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Monday
Jul242006

Marionette Obstetrics

Thanks to a blog reader, this EXTREMELY distressing piece of information came to my attention. Oh, to know the insurance company!

Let's explore, shall we?

- I received a booklet in the mail from the medical malpractice insurance company that covers most of us in Montana. The booklet is titled, "Insurance Recommendations for Obstetrical Practice". Under the title on the cover page is says, "There are only two options for delivery: An easy vaginal delivery or an easy cesarean section".

- The booklet then lists basically all types of obstetric management and situations and provides very matter of fact direction on how each of these situations should be managed. Dictums are provided - no acceptable alternative, one way, period.

- Some examples of the "recommendations" -"it is inappropriate to discuss serum screening in terms of "false positives". Rather this should be offered to all pregnant women in order to determine whether or not they are at increased risk for Down's syndrome, and the absolute magnitude of this risk."

-"cesarean section is almost always the appropriate route of delivery for lack of progress in labor, unless criteria for outlet forceps are met."

- These are only a very few examples of the mandates listed on 25 pages.

If any of us ever thought doctors might be puppets in the Land of Hysterical Birth, this information validates our inner knowledge.

Michael Moore (of Fahrenheit 911 fame) is in the midst of an expose about HMOs and insurance companies. I can only pray he uncovers this sort of information.

I wish I were friends with OBs sometimes so we could see, with our own eyes, the crap they are given by insurance companies. And pharmaceutical companies. And ACOG. They usually hold this information close to their vests, but this person, someone with half a conscience, decided to share with the Internet.

Let's all thank her, eh?

Reader Comments (7)

you know, in my state, there are two malpractice providers - both companies offer large premium discounts to practices with high cesarean rates.

unless a woman walks in pushing, has the luck of going into labor prior to her due date, is skinny and her baby small, her baby head down and not posterior, or she gets incredibly lucky and manages to sail through an induction -

it's so surprising women aren't being sectioned more!

at our local hospital, the rate is near 40% for primips and 55% for multips.

my new yellow page ad includes VBAC in large letters (though the ad rep got it wrong and put ZBAC...ugh!)

July 24, 2006 | Unregistered CommenterSage Femme

Holy crap. How scary is that?! Sometimes this monster we are trying to vanquish jut seems so big. In the meantime I just tell myself "one mama, one baby at a time". Sigh.

July 24, 2006 | Unregistered CommenterLouisa

I emailed Michael Moore the link. Let's hope he actually gets it and pays attention. It is appalling that our children have to be birthed at the hands of insurance companies.

July 24, 2006 | Unregistered CommenterAnonymous

Thanks for this post. Will you be submitting it to Grand Rounds?

I guess my nefarious goal is to see more physicians discussing out in the open what factors really motivate their decision-making. Is it best practices, evidence-based medicine? Is it the current body of scientific literature? Or is it the body of case law? I want to see them admit that fear of litigation and fear of their insurers are major influences in how they treat laboring women.

As my husband said, what about informed consent? What about a woman who doesn't WANT a c-sec for a frank breech? She knows the risks of surgical vs vaginal birth for a breech, knows that she wants a vaginal birth. Then what? The attending physician must hold her down and cut her anyway or lose his insurance? Does he terminate the relationship as she's laboring? This is frightening. And OB's keep wondering why we (birthing women) would choose homebirth.

July 25, 2006 | Unregistered CommenterLindsay

I was going to suggest you should contact Michael Moore, but I see anonymous did that.

Hh

"As my husband said, what about informed consent? What about a woman who doesn't WANT a c-sec for a frank breech? She knows the risks of surgical vs vaginal birth for a breech, knows that she wants a vaginal birth. Then what? The attending physician must hold her down and cut her anyway or lose his insurance? Does he terminate the relationship as she's laboring?"

I would like an answer to this question as well. In my state, the main malpractice ins co covers 95% of the OBs and hospitals. A couple years ago they lured this huge majority into their trap by promising not to raise rates for X number of years. After the OBs signed up, they said, "Oh yes, and once a c-section always a c-section or you will lose your coverage." Arrgh! Basically, the only ways to have a VBAC here is to homebirth, go to the one huge teaching hospital in the center of the state (where you are still very likely to be cut and treated as high risk) or walk in crowning. Full dialation/pushing is not good enough. They will still cut unless that baby's head is through the pelvis and on the perineum.

I would love to have women be able to stand up and say NO, but as it has been said many times before, "It's hard to be Rosa Parks when in full labor."

It's so sad what our society has come to in terms of birthing our future.

July 25, 2006 | Unregistered Commenteryvonne

Sage Femme: How horrible!!! I just don't even know what to say. How do you find out what the doctors pay and what the insurance companies offer? ZBAC? Egads... I would be so pissed!

Louisa: I know. The beast seems larger and meaner than we could ever imagine it was. I keep thinking of an iceberg... the part we see is a tiny fraction of the whole iceberg... where does the behemoth end?

Anon: Good going on the Michael Moore thing! And yes, it is appalling. :(

Lindsay: I don't know if Grand Rounds would even care about something like this. Do you think they would?

I know! What if women say no! What if they might actually have a say in their care? What will insurance companies do then?

Yvonne: Sometimes it seems things are so much worse than we even think they are. Hospitals and docs try to tell us it's all okay... they will make pretty rooms for the women to birth in... yet they can't even get it together enough to smack down the insurance corporations.

It's just so sad.

July 27, 2006 | Unregistered CommenterNavelgazing Midwife

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