Can the Financial Crisis Help Lower the C-Section Rate?
Money and C-sections. They go together like, uh–well, they don’t really go together. Unless you notice that cesareans cost a lot more than vaginal births. Add to that recovery time in the hospital for mama and babe, medications, and follow-up care, and you can almost hear the cha-ching!
Washington state has a new cost-cutting program that may also dramatically lower the rate of C-sections.
They’re going to start paying the same amount for an uncomplicated C-section as they do for a vaginal birth.
And because C-sections in that state cost on average $5000 more than vaginal births, this will help make sure the motive for the surgery–the most common in the United States besides circumcision–are the best interests of the patient.
We are choosing to improve quality mostly by using carrots rather than sticks.
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Washington, like many other states, is facing budget problems. This is just one measure, tucked deep into the new budget, designed to save the state money. The state will pay $1000, the same as a vaginal birth, for an uncomplicated C-section.
Of course some C-sections are medically necessary. But currently, one half of all C-sections in the States are elective. Every year for the past 11, we have set a new record in the number of cesareans performed. At 31.8% of all births ending in surgery, we’re way over the WHO’s recommendation of a 15% C-section rate.
Cesareans usually take longer to recover from than vaginal birth and generally require more post-op medications. Also, there is new evidence that a VBAC is safer for that baby than a second C-section. It logically follows that if there are fewer C-sections, there will be fewer costs associated with follow-up care.
Could this actually change the birth outcome in Washington? Yes. Half of all births there are paid for by Medicaid. And on top of that, it is estimated to save that state and the federal government $2 million each annually. I think both fiscal conservatives and natural birthing advocates could agree on this measure.
So is this Dick Morris’s worst nightmare: are we “forcing” vaginal births because of health care reform? I think not. I think this will give more women a chance to labor without anyone prepping surgical tools while they wait.
I heard about this story through the Midwife Monologues, the blogsite of a pair of local (to me) midwives. They’ve delivered babies I love.
There original story is here.
Image: tifhermom on Flickr under a Creative Commons License.
Thanks so much for the information. There is an OB in our town with a 48% C rate!!!!!!!!!!!!!!!!!!!!!! AHHHHHHHHhhhhhhhhhhhh!
Can you imagine that he is every doula (and mother’s) nightmare to get stuck with as a rotating physician. Unfortunately there is a lack of choices. I’d love to see the rate drop across the board and if we need a recession to do it–so be it.
It sure would be nice to see the C-section rate drop. My first one was necessary (low amniotic fluid and breech), my second probably necessary (breech, but had tried to plan VBAC), and I just can’t imagine choosing to go through a C-section out of preference. Just not me. I don’t like recovering from surgery, and recovery from my one vaginal birth was much more pleasant.
Stephanie–
You’ve mentioned before about your C-sections. Babies I love are C-section babies. I hope I never sound like I’m anti-C-section, when it’s necessary. I really appreciate you sharing your experiences.
But as an advocate for natural birthing–as in, let women labor and don’t push them into medical interventions unless they’re needed as opposed to convenient for the staff–I join your wish to see the C-section rate lower.
Of course, I hope that women can always get the care appropriate to their condition!
HALF of all births in Washington state are to women on Medicaid????
There is something profoundly screwed up about our country reflected in that statistic. So many of those women who could easily afford a large family only have a single child (or none), while so many of those who really can’t even afford to properly raise 1 have a litter…
Wow. What a statement.
Crimson Wife, I was on Medicaid for both my pregnancies–until health insurance kicked in for new-ish jobs. It wasn’t about “not being able to afford” a child, it was lack of health insurance. I got on Medicaid immediately for both pregnancies because I wanted prenatal care all through the pregnancies.
So what would you suggest: More abortions or a financial requirement to prove people could “properly” raise their “litter”?
p.s. I was on birth control for my first pregnancy. So that’s not a cover-all solution.
My first daughter was an emergency c-section. I had planned this wonderful drug-free natural labour and child birth. Turns out, being slightly under five foot tall, with narrow hips, isn’t conducive to having a nine pound baby. So, our second daughter, we planned a VBAC. Yeah, that’s right, another nine pound baby *sigh* For our third daughter - does this count as a litter? - we had moved to a small town and the hospital wasn’t insured for VBACs (WTF?) at all. So I didn’t even have the option. (Yup, that’s right, wouldn’t have mattered, another nine pounder lol)
I know of some women who have had a c-section that don’t even consider VBACs, because scheduling the birth is so much easier for them and their life - the same goes for women who insist on being induced for their births. I just don’t get that. I watch the Birth Day type shows and watch the women pushing the babies out and really yearn for that experience. To be able to hold my baby directly after birth, instead of some nurse holding her swaddled up next to my ear because I’m laid out on an operating table and then whisking them away because the docs need to close up. And to be able to sit in a hospital room and nurse, without being hopped up on pain killers, would be magic for me.
Oops…seems I have gone off on a rant. Guess I will sign off on this thought. I can only hope government doesn’t decide what is best for a woman, but the doctor and the patient decide together. I don’t get it, but if a woman doesn’t want a VBAC and the government forces her to try…well, that doesn’t make for a good birthing experience. Whatever a woman chooses for her birthing method, regardless of whether *I* personally get it or not, should be her choice, not some paper pusher.
I looked into the requirements of Medicaid during the last semester of my DH’s grad school when we were facing a 6 month gap in insurance coverage. IIRC, we would’ve had to had an income below $25k to qualify (this was in 2006). We were struggling to make ends meet on an income that was more than $1200/month above that level so I don’t know how somebody who did qualify could think they can properly raise multiple children.
Of course I’m not advocating abortion, but 1/3 of all pregnancies to unmarried women under the age of 25 were deliberate. Just look at those teen girls last year in Gloucester, MA who made a pact to get pregnant and raise their babies together.
Well, there you have it, folks. Proof from the aberration.
They did that, yes. So…I guess as a woman leaving a newly abusive man, I should not have been on Medicaid? Me and my “litter”. All I ever aspired to be was a woman who raised children on your dollar.
Damn liberals.
So, if she’s not advocating abortion, how does she propose to solve the “littering” problem? Adoption? Do you realize how many children are in the foster care system, waiting for an adoptive home? Talk about living on the public’s dime - darn women, having to pay for the medical care and then they give the kids away to live in the system on our dime until they are adopted, or thrown out on the streets at 18 (then they go on programs….etc, etc) Maybe we should just sterilize anyone who is deemed “unfit”. Hey, then we could build a city and put a wall around it and put all the undesirables in that city and forget about them.
I’m sorry, but anyone who starts out with “I’m not advocating x, but…” seems to just be trying dance around the fact that they are in fact advocating it. So, she’s either advocating that women on welfare get abortions, or she wants them to…what? adopt out? get forced sterilizations?
It’s easy to bitch and moan about what you think is wrong with something. Take a positive step and propose a solution, without tap dancing around the wording.
Kids, especially teenagers, make mistakes. Hormones rule them. Sometimes those hormones take over and make really really stupid mistakes. And they need help to climb out of the hole they have dug for themselves. Sometimes adults make the same mistakes and also need help. That is what the system is there for, to lend a helping hand when you need it. Just because you needed to make under 25K to qualify doesn’t mean you won’t make more than that in the future. Look at Whoopi Goldberg, who was once a welfare mom.
I was deliberately pregnant and unmarried under 25. And your point is…? Are you are prepared to tell me to my “face” that I am an unfit mother — or try to scramble and say “well you’re an exception”?
I, alas, was not on Medicare, although I would have loved to be. I tried to apply for the Oregon Health Plan, because I wasn’t working and wasn’t married to my partner so I couldn’t get insurance that way. Of course, my partner’s income was too high, so I was completely uninsured during pregnancy. So, while we had just enough income to scrape together money for the midwife, if I had had to transfer, we would have started out the Boychick’s life REALLY poor. That makes sense… how?
And since we’re on an ecological site, I think it behooves me to point out that many of those who can “afford” to have “only” one child often (not always) end up wasting FAR more resources on their one child than the “poor” with their “litter”*. Either way, they grow up into American consumers, of course, but one might have learned to buy every plastic gadget because they can “afford” it, and the “litter” might have learned to share, conserve, made do, reuse, do with out, and so on.
Whether or not one has an abundance of money bears no relation to whether one is capable of welcoming, loving, raising, and nurturing a child. Abusive, neglectful parents appear in every economic strata: loving, respectful parents appear in every economic strata. I would much rather my tax dollars go to making having a baby financially easier and less risky for a “poor” family than to shaming or prohibiting or punishing them for daring to make decisions for their own lives.
*As far as I can tell, in these conversations “litter” seems to mean “n+1″ where n=number of children the person using the term has, OR any number of children in a household of “.5n” where n=household income of person using it. I shan’t even go in to the obvious misogyny and classism inherent in the term.