Yesterday was tax day, the pinnacle of the season in which our CPAs need an extra hug and a mug of coffee. It’s also a time when many of us look back over the management of our personal finances and examine how we might do better in the future. This is especially true this 2019 tax filing season, since 2018 saw major tax reforms, yet many employees did not adjust their withholdings. The result, often, is an unanticipated tax bill in homes that previously received refunds — yikes! Fortunately for those of us who have been busy birthing babies, we’re enjoying boosted child tax credits — score!
That brings me to some funny topics. As a doula, my major interest is your physical, emotional, and spiritual journey to parenthood, followed closely by your baby’s adjustment to this new world. Money seems moot. Nevertheless, doing this wonderful work costs me and my family, so, I unfortunately have to charge my clients (sorry), and actually, financial acumen is extremely relevant to sustaining a solopreneur operation of any kind, but I would add especially for a birth worker (and that is a topic for a future blog post).
Today, here’s your predicament: you have finite resources and are looking for value. Doulas provide a valuable service by statistically reducing your odds of a birth that otherwise could be more costly, both financially and emotionally. Rates of cesarean birth, medicated birth, and dissatisfying birth are all lower for women who are accompanied by a doula. However, there is a cost to your doula. Believe it or not, I have to cover many career expenses — doula organization membership dues, continuing education, mileage, childcare, birth pools and other tools, plus lots and lots of honey sticks (and I mean LOTS). I also have opportunity cost (so much for the clean house and other job opportunities) and most importantly, my family makes major sacrifices to allow me to do this work. If I’m going to miss out on camping trips with my children, family reunions, recitals, or even the first day of kindergarten (yes, this happened), you better believe I’m not just going to be passionate about my work — I am also going to make at least some income.
So, what is the mutually beneficial solution to your need for cost effectiveness and my need for compensation? The answer (drumroll…): HSAs, FSAs, and HRAs! Yeah!
In case you’re unfamiliar, these savings vehicles work to your advantage by allowing you to pay for qualified health-related expenses with pre-tax dollars. So if you spend $1,000 on a birth doula with your HSA, then for tax purposes, it’s as if you earned $1,000 less. Now, if you have insurance like most Americans, you may not immediately think an HSA is worth your time. However, HSA, FSAs, and HRAs (please assume all of these when I say HSA throughout the rest of this blog) pay for many valuable health services and products that aren’t typically covered by insurance. Now, if you’re just buying bandaids with your HSA, it may not be worth the hassle of extra accounting. However, in the childbearing and postpartum years, uncovered services are often especially sought out by families and are pricey enough to warrant a hack on your taxes. Take the following examples:
Case A: Acupuncture for Induction
You passed your due date. Your OB/GYN starts pressuring you about potential induction, which you know can be a road to a more medicalized birth (not ideal for an otherwise low-risk pregnant lady). You’re smart, and say, “Hey, I’m down for that if it is necessary, but I know some alternatives. Husband & I will make some love tonight. I’m interested in giving acupuncture a try, too. Will you write a recommendation for acupuncture, given my condition?” Acupuncture, of course, is a low risk route to cervical ripening, and may promote spontaneous labor. If nothing else, it is a way more relaxing use of your time than hanging out in a scary hospital with cervidil stuffed in your vagina and a bag of pitocin down the hall. Because of your HSA and the doctor’s recommendation, acupuncture is paid for, pre-tax. Good job, mama (and come ON stubborn baby)!
Case B: Birth Control, Boobie Duty & Body Recomposition
You’ve given birth (hooray!) and study your postpartum body with a sense of gratitude, awe, and, well, a bit of criticism (let’s be honest). The thing is, you know that at this stage, it would be unreasonable to expect your body to look anything different. You know that. Still, you won’t be content with keeping things as they are. First, you have to survive the early postpartum weeks, when you and your newborn are bonding like best buddies. Breastfeeding takes some of your weight off effortlessly, but as you ease into a more normal life routine, you start drafting some goals — romancing your spouse again, regaining physical fitness, and gaining a bit of independence from your mini me. Pumping your breasts gives you the ticket you need to escape for the gym or a date while keeping baby nourished with the best. And thankfully, if your insurance didn’t pay for your breast pump, your HSA did. Before you begin a new fitness training program, you brilliantly sign up for a body scan, knowing that trackable data on your bone density, muscle, and fat percentages will drive you to the most effective plan of action. It may seem like a luxury to some, but you know your time as a mother is priceless, so you prioritize getting high quality, quantified information and an appropriate road map, and of course, you cover the cost with your pre-tax earnings through your HSA. Next on the list — since you’re looking so hot now — is date night. Because you are rightfully wary of hormonal birth control prescriptions, you’ve safely decided to stick with some trusty condoms, which are a covered by your HSA. You know that breastfeeding can no longer be relied upon for protection, since, by bottle feeding your pumped milk, you no longer are feeding exclusively on demand. That’s ok, though, because today’s condoms are well designed enough to feel really awesome and still provide reliable performance (reliability tip: put it on before any intercourse, because tiny amounts of semen do escape before the big O).
Case C: Counseling, Childbirth Education Classes, Cord Blood Banking, and Consecutive Children
Let’s just imagine another scenario. As savvy of a health consumer as you are, you simply can’t control everything in life. Tragically, your first born child has developed a serious and rare health condition. The good news is, you decided to conceive again, and with that news comes the possibility of banking your new baby’s blood for possible therapeutic use. Your compassionate doctor writes a letter of medical necessity, and you make plans to pay for the cord blood banking with your HSA. Because you’re undergoing serious stress with everything going on, you’re struggling to “keep it together.” Your doctor recommends and jots in a note that you try counseling, so you find a great counselor on your doula’s resource page, begin meeting with the counselor, and pay for your sessions using your HSA. As you advance through your pregnancy, you decide that it’s time to honor your new baby by giving more attention to his experience in the womb and his upcoming rite of passage to this side of the world. You learn that your HSA will pay for childbirth education classes, so you enroll and attend as a way to prepare for this next birth. Second babies (as well as third and other consecutive babies) all come in their own way, after all, so you can’t just expect things to occur as they did with your firstborn. Finally, you are approaching the end of your pregnancy, and realize that with all you have been through this past year, it would be so helpful to have a doula to support you, your spouse, and your firstborn child in this emotional time of transition. Your OB/GYN applauds your wisdom, and writes a letter of medical necessity to enable you to pay for the birth doula with your HSA. Knowing your doula is there for you and your family gives you a peace of mind that frees you to labor unhindered, and have a joyful birth. Holding your new bundle of pure love restores your faith. You count your blessings.
In summary, insurance does not often cover acupuncture, condoms, DEXA scans, doulas, childbirth education, counseling, and cord blood banking. With an HSA, however, you know know that you are not powerless in your quest to take charge of your body’s wellness story. You can attain the services and tools that your family needs, and your HSA will help you get there while incurring the least financial impact possible.
Christine Frackelton, CD(DONA), CBS 