Maternity Care and the Military

In the Washington DC Metro area it is a pretty good chance you or someone you know works for one of the branches of the military. So that means many of the active duty members and their spouses are covered by TRICARE. In looking at TRICARE's page regarding maternity care, it does not look like it gives a lot of options. Maternity care is expected to be carried out at an MTF or military treatment facility. However there is a catch if the local MTF does not provide obstetrical services:

If the local MTF does not provide obstetric services, the service member's primary care physician can refer her to a civilian provider.

So does this mean that in theory the primary care physician would refer to a midwife or a family physician? Would they consider out of hospital births? According to a local nurse-midwife, there are versions of the TRICARE plan (Standard and Prime) that allow for homebirth and out of hospital birth, but it takes some doing.

Why is this important? Well, because if a woman covered by TRICARE is limited to her MTF for care and her MTF has a high rate of cesarean or does not allow VBAC, that is not much of a choice is it. Many women with non-military insurance face these limitations as well, but they are not promised insurance for risking their lives or having their spouses risk their lives.

That being said, a study designed to find ways to reduce primary and repeat cesarean found that military hospitals represented lower rates for both compared to civilian plans. This was found to be the result of cost saving measures by a managed care plan rather than any special consideration towards physiological birth.