Tuesday, June 03, 2008

C-sections mean no insurance?

Navelgazing Midwife has much more to say about this, but this article talks about women who have had previous c-sections being denied insurance coverage, or having to pay additional expenses for their charges (unless they have been sterilized), because of the past c-section.

C-sections, of course, cost much more than a typical vaginal birth, cause many more complications, and are much more dangerous than a normal vaginal birth.

Now, before anybody goes throwing a fit saying, "But I had one because (the baby/I/both) would have died if we didn't!" well, I do know that there are times when a vaginal birth is impossible and a c-section is absolutely warranted. I am thankful they are there for the women and babies who truly need them.

BUT - the current c-section rate is the US is somewhere around 30% - in some places it's higher, and I've even heard of places where the rate is closer to 50%.

VBAC's (Vaginal Birth After Caesarean) are not "allowed" in many hospitals, and many doctors refuse to atted them. So, the general line of thinking (whether right or wrong) is "once a caesarean, always a caesarean," and even if a woman wants to have a VBAC, she is likely to be unable to find anyone to attend her birth or a place in which to deliver.

Now, many of those women who had unnecessary c-sections (and there is no way possible that 1/3 of babies NEED to be born by c-section, or the human race would not have survived this long) are being denied health insurance, being denied coverage for a repeat c-section (which, given the unavailability of VBAC's, is basically refusal to cover a subsequent pregnancy and birth), or being charged higher rates or separate riders for a future c-section, arguing that they can exclude them on the basis of a c-section being a pre-existing condition.

The implications of this are pretty scary. Many women go into birth not fully prepared or educated, and trust their doctors completely, so if they are told they "need" a c-section, "need" to be induced, "need" to have their labor augmented, or "need" any one of the long list of potentially unnecessary and harmful interventions (many of which eventually lead to that c-section), they trust their doctors. They never consider that many doctors never see a normal, natural, intervention-free birth, that doctors are trained to use all their equipment, that they are practicing in a way to protect themselves from a potential malpractice suit (and if a doctor has performed a c-section and there is a negative outcome, the doctor is generally assumed to have done everything in his power, whereas if he has performed an unnecessary c-section, he faces no repurcussions). And so they go along with it, end up with a c-section, and never have any option for anything else in the future.

And now, they may find themselves unable to have children in the future, unless they can figure out how to pay for a c-seciton out of pocket. And I don't know about you, but I can't really pull out my checkbook and cover that one right now.

First, how about universal health coverage, so this isn't an issue? Figure out a way to cover everyone, so we don't have to worry about whether a previous c-section, a birth defect, an inherited health problem, or our genetic makeup will exclude us from coverage. Radical idea, I know, but it seems to work for all those other industrialized nations.

But second, how about letting pregnancy and labor take its own course unless there's a darn good reason to do otherwise? Like not scheduling 38 week c-sections because a baby is "too big" (and then turns out to be 7 1/2 pounds). How about allowing truly elective c-sections only if the mother is willing to pay the full cost out of pocket, and understands all the potential implications?

Yes, I get riled up about this issue. I think women, and babies, deserve better, and sell themselves short when they don't trust their bodies to do what their bodies are designed to do - carry a baby and give birth. Plus, if I'd gone with a convential OB/GYN for Guthrie's birth, I'm pretty certain I would have been scared into having a c-section because he was "too big" for a vaginal birth. Oh, he was a big baby - over 9 pounds and 21 inches - and he was my longest and hardest labor of my 3, but he certainly wasn't "too big" - born after 7 1/2 hours of labor without a complication, without a tear, without an IV, epidural, or any other intervention.

The only good I can see coming from this development is that if enough women find out about it, and know what it could mean, maybe they will think things through and question whether that c-section is truly necessary.

(And because this comes with bad timing, as one of my friends just had a baby by c-section, if she reads this - as if she has time with a new baby - it's not directed at anyone in particular at all. Just my frustration with "the system" as it is.)

1 comment:

Julie said...

I know this is an old post, but I had to reply. It is so right on, everything you say. I had a midwife (planning a homebirth, but she kind of backed out, we didn't feel like finding new care............)and I was over due. We still wish we hadn't gone to the hospital for the induction! They scare you into these things and expect you to not question them.

We have already picked our midwife for any children to come, she's great and doesn't care that I'm a vbac, and has an amazing trust in birth. I know if we went with someone here local, I'd not have a chance at a vaginal birth.

Again, I'm really enjoying your blog, it's nice to meet someone who is from here, who actually has passion about some of the things that I/we do, most people just think I'm crazy! :)