Experience a cesarean and lose insurance coverage?

Original article here

This article, featured in the New York Times, June 1, 2008 online edition, tells of the latest frustration with our county’s rising and epidemic cesarean rates.  Women who have experienced a cesarean birth may either be turned down for health care coverage or their current coverage may raise their premiums and consider them to be high risk.

Add this to the decision of more hospitals deciding (contrary to all the evidence-based medicine) they won’t continue to offer women the choice of a VBAC (vaginal birth after cesarean), and our country’s 31% cesarean rate (MUCH higher in many areas of the country) and you have another simmering healthcare crisis.

So what is a woman to do?  She has become another cesarean statistic, her hospital has quit offering VBACs and now her insurance coverage is in jeopardy.

One thing every pregnancy woman can do is educate herself with her very first pregnancy so she won’t become a victim of an “unneccesarean” (an unnecessary cesarean).  Working in the field of births for many years, I can honestly say that when a cesarean is truly needed, you are very grateful they are available.  They save lives and that’s the truth.  But one-third (or more) of this generation’s women are not “broken” and unable to give birth vaginally.  Not that many emergencies happen.  Something has gone very wrong with the system, not women’s bodies.

Here are a few suggestions that have been shown to lower your statistical risk of delivering by cesarean:

  • Don’t allow an induction for any reason other than an immediate crisis for mother or baby.  These do NOT include caretaker going on vacation, you want the baby born on someone’s birthday, you are uncomfortable and ready to get this over with, or baby seems to be getting a ‘little large’.  Especially in first-time moms, you will considerably raise your risk of a cesarean outcome.
  • Avoid pain management that interferes with your mobility.  Staying upright and mobile not only assists greatly with the management of discomforts during labor, it can make all the difference in getting a baby to maneuver more easily through the contours of your pelvis.  Once you choose an epidural, you are confined to the bed and usually to laying on your back in order for them to provide good coverage and to work well.
  • Research the use of electronic fetal monitoring.  Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.  It can be used as a screen, but should not be considered a diagnostic tool without errors.  Request intermittent monitoring instead.
  • Avoid pitocin augmentation for a slow labor.  It can cause fetal distress which would lead to a cesarean.
  • If your baby approaches your upcoming delivery with a less-than-optimal position for birth, check out Spinning Babies website.  Lots of information there on encouraging a better position for baby, which could not only spare you a cesarean, but make for an easier, less painful vaginal birth!
  • If you have already experienced a cesarean birth, see my previous entry on “Protesting a VBAC denial“.  Join ICAN (International Cesarean Awareness Network) and visit their website for lots of information about cesarean prevention and VBAC safety.
  • Interview different care providers.  Find out their philosophy of normal birth, induction rate, interventions used,  and cesarean rate.  Find out how long they will usually allow the second stage of labor to occur without interventions or cesarean if baby is coping well.
  • Hire a professional support person (doula).  Studies have shown having a support person reduces cesarean rates.
  • Educate yourself with more than your typical hospital childbirth classes.  Read, ask questions, research, learn.  Most people put more time and effort into choosing a new computer or car than they do the birth of their child.  Learn what your rights are as a pregnant patient, both informed consent and informed refusal.

Here are some great places to check out:

Coalition for Improving Maternity Services

Childbirth Connection

Mothers Naturally

Citizens for Midwifery

Informed Choices in Childbirth

Lamaze Institute for Normal Birth