maintain a low client load in comparison to other midwives in order to provide the highest quality of personalized care and  work with  a maximum of two to three clients per month. As a result, I am able to offer just one reduced fee per month for families who truly cannot otherwise access private midwifery care. 

I ask that you and I work collectively to ensure that sliding scale fees go to the families most in need, and that midwifery is a sustainable practice available to you and others in the future. I definitely do not want to alienate families who can’t afford midwifery care. If you need help to access care, let’s talk about it. I am always happy to consider trade (we can be creative) and payment plans.‍

Please seriously consider whether you meet criteria for sliding scale/reduced fee if any of the following are true for your family:

• Your family owns a home

• Your family has savings

• Your family is planning a large purchase in the next year

• Your family is planning an expensive vacation in the next year

  Questions to ask yourself when thinking about a reduced midwifery fee

  Alexis J. Cunningfolk has a great post on class, economic justice and sliding scales which frames the discussion on sliding scales from the standpoint of access. 

Please consider:

• Asking your family and community to contribute to support your homebirth

• Getting creative about trade options

• Adding homebirth costs to your baby registry

• Reviewing your budget to see if there are areas where you could scale back to put money aside for the birth

• Making a modified payment plan with me

Sometimes my clients use their household income as a starting point to discuss a proposed reduced midwifery fee.The San Francisco Area Median Income (AMI) chart can be used as a starting reference to help consider a reduced fee proposal.  In addition to income please also consider your other resources like assets, savings, 401K, pensions and other employer benefits, family support, and rent control as a part of your personal equation. Ponder on whether your financial situation is temporary or if you expect your resources to change in the future. Ask yourself if paying for midwifery care is a sacrifice or a hardship for your family. ‍

Using my $9,500 San Francisco fee (outside of SF fees vary) as an example of a starting point…

• Under 70% AMI - $5,500 ($6,000 if there are appointments outside of SF) at this rate I make $2,324 after my expenses

• Under 80% AMI - $6,500 ($7,000 if there are appointments outside of SF) at this rate I make $3,324 after my expenses

• 80%-150% AMI - $7,000 ($7,500 if there are appointments outside of SF) at this rate I make $3,825 after my expenses

• Above 150% AMI - $9,500 ($10,000 if there are appointments outside of SF) at this rate I make $6,325 after my expenses

*If you make more than 200% for the SF AMI please consider offering a partial scholarship towards a lower income family’s midwifery fee.

Read the section Understanding Midwifery Fees to better understand what goes into a midwifery fee. 

I understand that it can feel like “sticker shock” to hear a midwifery fee. We aren’t used to paying up front for our healthcare. I would argue that midwifery care is more than just healthcare and is in fact an incredible deal! I view midwifery care as a package rate, not an hourly rate, for many reasons. Most importantly, I do not want to penalize clients who have longer or more complicated child birthing experiences by charging them more in their hour of need.

I have created a basic calculation below to help you better understand midwifery care. While it may occasionally be an overestimate for a rapid labor or a client who starts midwifery care later in their pregnancy, it's far more typical for the figures below to underestimate the time I spend with you.

• Minimum average cost or direct business expenses per client: $3,175 (total annual business expenses divided by average number of clients)

  • Independent contractors (assistant midwives, lactation consultants, physical therapists): $1,700

  • Travel, licensing/ certification fees, continuing education, supplies, equipment, medications, cell phone, pager, website etc: $1,475 (these costs never decline and can increase substantially when supply costs increase due to natural disasters, pandemics or due to a large car maintenance/repair bill)

• 62 hours of hands-on midwifery care on average

  • 31 hours in appointments (average of 15 prenatal and 6 postpartum)

  • 16 hours at the birth and immediate postpartum

  • 10+ hours back office/administrative including charting, interfacing with labs/lactation consultants/pelvic floor PTs/insurance billers/pediatricians etc., filing birth certificates, filing disability claims, filing breast pump requisitions and much more (this is a conservative estimate)

  • 5 + hour direct communication via text, phone and email (this is a conservative estimate)

This means that for an average course of care, with a client paying my full fee of $9,500 I make about $102 per hour. I would argue that this is a remarkably good bargain for personalized, private, concierge-style healthcare from a licensed provider! For comparison, I pay my home-visit veterinarian $550 per visit to see my cat and my therapist $225 for a 50-minute zoom visit. 

For context, the Bay Area's single OB offering comparable prenatal care and birth attendance charges $35,000-$80,000 (not covered by insurance), without the postpartum or newborn support included in midwifery care.

Access Matters: I believe homebirth midwifery care should not be limited to the wealthy. If you need a reduced fee, payment plan, or trade arrangement—or if you'd like to sponsor a scholarship for another family—please reach out.