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Entries in cesarean (4)


Cesarean Punishment

Insurance companies have begun refusing coverage to post-cesarean moms unless they have been sterilized during their cesarean.

The International Cesarean Awareness Network - ICAN - reports:

"Peggy Robertson of Colorado. When she applied for health insurance coverage with Golden Rule, her husband and her children were accepted, but her application was denied. After multiple inquiries directed to the insurance company, she was finally told that she was denied because she had delivered one of her children by cesarean. 'It was shocking. I assumed that as a woman in good health I would be readily accepted,' said Robertson. 'When I finally found someone who would explain why my application was denied, they had the audacity to ask me if I had been sterilized, stating that this was the only way I could get insurance coverage with them.'"

The New York Times article says:

"She was turned down because she had given birth by caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified."

Also, "Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

'Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,' Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

'“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,' Ms. Pisano said."

As an FYI, Golden Rule insurance company is owned by United Healthcare.

"Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized."

While I hadn't heard of this, it doesn't completely surprise me. I am individually un-insurable because of the gastric bypass. I used to be un-insurable because of diabetes and morbid obesity. Even though the gastric bypass put both diabetes and obesity to in the background, the fact of the surgery alone is cause enough to never be able to buy my own insurance.

I seriously wonder what will happen to the cesarean rate if ALL women had to pay for the surgery out of their own pockets. Scheduling a cesarean will come with a whole new set of issues besides the uterine scar, the secondary infertility, the placental difficulties, the higher risk of dying and having a premature baby as well as post-op pain and a much longer recovery. I wonder if finances will have any impact at all.

A part of me applauds the possible ramifications of their discrimination. Not the actual denials, but the possibilities it affords women who've had cesareans previously. Will VBAC once again be the preferred subsequent delivery?

This is certainly an interesting (and sad) development; we will all have to watch unfold.


Christina's Soreness

I meant to share this article about how sore Christina Aguilera was after her cesarean... surprisingly so.

"After six days of recovery, Aguilera is reportedly still ‘really sore’. A source revealed, 'It (childbirth) was more painful than she thought.'"

No kidding.

Tell all your other star friends that scheduling a cesarean doesn't relieve one from birthing pain, Christina! In fact, there aren't many women who had a vaginal birth that are still in that sort of pain 6 days postpartum. (A rare few, I know, are.)

Nice someone said something about post-op pain, eh?


VBAC Study Worth Seeing

Effect of Hospital Volume on Maternal Outcomes in Women with Prior Cesarean Delivery Undergoing Trial of Labor states in part:

The authors did not find evidence of an association between hospital VBAC volume and the likelihood of adverse outcomes in VBAC after adjustment for patient mix. Other risk factors consistent with prior research were identified, including induction of labor, 2+ prior cesarean deliveries, preeclampsia, diabetes mellitus, and high birth weight. Prior vaginal delivery was protective against adverse VBAC outcomes. The risk of an adverse VBAC outcome in low-volume hospitals was comparable to that in high-volume hospitals.

(end quote)

I wonder why they did a study about hospital volume in the first place? Was there a belief that hospitals that had a large number of patients also had worse outcomes of VBACs? I'm actually quite shocked that anyone even did a study on VBAC success!

I think the risk factors are really important for women wanting a VBAC. You don't fall into those categories? That bodes very well for your upcoming birth.

I also believe that women who are meticulous with their diets (including my earlier recommendations for organic beef and dairy, no dairy products the last 6 weeks of pregnancy and no juices) can go far to curb or eliminate the GDM and large babies. A great diet can also help avoid PIH/pre-eclampsia, as well. There are never guarantees, but every bit helps.


St. Elsewhere

My favorite show ever in the world of my life is St. Elsewhere. I love watching it now as much as I did when it was first on the air 25 years ago.

The writing was so perfect, so tender and so timely – it’s amazing watching it now that they know what AIDS is, how to do heart transplants so easily now, how seemingly tragic illnesses are now passing thoughts – and how diseases we never considered back then have taken over our lives now.

I am re-watching the series on a minor cable channel, and while I know the shows nearly by heart, I am still so intrigued and can’t wait for the next show each time the one I am watching ends.

Seeing Ed Begley Jr., Denzel Washington, Mark Harmon, Eric Laneuville (who “grew up” to direct many of the episodes and many, many other shows), Howie Mandel before anyone knew him as a comedian… just wild sometimes! William Daniels (Dr. Mark Craig) had the plum role of the icy physician who annoyed – and pushed – everyone to their limits. I hated and loved Craig all at once. Daniels is an amazing character actor. The heart transplant he did cost $110,000. Can you imagine something so inexpensive today?

Remember when date rape was addressed? Peter White raping women in the hospital? Date rape was barely even a new thought back then. Date rape is now such a common term, elementary school girls know it.

It’s bizarre watching the docs not use gloves when doing some procedures… touching open wounds, removing sutures… very weird.

Watching Craig dictate into a Dictaphone is blinkingly incredible. Living in a time without cell phones, archaic beepers – how did anyone on-call ever survive in traffic?

I loved when Erlich (Begley Jr.) did his OB rotation. Finally! They brought in wonderful stories I could relate to. When Alfre Woodard joined the cast, I was ecstatic. A black, fluffy OB/GYN who had a heart. Our own female Dr. Wonderful.

I spent part of the day in the hospital with another postpartum client yesterday. A beautiful labor turned into failure to progress and then a cesarean for an acynclitic baby… a near-brow presentation. I asked the OB if she (the baby) was brow, but I didn’t get a straight answer. Mom had pushed for more than 2 hours at home, baby perfectly fine and dandy the whole time, but once her forewaters broke and there was light meconium, I began the move to the hospital. She pushed another 3 hours in the hospital and then the doc used a vacuum. When the baby came back to us, she had the tell-tale suction cup mark on her head, but it was right at her forehead hairline, not on the crown where it should have been. Was this brow? Docs aren’t supposed to use vacuums on brows, but this wasn’t really on the brow, right? Was this more military? I would say probably.

I hadn’t had a cesarean baby in over two years and then I have two in a row. Even though both were 100% indicated, it makes me sad. Both women seem to be recovering well physically and emotionally, but I don’t think they have gotten to their place of mourning the loss of their homebirths quite yet. My newer mom, especially. She hasn’t gone home yet and going back to the house is often a time of great sadness. I’m just glad the place is picked up and back to normal for her. Sometimes, the pool is still up or the bed is still made for the birth, etc. We try to get things cleaned up, but when we head out quickly, there just isn’t time.

I’ll write more when I get back from seeing both my post-cesarean mamas.