BlogHer - Loss of insurance - another price to pay after a c-section? - Comments

Health insurance can make you crazy

ckingins — Sat, 19 Jul 2008 15:06:03 -0500

Having been in the industry for a while, initially on the operations side, there are a lot of things that don't make sense. I've not heard of someone being denied coverae solel because of having a C-section in the past but there could have been other factors. I've found that news stories don't always bust a gut to tell both sides :-)

To the question of covering home births, that has always been an issue. First, a carrier (insureance company) has to contract with midwives, or the OBs they work with. Then, services generally have to be rendered in a licensed setting. The jury is often out on the safety of home births, in their eyes, so don't count on it coming anytime soon.

I was an emergency nurse for years, so I know both sides of the coverage question. What they will and won't cover doen't always make sense, that's for sure. With my clients I just try to make it as easy and straight forward as possible. The problem now in California, not sure about the other 49, is that carriers are trying to come up with more affordable plans, and the first thing omitted is Maternity coverage. It's not available as a rider, the plan either comes for it or it doesn't. Makes for great rates for guys and women done with having babies, but makes it tough for me when looking for affordable plans for women in their 20s and 30s.

Believe me, just because I make a living doing this, doesn't mean I agree with everything the carriers do.

Colleen King

Colleen King Insurance Agency

Northridge, CA

Blog:www.askcolleenking.com

Web site: www.CKinginsurance.com

Email: Colleen@ckinginsurance.com

Denying Coverage Because of Other Surgeries

Kaceybu02 — Sun, 08 Jun 2008 15:21:37 -0500

"If insurance companies are going to start denying coverage for previous cesarean sections then what is to stop them from denying coverage for any type of previous surgery?"

You are totally right, which is why insurance companies sometimes deny coverage to women who have had breast augmentation surgeries. I am thankfully covered under my fiance, but he's in a union and MUST have coverage and there is no pre-existing clauses. I'm okay for now at 25, but the future's uncertain and my rheumatoid arthritis isn't going anywhere. Thankfully www.beautyandthebreast.org serves as an outlet to keep women informed. Great job BlogHer.

I do agree that it is unfair

mommyshighheelshoes — Sat, 07 Jun 2008 06:54:36 -0500

I do agree that it is unfair for a hospital to not allow a VBAC- if that is the woman's choice. On the other hand, some hospitals are not equipped with the equipment/staff if there was a complication from a VBAC which could increase a woman's risk if she chose to deliver there. I feel that each case for each woman is different and physicians have the obligation to make their best recomendations to those patients and their babies. This is a subject that you can go round and round about. I was lucky and did not have any complications from either of my C-sections. No depression, exellent apgar scores and I also successfully breast fed both of my babies even when I returned back to work full time.

I have a nurse friend who attempted a VBAC and it just didn't go well at all and then they had to do an emergency C. Looking back, her feeling was it was the worst decision and she should have just scheduled a C-section. Another friend who had two successful vaginal births, is due with her third next week. The baby is breech and she is torn with what to do and is frightened of a C-section, but frightened of a natural birth with a breech baby. We can always look back at decisions we have made in life and question them. The important thing is to make the best informed decision at the time and listen to your intuition.

I agree outlook is so important with the outcomes of everything in life. There are all sorts of people in this world. Those that are confident, those that easily intimidated. Who are we do judge any woman on her decisions in life. I just think we should think twice before pushing our opinions on others and judging anyone.

The health insurance crisis (increasing costs and decreased covereage) in this country is just unfortunate. These payers also need to be challenged when they give us a no. The squeaky wheel gets the oil most of the time. For any reason, we should challenge these payers and get as many health care providers involved as possible. It is unfortunate that physicians can't just do what they feel is right for their patients and have to get the okay from some person reviewing billing sheets who may not even know the slightest thing about the condition or patients life. They know that when they deny something the patient & physician are often too busy to fight the denial.

Best of luck to every woman and their babies with every birth they give- no matter how they deliver. The miracle of babies and giving birth is truly just amazing For those who can home birth- all the power and well wishes to you. For those scientists that have made such strides with modern medicine and technology- thank you! Thank you for the physicians, mid wives, nurses and medical staff out there that truly care about their patients and who try their hardest everyday to give their best advice and care for us!

mommyshighheelshoes

http://www.mommyshighheelshoes.com/

"Mommy's high heel shoes are tricky to walk in. They wobble. They flip and flop. Sometimes, they fall off."

C-sections

amamasblog — Sat, 07 Jun 2008 00:48:15 -0500

I want to reply to some of the comments this post has received.

Having had a C-section with my first baby in 2004, and a successful VBAC in 2006, with my second baby, I feel I know both sides of this issue fairly well.

C-sections are not totally safe. They are major surgery, and with ANY surgery there is always the risk of complications. Some of the complications with a C-section range from hemorrhage, post-partum infection, internal injuries, post-partum depression, placenta previa, breastfeeding problems, reproductive problems, and maternal death for the mother.

Another fact is uterine rupture is increased not just by having a VBAC, but by being pregnant again, because the uterus expands. Once you have had a C-section the chances for uterine rupture increase with every pregnancy. How come doctors usually don't disclose that fact, and scare women away from VBAC's, by telling them only a VBAC will cause uterine rupture?

By having an elective C-section your baby’s chances for neonatal respiratory distress syndrome (RDS), physician caused prematurity (since they can only guess, what the correct due date is), persistent pulmonary hypertension (PPH), are cut by the surgeon’s scalpel two to six percent of the time, and are less likely to be breastfed, are increased than babies who are born vaginally.

Your birthing options with future pregnancies are SEVERELY limited, after you have a c-section. There is a saying, “once a C-section, always a C-section.” VBAC is a very safe choice for the majority of women, but VBAC’s are discouraged and you will be lucky to find a doctor and a hospital that supports this choice. In some states, it is against the law for midwives to attend VBAC births. In all actuality, you will be pressured to have a repeat C-section with future pregnancies. Usually another C-section is the only choice offered to you, even if that isn’t the best choice for you, and your baby.

In most cases VBAC is a safe choice for the majority of women. From Childbirth Connection: Best research suggests that an extra 27 women experience a ruptured uterus in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, nearly 400 women would need to experience surgical birth to prevent ONE instance of uterine rupture during VBAC labors. (bold print mine.)

I am not aware of any studies that have taken into account the extra complications involved with c-sections (mentioned above), and comparing those to a VBAC delivery. It would be very interesting to have a complete picture. I don't believe it is ethical to tell women that repeat c-sections are safer than VBAC's, if ALL the factors are not included.

Sometimes c-sections ARE necessary and thank goodness that option exists. However, more often than not, a breech baby, for example is not always a medical emergency that warrants a c-section. The doctors and hospitals would like you to think this, but women have been giving birth to breech babies since the beginning of time. A breech baby delivery should be no more complicated in the hands of a skilled health care provider than a regular vaginal delivery. The difference is when doctors started practicing defensive medicine, is when breech delivery started becoming a medically necessary reason for a C-section.

To Two C-sections Later: Many women I have talked to want to have a vaginal birth after a c-section, because they had an awful experience with the c-section. It's great that wasn't your case, but as this original article pointed out, woman are losing insurance and can't get coverage, because C-sections are done too often when they aren't true medical emergencies.

To Lightning Strikes: As I wrote above, C-sections have their own set of complications as well. Doctors rarely tell women about the potential complications with repeat C-sections, because they are practicing defensive medicine. I am not judging women who have had C-sections, because I have had one, for a breech baby. But now that I am faced with being denied insurance, it gets more personal. Why should I be denied coverage because doctors recommend C-sections to women who don't truly need them? Why aren't other birthing options offered to women?

It pays to do your own research on the subject, and don't just take my word, or your doctor's word for it. By finding out the facts for yourself, you can make an informed decision.

If you want to read more about my experience with my C-section, you can read my blog post, The Reality of C-sections.

I urge anyone interested in the subject to read the article, “Cesearean Birth in a Culture of Fear.” It is written by Wendy Ponte, and it appeared in the September/October 2007 issue of Mothering magazine, and is the best article I have read on the subject to date.

Sometimes C-sections are the best choice, and sometimes they aren't. Sometimes a VBAC may be safer for a woman and her baby. But women should know ALL the facts, pro and con, on each procedure so they can make an informed decision.

Reasons why some choose a VBAC over a repeat c-section

Amy Gates — Sat, 07 Jun 2008 00:36:07 -0500

Hi Mommyshighheelshoes,

Thank you for your comment and sharing your experiences. I am glad you have two healthy children. :)

I haven't had a c-section myself, so I can't speak from personal experience about why some women would want to have a VBAC. However, I have done some reading in this area, as well as have a few friends who have had VBACs, and have come across many reasons why some women choose to have a VBAC rather than a repeat c-section. Some are:

VBAC is usually safer for mom and baby.

VBAC reduces the risks of infection to the mother.

Labor is good for babies in most cases.

Not having surgery makes mom's recovery easier.

VBAC reduces the risks of respiratory problems in babies.

VBAC involves a shorter hospital stay.

Breastfeeding is easier after a vaginal birth. Usually
for a variety of reasons, including faster and more direct access to
your baby and less postpartum pain for mom. -- http://pregnancy.about.com/od/vbac/a/reasons2vbac.htm

A
VBAC in your current pregnancy is the far safer choice for any future
pregnancies you may have. Each additional cesarean operation increases
the amount of internal scarring (adhesions) and the number of
uterine scars. The accumulating scar tissue makes it more and more
difficult for the egg to make its proper way from the ovary into the
uterus and for the placenta that nourishes the baby to grow and attach
normally. These problems can pose life-threatening risks to babies and
mothers. The scarring can also pose challenges for future surgical
procedures, cesarean or other. --http://www.childbirthconnection.org/article.asp?ck=10211#safer

More info on The VBAC Fact Sheet -- http://www.ican-online.org/vbac/vbac-fact-sheet

You also brought up the chance of uterine rupture and I found some information that addresses that risk.

"Dozens of studies report that for women who have had one prior cesarean
birth with a low-horizontal incision, the risk of uterine rupture is
0.5% to 1.0%." -- http://vbac.com/uterine.html

Ultimately whether to have a VBAC or a repeat c-section is a decision that each woman should have the right to make for herself and her family. What is right for one person, may not be right for another. Everyone has different circumstances and experiences that will affect their decision. What frustrates me in all of this is the # of hospitals that don't allow VBACs which then takes the power away from the woman and makes the choice for her. That, to me, is unfair and wrong.

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

VBAC

erinely — Sat, 07 Jun 2008 00:23:41 -0500

I do not agree that fear has nothing to do with a woman's ability to give birth. Fear can be a big factor.

I had a VBAC at home 14 years ago. It was the best thing I EVER did. I had a lay midwife and I lived 20 miles outside of town. I never saw one Dr. during my pregnancy or birth.

I had a c-sec with my first. I was set up to fail from the beginning when my certified nurse midwife said I was too small to deliver vaginally. I am 4'11". That was the beginning of the end for me in regards to natural childbirth with my first. I ended up with a c-section. After 20 hours of not progressing after my water broke and another 3 hours on pitocin, which did essentially nothing as soon as it was removed my labor stopped completely.

I was compeltely fearful in anticipation of the delivery for my second birth because I did not know what to expect.

Because of this fear it took me 20 plus hrs labor and 3 hrs pushing to deliver my daughter at home VBAC. VBAC should be an option for all women who want to give birth this way.

I'm positive that my labor did not progress quickly because I was too fearful of the pain and when I finally decided to put my body in the right position to get my labor to progress, my labor got going and I was ready to deliver...my long labor and lack of progress had to do with my fear of pain.

Believing in your ability to give birth has a significant effect on your ablility to be successful. And yes, your mental state can contribute to illness. Stress is a huge factor in illness.

You may not agree with this but various people have proven this very thing. Your mental state can affect your success in many areas of life, including your birth and your health.

If you want to stay healthy stay away from Dr's. That's my health care plan.

Women should not lose health care insurance because they have had a C-section. That's ridiculous.

Regards,

Erin

Erin Ely

http://elyorganics.com/

Lightening strikes

mommyshighheelshoes — Fri, 06 Jun 2008 23:31:33 -0500

So if there is a chance that you could get struck by lightening in a severe storm, would you stand outside or have your children go out and play? If there is a higher risk of injury/death in a car accident by not putting your child in his/her car seat, would you let your kids just sit on your lap instead of their seats? So why if there is any risk at all of losing your child or having complications, would you not opt for the C-section when it is reccomended by your physician. Why do we judge women who have C-sections and doctors who perform them? The most important thing is bringing healthy children into the world and keeping them safe when they arrive. Let's not judge those mothers who make different choices or come upon different circumstances than they had planned. Home birth isn't for everyone...just like C-sections aren't for everyone. Can we not just all support one another in our own individuial cirmumstances. Who are we to judge?

http://www.mommyshighheelshoes.com/

"Mommy's high heel shoes are tricky to walk in. They wobble. They flip and flop. Sometimes, they fall off."

Pretending will not make it so

Amy TuteurMD — Fri, 06 Jun 2008 21:41:19 -0500

Laura Shanley:

"Our greatest enemy in birth is fear. When women start trusting their bodies and believing in their own abilities the c-section rate will plummet."

That's ridiculous. There is no evidence that birth has anything to do with fear and no evidence that pretending that you have the "ability" to avoid complications will prevent any complications.

Many people do not realize that the ideas of Grantly Dick-Reid, the father of natural childbirth, and author of "Childbirth Without Fear" stemmed from his belief in eugenics. Dick-Reid was concerned that white people were committing "race suicide" by allowing "inferior" people to have more children than they were having. He believed that white women were having fewer children because they were too educated and too interested in political and economic equality. In addition, they feared the pain of childbirth. Dick-Read thought that "superior" white women should be manipulated in to having more children by convincing them that childbirth wasn't really painful; it was all in their heads.

It is important to understand that Grantly Dick-Read made it all up. He fabricated his theories out of whole cloth and drew deeply on racist notions of "primitive" women being hypersexualized and ideally suited for childbearing while educated while women suffered reproductive problems like "shriveled ovaries" and "hysteria" which led to pain in childbirth.

As Dick-Reid wrote in 1942:

"the mother is the factory, and by education and care she can be made more efficient in the art of motherhood"

So if Grantly Dick-Reid made it all up, why do some women still persists in promoting a theory that is fabricated and arose from racism and sexism? Advocates of homebirth, particularly advocates of unassisted homebirth, believe in the power of magical thinking. They actually counsel other women that "birth affirmations" and "believing in your abilities", both merely forms of pretending, has the power to prevent complications.

That, of course, is absurd, and the evidence confirms this. All the pretending of homebirth and unassisted birth advocates does not lower the rates of complications. Pretending does not lower the rate of breech, placenta previa, abruption, pre-eclampsia, hemorrhage, fetal distress, anoxic brain damage of the newborn or neonatal death.

Believing in your "ability to give birth" is no more effective than believing in your "ability to avoid cancer" or your "ability to prevent stroke". Childbirth is and has always been, in EVERY time, place and culture, one of the leading causes of death of young women and babies. All the pretending in the world does not change that. Giving birth at home does not lower the complication rate; it only lowers the chance that appropriate help will be available when unpreventable complications occur.

To claim otherwise is merely to give in to that perennial hope that wishing can make it so.

Amy TuteurMD

Questioning the "need" for a c-section

LauraShanley — Fri, 06 Jun 2008 17:06:54 -0500

While it’s not the best way to lower the c-section rate, taking the financial incentive away from hospitals might have a positive affect in the long run. Of course, the best way to lower it is for women to educate themselves as to when a c-section is TRULY needed. Unfortunately, the majority of women (in my experience) still believe that in THEIR case a c-section was truly needed. Without knowing all the facts, I certainly can’t comment on someone else’s birth, but women are often told that a breech position, a cord around the neck, or a reduced heart rate for the baby necessitates a c-section. This isn't always true. 25% of babies are born with the cord around their neck (my last one was, and I simply unwound it myself). A woman I know had 7 homebirths and the cord was around the neck each time - in one case twice, and in another 3 times. All the babies were fine. Our greatest enemy in birth is fear. When women start trusting their bodies and believing in their own abilities the c-section rate will plummet.

Laura Shanley

Bornfree! The Unassisted Childbirth Page

http://unassistedchildbirth.com

Two successful C-sections later...

mommyshighheelshoes — Wed, 04 Jun 2008 22:48:44 -0500

I have two kids 3 1/2 and 2, both of which were born via C-section. My first was an emergency C-sect. After an attempt to have a natural birth with not even an epidural- my daughter's heart rate dropped rapidly and I was rushed down the hall, put under general anesthesia and out came my healthy baby girl! Thank god for modern medicine! My second baby, my son, 20 months later was a scheduled C-section and I am thankful for that as well. He was 8# 11 oz and he came out 10 days early- could have been 9 1/2 #- I am not a big girl. I never really understood why women would want to try a vaginal birth after a C-section. I always have felt why take that risk of rupturing? Why mess up another part of your body? I may have a scar, but two C-sections later I have two amazing kids and no problems with anything "down there".

Not cool about higher health insurance premiums though....not cool at all. I will cross that bridge if/when I need to.

mommyshighheelshoes

http://www.mommyshighheelshoes.com/

"Mommy's high heel shoes are tricky to walk in. They wobble. They flip and flop. Sometimes, they fall off."

C-sections

amamasblog — Wed, 04 Jun 2008 01:11:01 -0500

The only way I see that real change will come, is when women say "no more" to the pressure of having c-sections, and demand more options for birthing "complicated" pregnancies.

Most midwives are trained for breech births, and can deliver breech babies safely. Why not doctors? Medical schools don't even teach the procedure anymore, and the end result is women suffer.

As soon as women decide not to give their birthing power over to an OB, and the hospitals and doctors start losing money, then change will happen. All of a sudden hospitals will reverse the ban on VBAC's in order to "win" those mothers back. They will stop pressuring women into c-sections.I really believe until the majority of women choose homebirth, and hit the doctors and hospitals where it hurts- in the pocket book- change will be very slow.

Unfortunately, most insurance companies won't cover homebirth, as you pointed out. It really is a frustrating circle.

Hopefully some OB's and hospitals will continue to offer choices, (like the hospital where I was "allowed" to have a VBAC), and others will see how successful they are and follow their example.

Support the OB's, and hospitals that do allow VBAC's, and other birthing options, like birthing with a midwife. Better yet, opt for a home birth. It is a start, and we have to start somewhere.

Loss of insurance - another price to pay after a c-section?

Amy Gates — Wed, 04 Jun 2008 00:25:06 -0500

An article in the New York Times this weekend reported that some women are being forced to pay higher health insurance premiums or are being denied insurance coverage all together if they've had a Caesarean section in their past. Peggy Robertson of Centennial, Colo., was turned down for individual health coverage by Golden Rule Insurance Company because she had given birth by c-section. No matter that she was in perfect health. "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."

This could be a serious problem and affect countless women given the c-section rate in this country. It is believed that the current c-section rate in the United States is at a record high of more than 30% (that is nearly 1 in 3 babies is born via cesarean section) despite the World Health Organization's recommendation that says "the best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006)."

Tina Cassidy from The Birth Book Blog believes the situation with the insurance company all comes down to money.

As always, it is money dictating the rules of health care. Of course, money (malpractice fears) is one of the reasons why the c-section rate in the US at 1 out of every 3 births. Honestly, it is surprising that it took insurance companies this long to wake up to the fact that they are paying either way -- for the c-sections that don't get done when they should, those that get done poorly (regardless of whether they were necessary) or when a woman is denied access to a vaginal birth after cesarean, which is happening more and more...

Perhaps it does all come down to money, but if that really were the case, then why wouldn't my insurance company reimburse me a measly $2000 (relatively speaking) to cover my prenatal care, home birth, and postnatal care that I had with a midwife for my son's birth in 2006? They refused to pay me one single penny, yet had I given birth in a hospital, they would've covered the entire thing (tens of thousands of dollars since I would've had a c-section due to my son being a surprise breech) less my one-time $10 copay. Logically, I figured that they'd rather pay for the lesser of the two, but logic apparently has no place when dealing with insurance companies. Maybe Tina is right on with her assessment. After all, why would they want to reimburse me and pay $2000 when they can get away with paying nothing at all?

Sharon Holley at The Traveling Midwife feels this is a great example for why we need national health coverage and also pondered what this could mean for the future of midwives and had other questions as well.

If insurance companies are going to start denying coverage for previous cesarean sections then what is to stop them from denying coverage for any type of previous surgery? Will this help bring midwives more respect as we have better c-section rates and still maintain excellent outcomes nationwide? Currently midwives are always battling with insurance companies to reimburse for care. Even Medicare and Medicaid does not pay 100% for services when compared to same services that are provided by physicians. Will this push women to question the need for a cesarean at the time of delivery?

Heather at A Mama's Blog who has had both a c-section and a VBAC (vaginal birth after cesarean) and has written about in the past about her c-section experience and what a c-section is really like believes the insurance situation should be alarming for all women in their child-bearing years.

Even if you have no intention what-so-ever of having a c-section, in the rare case that you did need a medically necessary one, you can be denied insurance coverage now, because the procedure has been over performed.

Doctors and hospitals must start allowing VBACs, and return to delivering breech babies, in order to lower the ever rising c-section rate. If nothing else, c-sections should be reserved for true emergency situations. Something has to change - now more than ever, our very health depends on it.

Louise at Colorado Health Insurance Insider writes about her experience in the insurance business and says:

I’ve written before about how caesareans should only be covered by health insurance if they are medically necessary - “elective” c-sections should always be patient-pay, regardless of what health insurance carrier the patient has. It mystifies me as to why someone would willingly choose a c-section instead of a vaginal birth, considering the increased risks, much longer recovery time, and permanent scar. But at the same time, a lot of doctors are also guilty of over-using medical intervention for convenience in obstetric care. Part of the problem is the ridiculous malpractice system we have in this country.

Louise goes on to add:

For women who are trying to secure individual health insurance policies, a prior c-section can be a headache. They should be able to find at least one company willing to offer coverage, but it may not be their first choice, and it may come with a higher price tag. Just one more reason why a c-section should be a last resort, and should never be performed without a medical reason.

Jennifer Block at Pushed Birth feels a policy like this is adding insult to injury.

The losers in all this, of course, are women and their families: going through unnecessary primary cesareans, then being discouraged or flat out denied normal, physiological birth for their next pregnancy, on top of that being denied health insurance because the repeat cesarean their providers are insisting upon would cost the insurer more money, and having babies at higher risk of being born too early, not to mention the risks of repeated major abdominal surgery for mom. And we call this maternity “care”?

Carolyn McConnell of Rock the Cradle - The Politics of Motherhood agrees and points out the results of a 2005 survey where one quarter of the women polled "reported feeling pressured by a medical professional to have a C-section."

And then they pay for it, in a high rate of infection of the incision, extended recovery and pain in comparison to vaginal birth, risks of injury to the baby, greater difficulty initiating breastfeeding, and greater risks of breathing problems in the baby—and finally in a loss of insurance coverage.

So, what now? On one hand I think it's good that insurance companies are finally realizing the cost they having to bear as a result of a c-section rate that is inexcusably high and perhaps this will encourage more women to become better informed about c-sections before they go to the hospital. Maybe this will also put some pressure on the OBs that are performing unnecessary c-sections. On the other hand, I don't feel it's fair to women to raise their premiums or deny them coverage based on something that many of them may have been pressured into in the first place. And in the case that it was a medically-necessary c-section, then what? Another thing that is disturbing to me in all of this is that many hospitals have banned VBACs, so even if a woman wants to have a vaginal birth after a c-section, her options are often very limited.

I don't know what the answer is, but I do know something needs to change in this country and the c-section rate must be lowered. Women, and their babies, deserve better care than this.

What are your thoughts?

Additional resources:
- Childbirth Connection - What Every Pregnant Woman Needs to Know About Cesarean Section
- International Cesarean Awareness Network
- VBAC

Contributing editor Amy Gates also writes about attachment parenting, activism, green living and photography at Crunchy Domestic Goddess.