Birth in the News
Recently 3 major news organizations have had articles about birth related issues: The LA Times, The Wall Street Journal, and Time magazine. All of these articles have merit, but also have some short comings, which I’d like to address.
LA Times
The LA Times article, Childbirth: Can the US Improve?, I thought was over all very good. I liked that it featured a mom who not only had to look around to find a Dr. willing to support her VBAC, but that she successfully birthed a reasonably large baby (8 lbs 11 oz) vaginally. I thought it dealt with the risks of cesarean and interventions very well, such as the increased risk of “ICU” admissions (that should be “NICU) for babies with planned births–that is, planned inductions or planned cesareans. They pointed out that when some hospitals institute rules banning “planned” deliveries prior to 39 weeks that are not medically indicated, NICU admissions dropped by 46%. Amazing. Here are some of my favorite quotes:
“We’re going in the wrong direction,” said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls the “perinatal paradox,” in which more intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions.
and
As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.
Now calculating numbers from above….with about 4 million births per year in the US, that $79 billion price tag on birth works out to just over $19,000 per birth. Wow. I didn’t even pay 10% of that for my most recent homebirth. I do wonder if there is some misreporting there…because as you can see from the quote I lifted, that is reported to be just the *hospital* costs–not the cost of prenatal lab tests, ultrasounds, and the midwife/OB prenatal care fees–yet in a chart that is inset into the article reports “uncomplicated” birth costs ranging from $2,600 to $4,500. I tend to think the $19,000 figure is more accurate, as I’ll discuss more with the Wall Street Journal article.
Another thing that I definitely did not like was that the article trots out the often repeated “too posh to push” arguement for the rising cesarean rate. Childbirth Connection found in their most recent Listening to Mothers Survey that the percent of women requesting a non-medically indicated primary cesarean is vanishingly small…but women are, of course, a conveniant scape goat for OB’s to point to for the rising cesarean rate.
Wall Street Journal
The Wall Street Journal article was actually an “oped” written by a mother about her experience with her hospital bills for birth. It certainly is eye opening…with an initial bill for an uncomplicated vaginal birth of $36,625. OUCH! Assuming she had a day in the hospital in labor, and 2 full days after the birth, that’s still over $10,000 per day. As I’ve often said about one of my reasons to homebirth “the hospital is a pretty expensive hotel.” Now granted…this hospital was in Los Angelos, not an area particularly known for a low cost of living, but still…
The author, Anna Matthews, writes of trying to find out prenatally how much she should expect to pay for the birth with her PPO style insurance. She was told that she would have to pay at most $1,370, but it might be less. She ended up paying $2,118.90 (which again…I paid less than that for my most recent homebirth even though it was not covered by insurance). I have to say…I feel her pain on this one just having tried to find out how much some lab tests would cost for my kids, and getting stuck with a bill that was MUCH higher than the insurance company quoted to me.
I find it insane that consumers can not get a straight answer in advance to how much they will pay for medical treatments. Its akin to walking into a grocery store with no prices posted, filling up your cart, going to check out where you are STILL not told how much you will have to pay, just that you will be sent a bill in a month–after you’ve eatten all of the food. Would you shop at a grocery store like this?
Along the cost issue, Anna reports:
Even though the pain-killing epidural shot felt priceless during my 20 hours of labor, I was amazed that its total cost could run so high.
Sterile Epidural Tray
So how much did it cost? Part that I find amusing was that she was billed $530.29 just for the sterile tray containing the equipment to place the epidural. I purchased a tray like this off of E-bay a few years ago to use as a class prop….for $10 including shipping across the country–TWICE. It was manufactured not 15 miles from where I live, then purchased by someone with a medical license, listed on E-bay in a lot of 10, purchased by a childbirth educator in Oregon, then mine was separated out of that lot and shipped to me.
Once three different bills were added together the total billed price for her epidural was…$4,212.84. Let that settle in for a moment.
If you had to pay for that out of pocket, would you try to find other, less expensive ways to deal with labor? Well really…you are paying it “out of pocket.” You just don’t see it directly because it is buried in the monthly insurance premium. This whole “cost of birth” issue is one of the reasons I favor a high-deductible system of health insurance. I believe that health care costs in America would drop dramatically if the majority of Americans carried high deductible policies and they knew up front what various medical services would cost. And really, most of us CAN afford high medical deductibles…after all, how many $30,000 SUV’s and minivans do you see dropping off kids at the local elementary school? Insurance isn’t paying for those. Not only high deductible…but I’d like to see billing directly to the consumer for routine care, not billing through the insurance company. Having the insurance company administrate bill payment just adds another layer of expense to the health care system. Having costs of care readily visible to the consumer also allows the consumer to “shop around” for the best price for services they desire.
In the end, Anna’s insurance nogotiated the total bills down to $17,300…which I still think is insanely high for a low-risk birth.
Time Magazine
Last, but not least, Time magazine writes about the frictions between midwives and OB’s, which is very timely with the situation going on right now in the Lehigh Valley (there is a Facebook group set up to communicate updates about this situation–please come join it!).
This article reports on a new study released recently by Oregon State University (OSU) that found that…are you sitting down for this?
There is friction between obstetricians and midwives.
Really? I never would have guessed. (insert eye roll)
The article does contain some gems though that are not to be missed, like this one:
…we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden.
Yes…I had blogged about that back in early 2005. I’ll have to dig out that blog post some day and repost it here. I even pointed out that Sweden does much better than the US…because my paternal grandmother was of Swedish descent, so I take a small amount of pride in that.
I applaud the article for pointing out that research is showing the homebirth is a safe option for low-risk women, but at the same time take points off for the author’s failure to fact check. The research article they site in support of homebirth attended by a Certified Nurse Midwife–known commonly as “the 2005 BMJ Homebirth Study“–did not look at homebirth with Certified Nurse Midwives (CNM), which are legal in all 50 states, but Certified PROFESSIONAL Midwives (CPM), which are only legal via legislation in 24 states…PA being a state where they have a tenuous legal standing of “legal by judicial interpretation.” A simple explaination of the difference between these two types of midwives are that Certified Nurse Midwives study nursing first, and then pursue a master’s degree in midwifery, while Certified Professional Midwives only study midwifery, with a lot of their study time in the form of “apprenticeship.” While CPM’s are often discussed disparagingly because of their “apprenticeship” style training, what is “residency” for a Dr. but an apprenticeship?
Cheyney (the author of the OSU study) points out:
When hospital-based obstetricians see midwives and their clients it’s usually because something has gone wrong and the laboring mother is rushed in for care. OBs don’t see the uneventful births that proceed successfully at home. What’s more, doctors in this position find themselves not just being forced to take on someone else’s case, but someone else’s problem. That’s enough to sour them on the entire profession.
Hmmm…so I wonder…with the same philosophy, if cardiologists should be “soured” on family physicians because they only see the patients of family physicians when they are having serious heart problems? Or should ER Dr’s be upset that people attempt to swim at home swimming pools, despite the dangers associated with them…rather than only swimming in pools that are located on hospital grounds where life-saving medical care is available in the case of a near drowning?
A final of my favorite gems from this article is this comment from Cheyney:
”The U.S. has a limited idea of what it means to have a positive outcome at the end of a delivery,” she says. “Basically it just means that everyone’s alive. But when you don’t have a lot of medical intervention, you also tend to have more breast-feeding and reduced rates of postpartum depression.”
Amen.
Tags: cesarean, cost of birth, Doctor, epidurals, health insurance, hospital birth, VBAC