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Entries in vaginal birth after cesarean (2)

Tuesday
Jun032008

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.

Thursday
Feb142008

The Best Response to ACOG Statement Yet

I've kept away from ACOG's Statement Against Homebirth because so many other people have done just fine responding to it.

However, I just came across a piece that is, to me, by far, the best response I have read. On
The Education of Genevieve's blog, she re-posts A Parody of the Recent ACOG Statement by a writer named Tienchinho. I've tried to find the author, but haven't been able to.

Assuming the author would love others to read her work, I re-publish it in its entirety.

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A Parody of the Recent ACOG Statement

FRESNO, CALIF.

As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes.

I acknowledge ACOG’s right not to support programs that advocate for, or individuals who provide, home births, but I do not support a system that denies families the essential information to make informed decisions regarding maternal care. Nor do I support a system that lacks the resources to make VBAC a viable option for all women and ensure the quality of the mother-child dyad immediately after birth.

Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at the hospital is especially dangerous because seemingly benign interventions such as epidural anesthesia or Pitocin augmentation can lead to complications with potentially catastrophic consequences for both the mother and baby, including death. Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby’s health and life at unnecessary risk.

Advocates cite the lack of rigorous scientific studies as one justification for promoting hospital births. Consistent dismissal of existing Level I evidence defining the risks of unnecessary interventions such as episiotomy, epidural anesthesia, and amniotomy has concerned proponents of natural childbirth for the past several decades and we remain committed to changing this. Birth advocates throughout the world use childbirth education, grassroots childbirth networks, and recently, the media to provide mothers and caregivers with the evidence.

Multiple factors are responsible for the persistent exceptions to evidence-based medicine in maternal care, but emerging contributors include a fear-based climate that skews mothers’ decision-making abilities and forces caregivers to follow “standards of care” that ignore the scientific evidence. The availability of a birth attendant to provide continuous labor support and of a midwife to provide expertise and intervention may be life-saving for the mother or newborn and lower the likelihood of a bad outcome.

I believe that the safest setting for labor, childbirth, and the immediate postpartum period is one that respects and trusts the birthing process, that meets the Baby-Friendly and Mother-Friendly standards jointly outlined by the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO), and the Coalition for Improving Maternity Services(CIMS) and is supported by birth advocacy groups.

It should be emphasized that childbirth comes with inherent risks. Implying otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures.

They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as “dystocia” and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby.

I encourage all pregnant women to get prenatal care and to make a birth plan.
Safeguarding the process of giving birth promotes a healthy and safe outcome for
both mother and baby. Every woman should seek balanced information to guide her
decisions throughout pregnancy, childbirth and parenting. For women who despair in the lack of choices, they should look for hope in mothers who have navigated this climate of fear successfully. We are here.

(end post)

BRAVA!!!