Gratitude

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Gratitude is the fairest blossom, which springs from the soul – Henry Ward Beecher.

The old adage, “Avoid politics at family gatherings,” is particularly prescient for the 2016 Thanksgiving holiday. Some have family members who enjoy political arguments or the ability to get a rise out of those who hold different beliefs. But if this political season has taught us one thing, it’s the importance of civility, respect, and graciousness.

Don’t take the bait.

The Thanksgiving table may not be the place to convert hearts or minds. Make a choice instead to focus on the history of the holiday. At the heart of the historical day is a story of survival, friendship, and the setting aside of differences to break bread at one table. The literal history of the first Thanksgiving continues to be debated by historians, but most Americans can agree that the holiday each November is a time when we come together to remember the hardship of the early Americans settlers and the Wampanoag tribe who shared their wisdom and skills. Without the help of the indigenous peoples of America, the settlers would have starved.

Our modern tables are often filled with rich desserts, casseroles, and farmed turkeys. The settlers’ table was likely set with a lean venison and goose or fish, nuts, and stewed fruits, cornbread and squash. There wouldn’t have been flour for pies, nor sugar to sweeten desserts. I wonder—were they able to communicate? Did a settler or Native American serve as translator? Was there more silence than conversation as they sat at one table to share the harvest?

I try to imagine what it felt like to be so far from an ancestral home, hungry, hope fueling the courageous act of sailing across a giant ocean to find religious freedom and peace—what it felt like to see strangers arriving on the shores of ancestral lands. I imagine that what guided their hands as they baked cornbread over a fire, turned a wild turkey on a spit, or buried squash in the embers, was thankfulness. Their stomachs would be full that day; their children would not be hungry. Because of the friendships forged across language and cultural barriers, they spooned gratitude along with the stewed apples and chestnuts. It was a delicate thing, this gratitude – something that sprouted from new experiences, vulnerability, and interdependence. I would imagine there was even fear sitting between the indigenous people and the new settlers. But break bread they did.

This year, when the country is feeling more divided than ever, it’s imperative to strip Thanksgiving dinner down to its barest, naked element. To remember the simplicity of that first Thanksgiving meal. Navigating a political discussion may mean simply stepping away from the lure of a heated discussion, setting aside personal fears or judgment in order to focus instead on the central tenet of the holiday: thankfulness. Consider these wise words from Dalai Lama XIV:

Every day, think as you wake up, today I am fortunate to be alive, I have a precious human life, I am not going to waste it. I am going to use all my energies to develop myself, to expand my heart out to others; to achieve enlightenment for the benefit of all beings. I am going to have kind thoughts towards others, I am not going to get angry or think badly about others. I am going to benefit others as much as I can.

Focus instead on the new recipients of the Presidential Medal of Freedom. On the inspirational words of Michele Obama, “…Our motto is, when they go low, we go high.” Focus instead on the food that fills the table. On the plump, roasted turkey; on the warm cornbread or rolls; on the ease with which so many are now able to fill the table. Remember the gratitude the settlers served with stewed apples and roasted chestnuts. Each time you pass a dish or offer a serving of food to a relative, focus on the Latin root of the word gratitude, gratus, pleasing or thankful. Set aside worries and tensions, and steer conversation to topics that expand the heart and bring your family together. Remember the interconnectedness of the people who didn’t share a common language, but broke bread together. Because sometimes, breaking bread is the most important thing we can do.

Official 1864 proclamation by President Abraham Lincoln

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Insurance vs. Samaritan Ministries and other Christian health care cost sharing plans; what’s right for you?

Premier Birth CenterMidwives are often asked which health insurance plans have the best coverage for home births or birth center births. Everyone’s financial picture is different, and we can’t give you advice about which insurance plan you should choose. In these times of great change in health insurance, conservative plans rise to the top as a very progressive idea, especially for out-of-hospital births. Christian health care cost sharing plans like Samaritan Ministries and Christian Care Ministry (Medi-Share) are an idea we encourage families to consider when they look at options for paying for their health care expenses. Premier Birth Center supports Samaritan Ministries by not requiring any pre-payment or out-of-pocket expense for Samaritan members. 

 

Commercial Insurance

Most people have commercial insurance, such as Blue Cross/Blue Shield (Anthem, CareFirst), Aetna, Cigna, United Healthcare, etc. These plans are often subsidized by their employer or by the government (through “Obamacare”). ObamacareMonthly payments (premiums) generally vary according to the size of your deductible and co-payment. HMO plans tend to have lower premiums than PPO plans, but when you have an HMO, you are limited to using the providers within the insurance company’s plan. PPO plans usually have in-network and out-of-network benefits, although some plans do not have out-of-network benefits at all. Some plans allow for an in-network exception. Some plans will pay for all kinds of midwives, some exclude certain credentials. Some will pay for a birth center birth, but will not pay for a home birth.

With commercial insurance, you generally have a deductible, co-payments, and co-insurance. The deductible can be different for in-network vs. out-of-network claims. So, let’s say you have a $2000 out-of-network deductible with a 70/30 co-pay. You will need to pay the $2000 before your insurance will pay anything at all. Once you have met your deductible, your insurance will pay 70% of what they consider to be the “usual and customary” amount for the codes your provider submits on their claims to your insurance, and you are responsible for the other 30%. So, if there are $6000 in usual and customary expenses after the deductible, you will need to pay 30% of that $6000, or $1800, in addition to the $2000 deductible, for a grand total of $3800 out of pocket expense.

There are many variables, and even when we think a plan will pay well, we sometimes are surprised be a claim being denied after the birth. There really is no way to know for sure whether a plan will pay and how much they will pay, so we often will tell people to plan for the maximum out of pocket (no reimbursement at all), just in case there is a surprise. It is better to be prepared for that and then be pleasantly surprised if your insurance pays well, but most of the time people are very disappointed by how poorly their supposedly “awesome” commercial insurance reimburses for their home birth or birth center birth.

Doesn’t a hospital birth cost less than a birth center or home birth?

Medical CostsOften, people look at their commercial insurance and think a hospital birth will cost them less than a birth center or home birth. Sometimes, this is true. But, if they have a deductible and co-pay, they may be surprised to find that their hospital bill will end up costing about the same or even more. Using a $1500 in-network deductible and an 80/20 co-pay as an example, if you had a $15,000-$25,000 hospital birth, you could easily end up with a bill for $4000-$5000.

Christian Health Care Cost Sharing Plans

Medi-ShareThese plans are not health insurance, although they do “count” as coverage for the Affordable Care Act. As Christian Care Ministry says, they are a “healthcare sharing ministry where members share each other’s medical expenses.” Members pay a monthly “share” instead of a premium.

Samaritan MinistriesEach health care sharing plan has slight differences in the way that their programs are run. For Samaritan Ministries, if a member has a qualified medical need, that need is published to the membership. Members will send their shares directly to the person in need, often with a note of encouragement, expressing their plan to keep the family in their prayers. Members have reported feeling very uplifted and supported by the personal and spiritual connection with other Samaritan members.

The monthly share for these plans is quite low compared to commercial insurance. Samaritan Ministries‘ monthly share for a family is $405 (as of May 2016). Christian Care Ministries‘ monthly share varies according to family size, date of birth, and Annual Household Portion (out of pocket cost per year before needs are published for sharing).

The plans have guidelines for their programs available on their websites. These guidelines detail what is and is not considered to be a publishable need, as well as what the qualifications are for membership. Generally, members are required to be Christians and live a Biblical lifestyle.

Samaritan rewards families who choose midwifery care. They waive the initial unpublishable $300 need amount for homebirth and VBAC because “they lower overall maternity costs,” and they also will pay up to $500 for doula services. They will pay in advance of the birth if the maternity care provider discounts the fee for paying in advance.

The big question: What if I transfer?

Good question. We can’t answer that question fully for every person, but in our experience, Samaritan Ministries has handled this very well. The ministry will help negotiate lower fees with the hospital and the remaining hospital bills are handled like other publishable needs.

If you would like more information about Samaritan Ministries or Christian Care Ministry, we encourage you to explore their websites to see if these plans might work for you. Your midwife can also answer questions about her experience with these plans, as well. Call Premier Birth Center at 540-709-1737 for more information about health insurance and Christian healthcare sharing plans.

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

A Traditional Hospital Birth is an Oxymoron

Home birth with midwives is not a trend. Hospital birth with doctors was a trend that lasted 70-80 years before women began returning to what they know truly works.

When I ask someone whether they’ve considered having their baby at home or at a birth center, I often hear them respond with something like, “I decided to have a traditional birth in the hospital.” This generally makes me smile, because giving birth in a hospital is hardly the traditional way to give birth! Traditionally, women have been the healers in communities. Women have traditionally held the wisdom of the healing power of herbs, and carried the rich oral history of birth and healing from generation to generation. Traditionally, older women taught younger women how to care for their own families and neighbors, thus training the next generation of community healers. Women tended to the sick and the dying, as well as to the birthing women in their communities. The experimental way to give birth is this relatively new idea of giving birth in the hospital with doctors. It has been only recently that healing became the more male-oriented profession of medicine.

Nigerian Midwife Assisted Birth

Note the upright position adopted by Nigerian women. U.E. Egwatuatu.

Midwives have been helping women give birth since before recorded history, and most of the people alive today were born into the hands of midwives. Just a little over a century ago, in 1900, midwives attended half of the births in the US, and only about 5% of births happened in hospitals. By 1939, about half of women gave birth in hospitals, virtually all with twilight sleep. By 1960, 97% of births happened in hospitals. Why the dramatic change? Was it because hospital birth was safer?

No. In fact, when doctors first began attending births, and births began their shift to the hospitals, outcomes for mothers and babies worsened significantly for a while. The experiment was a horrible failure! Part of this decline in safety was due to a lack of care taken in prevention of the transmission of infections. Doctors would go from doing autopsies straight to catching babies, without even washing their hands. It was no wonder that infection became rampant. Once the connection was made between hygiene and infection control, outcomes began to improve. Men in obstetricsOne big reason births moved to the hospital was women’s desire for pain control. It was an attractive option for those who could afford it, which made hospital birth a show of affluence and status, as well as a desirable choice for women who were afraid of the pain of childbirth. The use of “twilight sleep,” where women were given amnesic medications during labor and knocked out for the birth, became a popular option. Doctors would have to use forceps to help the babies be born, because the mothers were unconscious and unable to push the babies out themselves. Of course, these deliveries were risky, causing a lot of damage both to mothers and babies.

Now, we have generations of people in the United States who have only known hospital births for their family members. Looking at my own extended family, I believe I may have only one living relative (other than my own children) who was born at home, and she will be 104 years old this year. Most people’s reference point for birth is that it is a medical procedure. In the media, we see hyped up shows like “Maternity Ward” and “A Baby Story” that show highly interventive, medicalized, often scary births. Most people see that as traditional, normal, and oddly somehow safer than an out-of-hospital birth, rather than what midwives know as the truth of birth: birth with midwives is traditional, normal, and safe, emergencies are rare, and birth almost always works or there wouldn’t be so many people on the planet. Midwives, and more specifically midwives who attend out-of-hospital births, are the birth practitioners who are guardians of traditional, natural, physiologic birth. We’re the only health care providers who ever see births that are truly natural.

Hospitals have made huge improvements over the years in trying to make birth more family-centered, but even the most natural-minded hospital-based practices don’t come close to a home birth or freestanding birth center experience. When was the last time you heard of a hospital birth where a woman with no IV (or saline lock) gave birth attended by the midwife she’d seen for all of her prenatal visits, birthed her baby in a quiet, dimly-lit room, and caught her own baby in a birth pool in whatever position she wanted to be in? We home birth and birth center midwives see that kind of stuff all the time. Fortunately, as people become more educated about midwifery and about the benefits of the midwifery model of care, the tide is beginning to turn. People are increasingly seeking the help of midwives for their babies’ births, and are returning to traditional care. Modern day midwives are increasing in numbers, especially in out of hospital settings. The Internet, films like The Business of Being Born and Orgasmic Birth, as well as help from organizations like The Big Push for Midwives, MANA, and NARM have all helped to increase awareness of birth options for families. The links below are full of historical information about midwifery, traditional birth, and about continuing struggles for the freedom to choose where and with whom a woman may give birth. Something to think about the next time says they want a traditional hospital birth.