For some, cost is the aspect of attempting an out-of-hospital birth that makes it the least appealing, and sometimes an all-out non-viable personal option. The short and quick of it is, payment is required in full prior to 37 weeks, or the point at which an out-of-hospital birth is possible. If you had paid for your delivery, and then went on to labor and needed to transport for any reason, you would also need to pay any associated hospital fees. Again, for some people, that does it.
Why should it not completely dissuade you?
Many people who choose to birth outside the hospital do have medical insurance. While this does not necessarily cover the costs of home birth (more to come in a future post), it is helpful in the event of a transport or emergency. The medical insurance would cover the costs of the hospital according to your policy. So, even if the entire amount of your midwifery care has been out-of-pocket, the hospital bill may only be a fraction or percentage of total costs in regard to what you are responsible for after insurance adjustments and payments. Both will likely be applied to any deductibles.
What is the value of peace-of-mind?
Though impossible to quantify, I would argue that with the support of a healthy birth team, it is priceless. I cannot know upon meeting an individual what type of birth she will go on to have; however, if the couple is educated and supported throughout their journey and not filtered through a system or process, then they are set up for optimal success.
Personally, I would much rather be set up for success with a variety of tools available and know that I tried it all even if the outcome was different than my expectations than to save some money, become a number and lose my individuality.