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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.


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.

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  1. 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.

  2. 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.

  3. 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!

  4. 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…

  5. 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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. Do you know how the $1000 per birth, vaginal or c-section, gets passed down the food chain? For example, are the doctors involved going to be paid the same amount regardless of the type of birth too or just the hospital?

    While I support any measure that could reduce the rate of unnecessary c-sections, I can see the potential for this turning into a power struggle between the hospital (trying to manage its budget) and the doctors (trying to make as much as they can and still justifying the surgeries).

    I’m not sure that I have a solution and don’t know that I know enough about the American health care system to propose alternatives, but I worry that this will just shift the problem to a different place rather than solving it.

    Oh, and I live in an area where close to 100% of births are paid for by public health care :D….it’s called Canada (the only exceptions would be people who give birth in Canada while here on vacation/temporary stay and would need their own insurance or money to pay for their birth).

  12. Wow, that “litter” comment was really uncalled for. I was unmarried and pregnant before 25 as well. And used Medicare. And guess what, I can afford my children very nicely, thank you. As I’m sure many others can as well. What does it mean? It means that our current health care system needs to be massively overhauled and fixed. It means we need to drop all the red tape and price gouging that prevents many people from being able to get insurance. And it also means we need to drop the shame game that goes on when we find out a person is using Medicare. The only person that makes a crappy person is the one pointing fingers. Like Crimson.

    How about a new resolution that people who refer to children as “litters” don’t need to be raising kids at all. They’re clearly not mentally stable enough to do so, and frankly that’s far more important than money any day.

  13. In my estimation, some unmarried women under the age of 25 get pregnant for all the wrong, selfish, inconsiderate, short-sighted, negligent reasons. Some married women over the age of 25 do, too. I have no idea how many “some” is, but I would definitely say that it does happen, regardless of age and marital status. Sometimes getting pregnant can be a very foolish decision.

    HOWEVER. The fact that I think so does not mean that I think anyone should be denied healthcare on the basis of marital status or age. It shouldn’t matter at all what I think when it comes to someone else’s medical care. You shouldn’t have to “earn” healthcare by living your life in terms of someone else’s standards. And healthcare shouldn’t be available only on the condition that people don’t make any mistakes. “Universal health care” doesn’t mean “universal except for those we deem unfit”. It means universal. Period.

  14. I was a teenage mother and in my early 20’s a single mother of 3 (I suppose deliberately, since I chose not to abort) . Money was never in abundance but I recall observing women in their 30’s,financially-secure,educated,employed who I wouldn’t allow to care for a pet goldfish. I was doing a hell of a lot better than many who were better equipped by your standards. Wise and creative resource management is an amazing skill and has served me well in raising my own litter (7 total, if you most know)

    I was an Early Childhood Educator for many years. I saw many cases of abuse,neglect & downright bad parenting and 75% of the time, the family didn’t fall into the category of “poor”. Financial status is irrelevant to ability to raise a child ,from both my own experience and observation.

  15. Oh..and even more impressive than Whoopi? How about Maya Angelou. Teen mom,welfare mom turned Pulitzer Prize winner. I think she’s doing alright.

  16. The solution? Don’t have sex outside of marriage, period. And don’t give me all this B.S. about it being “too hard” because I know from personal experience that it can be done. Does it mean going against the “nothing is right or wrong so do whatever you want” ethic in this country? Yes. But we are more than mere animals driven by lust- we can control our urges if we choose to do so.

  17. hehe…ok.You do realize that MARRIED women receive public assistance,food stamps & Medicaid,right? There are families covered by those things,not just single mothers.

  18. Right Crimson. Because married women are all totally responsible and wealthy and never, ever are in need. While all unmarried ones are irresponsible and poor. Life must be pretty simple in your little bubble of ignorance, however if you would ever like to visit the real world I’m sure we could arrange a tour.

  19. Dear Sarah Palin,
    Contact me about your abstinence-only education program in ten years.
    Those with Common Sense.

  20. The most amusing part of this conversation is that I never had to use Medicaid as a single mother.Partnered, I did for 1 of my children.

  21. um … wow. Crimson Wife, I don’t even know where to begin. I had my first child, by choice, unmarried. My son was born by an unwanted, unnecessary C/section which resulted in post-operative complications for both of us. I can’t even remember how much my medical bills were but my son’s alone were in excess of $30,000 – and that was fifteen years ago. Virtually every cent of the medical bills were covered by my health insurance – insurance I paid for myself as the owner of my own law practice. Yes, I managed all this as a mere animal driven by lust.

    However, once I became a mother my income dropped so fast and far that I could no longer afford my health insurance premiums. So I got married to my son’s father. I got married so I could get health insurance as a spouse – cause that’s the kind of slut I am. I am an insurance whore. My sin won’t cost you a dime.

  22. Wow, you must have some serious lack of budgeting skills crimson. My “litter” of kids, my husband & I survive quite nicely on less $22k a year. Of course, I live in a country where every baby born is on Medicare…’cause us “socialists” are just crazy that way.

    I hope this measure helps. Something needs to be done about the skyrocketing rated. SOGC has come out against the cesarean rate, although they mostly blamed older & fatter women for it. It’ll be interesting to see next year if the numbers go down, especially since they also revised their breech guidelines.

  23. Well Lisa, you’re Canadian, right? So logically, you and your entire “litter” come down to the States for your health care so you don’t die up there waiting for an appointment, right?
    So…aren’t you on my tax dollars too? 😉


  24. 35.7% of all children in families headed by an unmarried woman are on Medicaid compared to only 5.7% of children in families where the parents are married to each other. So while a few married couples are broke enough to qualify for Medicaid, it’s only 1 out of 20 vs. 1 in 3 single moms.

    What you do with your own life is your business until you come asking me to pay for the natural consequences of your irresponsible behavior.

  25. Well, Crimson. Let’s see here.
    Many, many women are single moms because they leave bad relationships. Abusive relationships, even.
    And/or they don’t get child support from the fathers.
    So they live in poverty.
    I suppose a misogynist would advocate that we punish the children for the supposed “crimes” of their mothers (moms only though). We should punish them for these financial situations beyond their doing.

    Or perhaps the “irresponsible” moms could stay in horrible–possibly abusive–relationships instead? Then when the kids grow up (or even as juveniles), your tax dollars can pay for their incarceration instead!

    I left a bad relationship to be a single mom. Said partner was not abusive until well into the relationship. After I had a table thrown at me and was beaten up while pregnant, I cut off all contact. I also quit my job, moved, and changed my number. Those things can definitely lead to financial problems.
    Obviously “irresponsible” of me, all said.

  26. Well in Crimson’s perfect world all married couples are sunshine and flowers and responsible and perfect. But only if they follow her version of God, I’m sure. And all the filthy, irresponsible whores who dare to have sex outside of her ideal confines of marriage deserve what they get. Eh, her attitudes are a dime a dozen and have far more to do with her perceived moral superiority than anything else. She just wants you all to know that she’s so much better than you and because of that you deserve to life in poverty and die suffering. That will teach you to keep your legs closed and your bible open!

  27. Without reading all the comments, only the first page, I just want to address the Necessity of C-Section for Breech. This is absolutely untrue! About 100 years ago doctors *preferred* breeches because they found them EASIER! What happened to that? I have seen many videos of breech babies delivered vaginally. At a teaching hospital/midwifery school in Ontario, Canada, they are teaching new students the “old” method of delivering breech babies. Breech is simply NOT an emergency ALWAYS needing to end in C-section.

  28. Crimson, Many abortions are paid for using Medicaid. I imagine that must really piss you off! Oh,wait…but if those fetuses are aborted…hmm…then you won’t end up supporting the children of irresponsible whores, so maybe that is a bit more acceptable just to abort. Saves you money in the long run!

    Ah,the dilemmas of classist discrimination & moral judgments concerning personal responsibilities of others.

  29. Oh yeah, forgot that your system is supposed to be so awesome we all are getting passports & spending hours/days getting there just to get immediate “care” by your overpaid butchers….I mean doctors. Sorry, the unnecessary surgery rate in places down there always makes me forget what profession I’m talking about.

  30. The thing is, unless you have access to a person’s financial records, you have no business saying that they can’t afford their kids. Being on Medicaid has more to do with not being able to afford insurance than not being able to afford kids. Consider that in many states, midwifery is illegal, so a pregnant woman either has to give birth at home and alone, or go to a hospital and have medical interventions and possibly surgery forced on her. And then she can be denied health insurance because of “pregnancy complications.” In contrast, a friend of mine delivered at home with a midwife in attendance and the delivery and 9 months worth of care cost her 600 dollars which is FAR below what my 2 hospital births WITH insurance costs. The system is screwed up and health costs keep rising and that is why people end up on medicaid. You might be surprised that many of the married couples that you think can afford their kids are actually neck deep in debt. How about a little less judgement and more compassion.

  31. 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!


  1. […] procedure overused in many countries throughout the world. As we’ve reported before, the US c-section rate is 31.8%, half of those being elective procedures, and that rate continues to rise. WHO recommends […]

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