Women denied health insurance because they’ve been raped, because of domestic violence, because they’ve had a C-section… Insurers telling women who’ve given birth by cesarean, “Alright, we’ll cover you–but only if you get sterilized.” Parents denied coverage for their children because they’re too big, too small, because they hold their breath …(?!?) It sounds too outrageous/absurd/illegal to believe, but listen to the testimony of Peggy Robertson (courtesy of the Service Employees International Union’s campaign for healthcare reform):







Here Robertson illustrates the awful bind so many women are in: No hospital will take her for VBAC, she doesn’t want another cesarean, she feels she has no choice but to have one, yet she can’t afford it. Her health insurer’s answer to this? Don’t have any more children. So much for reproductive choice.

RH Reality Check’s Jodi Jacobson has a novel idea: “I say the insurance industry as currently constructed is too sick to function and should be declared a national ‘pre-existing’ condition of which we should rid ourselves permanently.”

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn’t even a disease: childbirth. It costs the country far more than any other health condition. But cost hasn’t translated into quality…

[Read the op-ed, “Midwives Deliver,” in the Los Angeles Times]

Mr. Daschle,

It’s true, those insurance execs who are coopting your call for “community” health reform discussions this week and next will probably have the higher-end rum in their eggnog, but don’t drink it. They want to keep profiteering off the very communities you and President-elect Obama asked to come together, share stories, and brainstorm for better health care.

If you really want to hear it from the heartland, decline those invitations, and may I suggest that you head to Kansas City tomorrow, December 20, where leaders of the maternity care reform movement will be hosting THE house party of the health care reform season. You want stories? These families have stories. Looking for fresh ideas about how the system needs to be reformed? These women will tell you how the U.S. could save billions by overhauling birth care. (In short, we’re overspending and underserving women and families. See this report for details.)

The “Maternity Care Community Discussion in the Heartland” starts at 2 pm in Lees Summit, MO. You should be there.

“Ladies, the physicians of America have issued their decree: they don’t want you having your babies at home with midwives. We can’t imagine why not…”


Click here to read the rest of this Huffington Post opinion co-authored by Jennifer Block, Ricki Lake & Abby Epstein

The New York Times is on a roll this week. One article reports on a study linking the rising cesarean rate to the rise in “late preterm” infants — those born at 34 to 37 weeks, when they are at a higher risk of breathing problems, breastfeeding difficulties, and spending their first days of life separated from their mothers in a Neonatal Intensive Care Unit. Another article blows the whistle on insurance companies denying individual plans to women who’ve previously given birth by cesarean. Treating the first cesarean as a pre-existing condition, the insurers argue such women are at a higher “risk” of having another surgery — which they are, because so many physicians and hospitals are discouraging, or refusing outright, women a vaginal birth after cesarean (VBAC). The Times reports that 500,000 U.S. women anually give birth after previous cesarean, and it has previously reported that at least 300 hospitals have official VBAC bans.

The medical insurers blame physicians and women for a glut of “elective” C-sections, which cost them more; physicians blame women and their own malpractice insurers. “I think there is pressure by patients on physicians to deliver early-ish when someone’s uncomfortable,” said Sarah J. Kilpatrick, head of ACOG’s obstetric practice committee, “and there is medico-legal pressure. Obstetricians are afraid of being sued,” so they may “proceed with a Caesarean to deliver the fetus when the fetus is probably fine.” What Kilpatrick doesn’t say is that the ACOG committee she heads is responsible for the de facto VBAC ban, which plays a huge part in the rising cesarean rate — and, as the study suggests, the rising rate of preterm babies.

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”?

The two most common reasons given for a high C-section rate are that a) more women are having “high-risk” pregnancies, and b) more women are obese. This week’s Washington Post story on the link between rising malpractice premiums and rising cesarean rates suggests (like others before it) that it’s not so much women and their health status that are to blame, but their providers and a system that rewards unnecessary intervention. Nearly 1 in 3 American women are going through major surgery to give birth, but only a fraction of them are “high risk” or obese (and the C-section rate has been rising at a much faster clip than the rates of obesity and multiples).

Take a look at Our Bodies, Ourselves‘ take on the purported connection between obesity and cesarean section. While it’s true that obese women are more likely to have a cesarean, it’s not clear that it’s because they need a cesarean. In fact, many of the women labeled “high risk” are labeled so more because a physician is at risk of losing a hypothetical lawsuit, not because supporting a physiological birth would increase the mother’s or baby’s risk of complications. And that’s unethical. “Any physician who picks up a scalpel and does major abdominal surgery…because that doctor is afraid of litigation, is not practicing medicine but is practicing fear and greed,” Marsden Wagner, MD, told the Post.

Maybe you’ve already heard about Ricki Lake’s “awesome” vagina — she included the waterbirth of her second child in the fantastic documentary The Business of Being Born (Lake produced it, Abby Epstein directed it). But now, six months after the film’s premiere, on the other side of the globe, Lake’s movie is being taken a bit more seriously: it’s being likened to Al Gore’s Inconvenient Truth.

With an election weeks away, Australia’s What Women Want party is calling for maternity care reform to be as big of an issue as global warming, and party leaders have enlisted Ms. Lake as their celebrity spokeswoman. Like in the U.S., nearly a third of Australian women give birth by major surgery, and the government is not promoting home birth as an alternative. Lake says she’s calling for more choice.

Want to see the film? Click here for a list of sneak previews being held around the country. I’ll be speaking at one in Des Moines tomorrow, November 6.

Childbirth is a political issue, and the left-leaning news portal Alternet.org is highlighting the lack of choices U.S. women have in how, where, and with whom they give birth. In a sweeping article published yesterday, authors Manda Aufochs Gillespie and Mariya Strauss give a great overview of U.S. maternity care (and link up to Pushedbirth.com, among other online resources). The two also have some sharp insights into why there hasn’t been more of a consumer demand for different care. The “But it won’t happen to me” myth pervades, they argue, and gives women a false sense of security in their provider. But we also can’t underestimate how the health care system mediates our perception of what’s safe, of what’s normal, say the authors.

Since medical insurers often won’t cover midwives and birth outside the hospital, many women never consider either as valid options, and therefore accept high levels of medical intervention as necessary. “For most women, the fact that hospitals have virtually cornered the market on childbirth and maternity care means that birth itself can assume the form of a medical problem rather than a normal human process. And, since most mothers are giving birth in a hospital room surrounded by highly trained doctors and sophisticated medical instruments, a low-risk, unmedicated labor can rapidly convert into a complex surgical case.” Read the article.

Lonnie Morris is famous in Northern New Jersey — she’s one of a handful of alternatives for women who want to avoid a pushed birth in the state with the highest cesarean rate in the country. For many years she ran an independent birth center, The Childbirth Center, in Englewood, NJ. But in 2003, the amount due on her malpractice insurance bill suddenly had one too many zeros. It wasn’t a typo, and Morris had to close up shop. The kind maternity ward at Pascack Valley Hospital took her in, and over the past three years she and a team of nurse-midwives have attended about 750 women there, with great success. Women were encouraged to keep active in labor and give birth in upright positions, even in the water; they were not tied down in bed with monitors and induction drugs. The midwives also delivered VBACs and twins, and still their cesarean rate was 11% — the hospital’s overall rate was 36%.

But woman-centered, cost-effective care doesn’t much help a hospital’s bottom line, and Pascack (in financial trouble for years) is closing its doors come December. Morris and the birth center were supposed to get a luxe new labor ward with sparkling tubs; instead, they’re getting the boot. And the dozens of pregnant women who are due in the next two months are scrambling along with the midwives to find a labor ward that will have them. Low C-section rate, high patient satisfaction — you’d think there would be a bidding war for Lonnie and her clan, but on the contrary, they can’t find a new home. “We have no place to go,” Morris told The Bergen Record.