Two things I think you should know about

I have a couple of important things to quickly mention today.

It was just a couple of weeks ago that I wrote about the global food crisis where the poorest of the poor are being hit the hardest and people in Haiti are resorting to eating dirt “cookies” made from shortening, salt and dirt. I also interviewed my friend who is in the process of adopting two young children from Foyer de Sion Orphanage in Haiti.

Another friend of ours is trying to raise awareness about the food situation and do something to help out the children in the orphanage by holding a contest. It doesn’t take much to make a difference. A mere $7 donation would feed 63 children at the orphanage for two days; $100 would buy nearly 200 pounds of staple foods like rice, sugar, flour, and powdered milk. Head on over to her blog, read how you can help and also get your name entered into a drawing with a chance to win a $25 Target gift card. It’s a win-win. Hope Gives Life – Help for Haitian Children in Need


Have you ever slept next to your child? Do you currently co-sleep or bedshare with your child(ren)? Please take this short survey and help the Fennells (a family who has been involved in promoting safe co-sleeping for many years) meet their goal of getting 50,000 co-sleeping families to complete the survey before the end of the year. The Great Co-Sleeping Survey

Loss of insurance – another price to pay after a c-section?

An article in the New York Times this weekend reported that some women are being forced to pay higher health insurance premiums or are being denied insurance coverage all together if they’ve had a Caesarean section in their past. Peggy Robertson of Centennial, Colo., was turned down for individual health coverage by Golden Rule Insurance Company because she had given birth by c-section. No matter that she was in perfect health. “Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it.”

Photo courtesy grendellion
Photo courtesy grendellion

This could be a serious problem and affect countless women given the c-section rate in this country. It is believed that the current c-section rate in the United States is at a record high of more than 30% (that is nearly 1 in 3 babies is born via cesarean section) despite the World Health Organization’s recommendation that says “the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).”

Tina Cassidy from The Birth Book Blog believes the situation with the insurance company all comes down to money.

As always, it is money dictating the rules of health care. Of course, money (malpractice fears) is one of the reasons why the c-section rate in the US at 1 out of every 3 births. Honestly, it is surprising that it took insurance companies this long to wake up to the fact that they are paying either way — for the c-sections that don’t get done when they should, those that get done poorly (regardless of whether they were necessary) or when a woman is denied access to a vaginal birth after cesarean, which is happening more and more…

Perhaps it does all come down to money, but if that really were the case, then why wouldn’t my insurance company reimburse me a measly $2000 (relatively speaking) to cover my prenatal care, home birth, and postnatal care that I had with a midwife for my son’s birth in 2006? They refused to pay me one single penny, yet had I given birth in a hospital, they would’ve covered the entire thing (tens of thousands of dollars since I would’ve had a c-section due to my son being a surprise breech) less my one-time $10 copay. Logically, I figured that they’d rather pay for the lesser of the two, but logic apparently has no place when dealing with insurance companies. Maybe Tina is right on with her assessment. After all, why would they want to reimburse me and pay $2000 when they can get away with paying nothing at all?

Sharon Holley at The Traveling Midwife feels this is a great example for why we need national health coverage and also pondered what this could mean for the future of midwives and had other questions as well.

If insurance companies are going to start denying coverage for previous cesarean sections then what is to stop them from denying coverage for any type of previous surgery? Will this help bring midwives more respect as we have better c-section rates and still maintain excellent outcomes nationwide? Currently midwives are always battling with insurance companies to reimburse for care. Even Medicare and Medicaid does not pay 100% for services when compared to same services that are provided by physicians. Will this push women to question the need for a cesarean at the time of delivery?

Heather at A Mama’s Blog who has had both a c-section and a VBAC (vaginal birth after cesarean) and has written about in the past about her c-section experience and what a c-section is really like believes the insurance situation should be alarming for all women in their child-bearing years.

Even if you have no intention what-so-ever of having a c-section, in the rare case that you did need a medically necessary one, you can be denied insurance coverage now, because the procedure has been over performed.

Doctors and hospitals must start allowing VBACs, and return to delivering breech babies, in order to lower the ever rising c-section rate. If nothing else, c-sections should be reserved for true emergency situations. Something has to change – now more than ever, our very health depends on it.

Louise at Colorado Health Insurance Insider writes about her experience in the insurance business and says:

I’ve written before about how caesareans should only be covered by health insurance if they are medically necessary – “elective” c-sections should always be patient-pay, regardless of what health insurance carrier the patient has. It mystifies me as to why someone would willingly choose a c-section instead of a vaginal birth, considering the increased risks, much longer recovery time, and permanent scar. But at the same time, a lot of doctors are also guilty of over-using medical intervention for convenience in obstetric care. Part of the problem is the ridiculous malpractice system we have in this country.

Louise goes on to add:

For women who are trying to secure individual health insurance policies, a prior c-section can be a headache. They should be able to find at least one company willing to offer coverage, but it may not be their first choice, and it may come with a higher price tag. Just one more reason why a c-section should be a last resort, and should never be performed without a medical reason.

Jennifer Block at Pushed Birth feels a policy like this is adding insult to injury.

The losers in all this, of course, are women and their families: going through unnecessary primary cesareans, then being discouraged or flat out denied normal, physiological birth for their next pregnancy, on top of that being denied health insurance because the repeat cesarean their providers are insisting upon would cost the insurer more money, and having babies at higher risk of being born too early, not to mention the risks of repeated major abdominal surgery for mom. And we call this maternity “care”?

Carolyn McConnell of Rock the Cradle – The Politics of Motherhood agrees and points out the results of a 2005 survey where one quarter of the women polled “reported feeling pressured by a medical professional to have a C-section.”

And then they pay for it, in a high rate of infection of the incision, extended recovery and pain in comparison to vaginal birth, risks of injury to the baby, greater difficulty initiating breastfeeding, and greater risks of breathing problems in the baby—and finally in a loss of insurance coverage.

So, what now? On one hand I think it’s good that insurance companies are finally realizing the cost they having to bear as a result of a c-section rate that is inexcusably high and perhaps this will encourage more women to become better informed about c-sections before they go to the hospital. Maybe this will also put some pressure on the OBs that are performing unnecessary c-sections. On the other hand, I don’t feel it’s fair to women to raise their premiums or deny them coverage based on something that many of them may have been pressured into in the first place. And in the case that it was a medically-necessary c-section, then what? Another thing that is disturbing to me in all of this is that many hospitals have banned VBACs, so even if a woman wants to have a vaginal birth after a c-section, her options are often very limited.

I don’t know what the answer is, but I do know something needs to change in this country and the c-section rate must be lowered. Women, and their babies, deserve better care than this.

What do you think?

Additional resources:

Cross-posted at BlogHer

On Nursing a Preschooler

When I wrote this post for the Attachment Parenting blog – API Speaks, I was unsure if I wanted to cross-post it on my own blog as well. I think most of my readers know I’m still nursing my almost 4-year-old daughter, and while I’m OK with the fact that I am, it’s not something I try to draw attention to either. I mean, it’s not the most socially acceptable thing to do here in the USA. Anyway, I decided to post it after all. Maybe it will keep another mom nursing a preschooler from feeling like she’s the only one in the world doing it. There have to be others out there, right? It’s just something so few people talk about. But here goes, I am talking about it…

When I was preparing for my daughter Ava’s birth, there were a lot of uncertainties about what motherhood would have in store for me, but there was one thing I knew for certain – I would breastfeed. I didn’t have a time limit set on how long I would breastfeed, I just knew I would do it, as my mom had done with me and my siblings.

My daughter Ava is now just three weeks away from her fourth birthday and she is still nursing. I am sometimes conflicted about how I feel about it. After all, it’s not like I began my nursing journey saying, “I want to nurse my child until she’s at least four. I did, however, believe I wanted my child to wean when she was ready, but I didn’t anticipate how I might feel or what I might do if her idea/time frame of weaning readiness differed from my idea of when I thought she should be ready.

Ava nursed pretty much on demand, or, a phrase I rather prefer, on cue until she was around 2 years old. It was then that I was pregnant with her brother Julian and decided I need to cut back her nursing frequency a bit for my own peace of mind. A few months before Julian’s birth, she was down to nursing once per day (before bed) and that’s pretty much what she’s been doing ever since (for the last year and a half).

A few months ago, I toyed with the idea of weaning her by her fourth birthday, so I threw the suggestion out there to her. At first she seemed amenable to the idea, but has since changed her tune, citing, “But I love mama milk,” which made me smile. And then she also added, “I’m going to nurse until I’m 8!” which made me shift a little uncomfortably in my seat.

I feel like overall (with the exception of a few difficult months during my pregnancy) we’ve had a great nursing relationship and she’s received so many wonderful benefits – great health, emotional security, bonding with her brother at the breast, etc. – over the past four years. I know it would be bittersweet if she weaned now, but I would feel very good about what I’ve been able to give her, as well as what she’s been able to give me. However, I don’t think she’s ready yet and, as much as I’d like to just be nursing one child again, I don’t think I am going to insist that she wean. I may still make suggestions and talk up the very rare occasions that she goes to sleep without having “na-na” by telling her how proud I am and what a big girl she is, but, for now, I think that’s as far as I’m going to take it. When all is said and done, I really do want her to be able to decide when she is done.

Ava, almost 4 yrs oldI didn’t set out to nurse a preschooler, but somehow along the way, my sweet little baby grew from an infant to a toddler and eventually blossomed into a preschooler in what now seems like the blink of an eye. I am confident this won’t go on forever and when I look back on this time when she’s 10 or 20 or 30, and I look at the young woman she’s become, I am hopeful that I will feel good about the choices I made and have no regrets.

If you enjoyed this post, please subscribe to my mailing list.

* indicates required