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

Getting our green groove on!

Amy’s picHello. :) I’m Amy, also known around the internets as amygeekgrl. Welcome to my groovy green blog party, part of the Ultimate Blog Party hosted by 5 Minutes for Mom! I’m so glad you stopped by. :) Come in, have a seat and let me offer you something to eat.

Brownies with heart -2/7/08

Oat-nut scone with strawberry jam

Can I tempt you with some homemade granola or perhaps an oat-nut scone topped with strawberry jam or maybe you’re in the mood for a Grilled Panini with Provolone and Basil or a brownie baked with love? I have a fair bit to choose from here, as I enjoy cooking and baking a great deal. :) I just wish I had more time to do more of both.

Me and the kids on New Year’s Eve - 12/31/07Now that you’ve got something to munch on, let me tell you a little bit about myself. First and foremost, I’m a mom. I stay at home with my two amazing children – Ava (3 3/4 years old) and Julian (15 months). My husband Jody and I try to raise them with the philosophy of attachment parenting in mind, though we really just follow our instincts and do what feels right for our family.

I have a lot of passions that I like to write about on my blog. Some of them include home birth (my son was a footling breech and born at home), breastfeeding (I’ve shared my experiences of nursing while pregnant and tandem nursing), and informed healthcare decisions (why we delay/selectively vaccinate). I also write a lot about the environment (picking up trash in our neighborhood, composting, and recycling) and do a weekly Green Tip of the Week column with suggestions to make life a bit more eco-friendly. Some would call me a hippie or granola or crunchy, hence my blog title. ;)

One of my favorite quotes is “You must be the change you wish to see in the world” by Gandhi. I try to live by that philosophy both on my blog and in my life.

I also write about maternal health as a contributing editor on BlogHer, write reviews for Green Mom Finds and will soon be joining the team of Blissfully Domestic as the Eco-Diva.

I like to do giveaways here at Crunchy Domestic Goddess. In the past I’ve given away t-shirts, natural cleaners, reusable bags, books, toys, and even a digital camera. I currently have a giveaway going on right now for a bottle of Shaklee Basic H2 natural cleaner. It’s good stuff! The deadline to enter is March 13. Hope you’ll check it out and enter to win!

In addition to my blog, I also have two online stores – Attached At The Hip, featuring AP advocacy wear and more and home to the I make milk. What’s your superpower? shirt, and Cute As A Bug, featuring cute and original designs for babies, kids and adults. I enjoy photography (and love taking part in Best Shot Monday), reading, and hiking.

green balloonsYa know, this is my kind of party, very environmentally friendly – no paper or plastic waste and little carbon emissions! :) I hope you enjoyed your visit and will come back again.
Please feel free to sign up for my RSS feed or follow me on Twitter (amygeekgrl)! And, of course, be sure to leave me a comment so I can try to come check out your party too. :)

Now it’s time for the kids and I to get our party groove on, but feel free to visit the rest of the other party people linked up at 5 Minutes for Mom.

Julian’s got his cape and is ready to party! Ava’s got her cake and is ready to party!

Edited to add: I’ve donated a prize – an I make milk. What’s your superpower? short-sleeved t-shirt – to the Ultimate Blog Party. It is prize #141 on the prize list.

There are so many great prizes to choose from in this year’s Ultimate Blog Party, but my top fvie choices are: Bead Dangle Photo Tile Necklace by Elemental Memories, Marketing for Entrepreneurs by Lis Garrett, Burt’s Bees Naturally Ageless skin care line by Geggie, Go BPA Free Sippy Sampler Kit by The Soft Landing and Rocking Horse by A Rocking Horse To Love. If my top five picks are already taken, then I’d also love any of the following (in order of preference) #11, 12, 15, 2, 3, 14, 32, 34, 37, 70, 72, 79, 87, and 5 or anything related to a toddler or preschooler. :)

A letter to my body

BlogHer has unveiled a new topic area: Body Image and is encouraging everyone to write a Letter to Our Body.

Hello dear body o’ mine,

It’s been a while since we talked so I thought I’d take this opportunity to chat with you for a bit.

My bicep in 2005First of all, thank you for sticking with me all of these years. You’ve done some amazing things over the past 32 years and put up with some crap from me and yet, despite that I don’t often acknowledge your greatness, you keep on keepin’ on.

You proved yourself awfully resilient from an early age when you endured three eye muscle surgeries (for strabismus) before you/I were even 2 years old. You rose to the challenge when, at age 6, I stepped on a piece of wood while in a lake, and was on crutches for a few weeks while you healed yourself. You stayed remarkably healthy and strong throughout my middle school years when a bag of Funyons and a candy bar was often considered a “cooler” lunch than a sandwich and apple. And you kept on truckin’ throughout high school when I got us up before school for 7 a.m. band/flag corps practice, then went to school, then had drill team practice after school, then did homework and often worked until 10 p.m. at K-mart. You are a machine for getting by on so little sleep and still functioning well enough to get good grades throughout high school.

Then there were the college years, where I was often an emotional wreck, ate crappy cafeteria food, pulled all-nighters cramming for exams, not to mention the experimentation with drinking and smoking (cigs, cloves and other). I know there wasn’t a huge amount of either of the two, regardless thank you for responding so well the majority of the time, and keeping me on the straight and narrow even though I have a serious family history of addiction. You don’t know how thankful I am for not falling victim to it.

After college I began to wise up a bit and understand that you deserved better. I started drinking water instead of soda and even went the vegetarian route a few times. However, I admit exercise was not then and is still not one of my biggest priorities. You deserve better from me in that regard.

When I got pregnant for the first time, I believed in you to help me through a natural childbirth. And while I did the best I could with the cards dealt me (HELLP syndrome), I ended up having to be hooked up to machines and on drugs (magnesium sulfate) that I never knew existed. Even though I was seriously sleep deprived and bed-ridden and drugged, you stayed strong for both me and my baby girl. Thank you from the bottom of my heart for that.

After Ava’s birth, you recovered from anemia and, as Ava grew older, I started to pay closer attention to the foods we ingested, both for her health and for yours. Instead of frozen dinners, I opted for more whole, organic foods. I think this helped you, my body, a great deal when I got pregnant with my second child.

Knowing that I wanted a home birth this time around, I was willing to do just about any and everything to keep you in the best shape possible so that I could to achieve that, which meant eating more protein throughout my pregnancy, going for acupuncture, and drinking some nasty concoctions of Chinese herbs. All of it paid off when I went into labor on my own without any symptoms of HELLP.

You proved yourself to be a birthing warrior when you gave birth vaginally to a 9 1/2 lb. surprise footling breech baby boy in our bedroom at home. No drugs, no machines, just pure hormones, endorphins, love and determination. You were amazing. Again, thank you for doing exactly what you needed to do to have a healthy baby.

These past nearly four years of motherhood have caused some wear and tear on you, this I know. Sleep deprivation can be hard on a body, as can breastfeeding hunched over with poor posture. I will do my best to honor your cues as to when you need sleep and to be mindful of my posture. I know I need to take care of you to be able to take care of my family.

I hope to have a long run with you, dear body, and I pledge to continue to nourish you with good foods, save the occasional sweet treat. I gotta be honest, I think you do love your chocolate. ;) I pledge to exercise more. I can’t promise anything fancy, but I can do more frequent walks and at least that is something. I also will try to take some time to honor you on a regular basis and appreciate you for the wonderful life you give me.

You are an incredible thing, my body. You are strong, resilient, healthy and amazing, and I thank and love you.

Sincerely,

Amy
(Crunchy Domestic Goddess)

The Big Push for Midwives Campaign 2008

Cross-posted over at BlogHers Act.

Obama, Clinton, McCain, Romney, Paul and Huckabee aren’t the only ones hitting the campaign trail this winter. Thanks to a nonpartisan coalition of consumer advocates, The Big Push for Midwives – a campaign of a different variety, but equally as important – is pushing for the regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico.

Midwife with mother and babyAccording to The Chicago Tribune, “Certified professional midwives, who are lay practitioners specializing in home births, are banned in 26 states… They fall under a different legal classification than certified nurse-midwives, advanced practice nurses who are licensed in all 50 states and work mainly in hospitals.”

Why is this important?

We live in an age where surgical birth via cesarean section (which is full of risks to both the mother and the baby) is becoming more and more common, while physiological birth (where labor starts spontaneously, progresses spontaneously without drugs, and birth happens spontaneously) is almost unheard of in many hospitals. Yet many women want the option of a physiological birth with a trained care provider (midwife) in a birthing center or in their own home. However, because of current laws, that option is not always available.

I believe that all women deserve the right to choose a maternity care provider that is best for their needs which is why The Big Push for Midwives is so important.

The Big Push for Midwives is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states and the District of Columbia, and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Our goals are to fully integrate the Midwives Model of Care into the health care systems of our states, to highlight the importance of family healthcare choices and to defend the ability of CPMs to provide legal and safe prenatal, birth and postpartum care to families in every state. Childbirth activists from the campaign’s participating states are pooling their collective resources and experience to coordinate and optimize advocacy efforts during 2008.

Amie Newman at RH Reality Check links midwifery and home birth with the rest of reproductive freedom, and believes that women should have the right to childbirth choices just as they do the right to abortion choices.

Hmmm. Sounds like reproductive justice to me. Substitute “abortion access” for “Midwives Model of Care,” “abortion providers” for “CPMs,” and “abortion care” for “prenatal, birth and postpartum care” and you can see how the underlying issues are essentially the same whether you’re talking about abortion rights or childbirth choices.

That is, whether we’re talking about provider choices for childbirth or access to abortion, it is not too much to ask that wherever women live in this nation, the options for reproductive health care are not effectively criminalized in some states and legal in others.

Jennifer Block at Pushed Birth notes that:

… the research data, as well as other countries that are caring for women and babies better than we are, show that midwives should be supporting normal labor and deliveries (the majority), while MDs should be caring for the complications, emergencies, and women with risk factors. This “division of labor” also happens to be far more cost-effective than our current system, which bleeds more cash for less care than any other in the world. The bottom line from a public health perspective: home-birth midwives should be legitimate care providers, not criminals.

Erika of Inspired Mama Musings headed out on her birthday of Jan. 24 with her two kids in tow to a peaceful protest at the capitol building in Idaho to support her local midwives, a cause that’s near and dear to her heart.

I am very fortunate and blessed to have had births attended by midwives and my hope is that the women and families of Idaho will always have that option.

Idaho is just one of 20 states that are introducing legislation or have legislation in the planning stages. Pennsylvania is another.

Annette of Natural Childhood also attended a rally supporting midwives at the capitol in Harrisburg, Penn., and included several pictures from the rally on her blog.

Our Bodies, Ourselves is also a supporter of The Big Push.

“This is the perfect time to insist that women in all communities have access to the option of midwifery care,” said Executive Director Judy Norsigian. “This would lower the number of unnecessary cesareans and enable many more women to enjoy the benefits of active support during labor and birth.”

Also worth noting is the book “Our Bodies, Ourselves: Pregnancy and Birth” is due out in March and includes information about the benefits of midwifery. And there’s a great article on the Our Bodies, Ourselves web site that compares and contrasts the type of care typically provided by midwives vs. that provided by obstetricians.

The Midwives Model of Care, based on the fact that pregnancy and birth are normal life processes, is a fundamentally different approach to pregnancy and childbirth and is in stark contrast to the standard Medical Model of Care. “The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”

If you’re interested in advocating on behalf of licensing CPMs in your state, please check the list of state organizations and their various discussion lists and websites, where you can find out more information about how to get involved. If your state isn’t on this list and you’d like to get involved, you may email Katie Prown and she can point you to additional resources. You may also make a donation to The Big Push for Midwives Campaign.

Photo credit: Thanks to Homestyle Midwifery Care for this beautiful image.

Update on BOBB Netflix release and other birth movies

In case you aren’t on the Business of Being Born mailing list, but are waiting for the DVD release to Netflix, I wanted to let you know you are going to have to wait a little longer. The Netflix release has been pushed back to Feb. 26. The good news is that the reason it was pushed back is because BOBB is now planning a theatrical run in Chicago, Seattle, and Tulsa. So, yay for more exposure! The bad news, of course, is it that means more waiting, unless you happen to be in Chicago, Seattle or Tulsa. Then by all means get yourself to the theater! :) And then email me and let me know what you thought!

Other birth movies on the horizon:

Le Premier Cri (The First Cry) – which follows 10 pregnant women all around the world, as they live, work and give birth. – This looks amazing and brought tears to my eyes the first time I watched the trailer. If you’d like to know more, here is a translated interview with the director.

Home Delivery – This film documents the lives of three women in New York, who for very different reasons have decided to go up against social trends and take the birth of their children into their own hands… and homes. – This film looks very different than the birth movies I’ve seen/heard about in the past, but seems very interesting as well.

Insurance update – the home birth saga continues

A while back I posted that I was trying to get our insurance company to acknowledge a claim for Julian’s home birth. I made phone call after phone call asking them if they had all of the information they needed to process the claim and each time, they would come back with one more thing that was still needed. I’d send them that “one thing” and then there’d be something else. It was always something.

I received an “explanation of benefits” in the mail from them a few months ago that said the claim had been closed because they hadn’t received everything they’d requested from me (BS!), and that they’d consider reopening it if the information was sent in. I threw up my hands in frustration and pretty much resigned myself to the thought that we would never get anything from them.

Then my midwife told me that she had contracted with a billing company and they could take over my case for me. So I sent them the information they required about two months ago and hadn’t heard a word from them until a couple weeks ago. Jody got a call saying that they needed the “explanation of benefits” that the insurance company sent to me and that they were “very optimistic” that we’d get some money from them.

I dug up that form and Jody faxed it in so now we wait and see. It would be awesome if they end up paying for part (or all!) of my midwife’s fees. Considering we paid $2200 for prenatal care, the birth and postnatal care, it would be a serious bargain for the insurance company. If I had had a hospital birth, which would have involved a c-section since Julian ended up being breech, it would have been tens of thousands of dollars and that’s just for the birth and not including the prenatal/postnatal care.

I’m not holding my breath, but I sure would love to see some of that money back in our pocket. :)