Why Won't The Government Step In?

We are seeing historically high cesarean section numbers in this country, and the sad fact is over 40% of all these cesarean sections are being paid for by the government funded health program medicaid. I normally would have never known this, but in 2008 I met with then Congressman Christopher Shays from Connecticut, who in turn provided me with this information.
When I had my second cesarean section, which was not planned or elective, I received a bill from the hospital because they had not been informed of my updated medical insurance information. For a cesarean section, and a 3 day stay, because I got out of there has fast as I possibly could, and they would allow me, it was over $15,000. In 2007 there were 4.3 million births in The United States.
So lets break this down.

4,300,000 Babies Born
1,337,300 cesarean sections
31.1% cesarean section rate

1,337,300 Cesarean Sections
534,920 Cesarean Sections Paid by The US Government
40% of all cesarean sections

Now, lets use my hospital bill, which is smaller than some because I chose to leave early, and not use any pain medication.

534,920 x 15,000 = $8,023,800,000
Over 8 BILLION dollars being spent on cesarean sections, when it is estimated that almost HALF of them are not medically necessary, or caused by medical interventions put in place by hospital staff.

I know it does not seem like a huge amount of money compared to the amount of debt the country is in general, but if we could cut over 4 BILLION dollars in this type of spending, it would make a difference. If medicaid started providing more coverage for midwives, birth centers, home births, again this could all be cut. These numbers are ONLY for hospital births, this does not include the bills for pre natal care, ultrasounds, pre natal testing, bloodwork, and everything else that our current maternity care system puts woman through.
Granted there are some needs for high tech maternity care, just not in every woman, which is what is being suggested today. In low risk, healthy women, the routine testing, inductions, cesarean sections, and what we are seeing are complete over kill.

When will our government notice this and not only save themselves money, but help to lower our maternal and infant death rates?

Things More Likely to Occur than Uterine Rupture

I came across this post years ago, and I love it. I thought I would share this with everyone.

Written by Eileen Sullivan, with assistance from her husband, Patrick.

After checking, it seems I was a bit off on the frequency of deadly lightning strikes... you are more likely to suffer a rupture than to be struck and killed by lightning, by about thirty times. Then again, how many people do you know who HAVE been struck and killed by lightning?

Ruptures are also more common than dying in a plane crash. Henci Goer's review of the literature on VBACs found 46 ruptures in 15,154 labors. This equates to a 0.3% rate... or 1 in 333, if you prefer. Your annual risk of dying in a plane crash is 1 in 4000, according to one source, and 1 in 700,000 according to another. I can't explain the massive discrepancy between the two figures, except to quote Mark Twain about "lies, damn lies, and statistics."

Since you asked, here are some more probability statistics for you:

Your risk of dying in a car accident, over the course of your lifetime, is between 1 in 42 and 1 in 75. This is roughly 4 to 5 times greater than the risk of uterine rupture.

You're about twice as likely to have your car stolen (that's an annual risk) than to experience a uterine rupture.

Your odds of being murdered are 1 in 140 over the course of your lifetime. That's 2 times more likely than the risk of rupture.

The annual risk of having a heart attack is 1 in 160, 2 times more likely than rupture. Your risk of dying from heart disease is roughly 1 in 6, or 55 times greater than your risk of rupture.

The annual risk of having a heart attack is 1 in 160, 2 times more likely than rupture. Your risk of dying from heart disease is roughly 1 in 6, or 55 times greater than your risk of rupture.

If you're a smoker, your risk of dying from lung cancer is 1 and a half times more likely than a VBAC mom rupturing during her labor.

You're about 17 times more likely to contract an STD this year than you are to have a uterine rupture; more likely to contract gonorrhea than to rupture, as well.

You're 13 times more likely to get food poisoning than to rupture.

You're more likely to have twins than a uterine rupture. Odds of twins: 1 in 90. That's about 3 1/2 times the likelihood of rupture.

If you ride horseback, you're 3 times more likely to die in a riding accident than you are to experience a uterine rupture.

If you ride a bike on the street, you are 4 times more likely to die in an accident (annual risk) than you are to suffer a rupture.

Having a serious fire in your home during the next year is twice as likely as experiencing a rupture.

You're ten times as likely to win at roulette as you are to have a uterine rupture.

If you flip a coin, you'll be more likely to get heads (or tails) 8 times in a row than to rupture.

The risk of cord prolapse is 1 in 37 (2.7%), or nearly ten times more likely than that of rupture.

And a final irony (heads up, those of you who want a doc to give his/her opinion on your likelihood of rupture next pregnancy!)...

You're 6 times more likely to have a doctor who is an impostor than you are to suffer a rupture. Two percent of docs are phonies (1 in 50), according to several sources I found.

So instead of worrying about rupture, why not take a few minutes to check up on your doctor's credentials? ;) It'd be a more profitable use of your time, and a substantially more likely cause for alarm.

Get On Track, With a Successful VBAC!

By VBAC Mom, Sally H.

Get On Track, With a Successful VBAC

When I was approached to write a blog about my experience with a VBAC, I have to admit that I was little reluctant. I mean who wants to hear another story about VBACs? But when I starting to tell other women about my VBAC experience they encouraged me to share my story. You see, like me they wanted to try to have one, but unlike me, they were told they couldn’t. I couldn’t believe this. Even though the success rate of having a VBAC is 75%, many women are denied this either because her doctor does not want to risk the liability or her doctor or even her spouse is afraid of the possibility of her uterus rupturing. Sure, there are many risks with pregnancies and many risks with birth. In fact, death is a risk for both mother and baby any time when giving birth. In fact, according to ICAN, “the risk of fetal death among the 13,115 women attempting VBAC was 0.038 percent (5/13,115). Thus the risk of a baby dying in association with VBAC was 12 times lower than the risk of a baby dying from non-rupture-related causes.” So how do we change the tide and encourage our doctors, spouses and even the hospitals that VBACs are safe and they are worth the attempt?

When I was pregnant with my second child in 2005 I knew that I wanted a VBAC. My first delivery was a nightmare and my doctor explained that the need for the ‘emergency C-section” was eminent. I did not want to go through with the pain of another C-section again. I certainly did not want to miss the opportunity of giving birth naturally. I had read enough to know that I was not in the high risk group, however my biggest obstacle was getting my doctor to be in agreement with me. More importantly, I had to get my husband to be in agreement as well. We barely fight, but we fought over this for weeks. This is a serious decision to make. If there is not the support from your doctor or midwife, nor your spouse, then I suggest you get them to agree with you or find another doctor or hospital. I guess you cannot go out and find another husband, but there is so much supported evidence as to why VBAC are safer than repeat C-sections that he may oblige.

VBACs are safer for both mother and baby. VBAC is not major surgery, repeat C-sections are and who wants more surgery?

So, you have to get them to be in agreement with you. I was fortunate that I had my doctor’s approval. There were other doctors in this practice who were not with me and my VBAC but I explained that this is what I really wanted. They all agreed for me to go into labor naturally and when the time came to be in a birthing room next to the ER, you know just in case. I had my plan and the hospital made me sign a consent form which basically said that I knew of my risks of attempting a VBAC, but I am willing to take it anyway. It is so funny how even at the last minute the head nurses and the hospital were still asking me if this is what I wanted. I remember looking at them and saying through my grunts of labor, “don’t you think this is what my baby wants?” My first one was poked in the eye in utero, was drugged from the anesthesia and I did not get to hold nor see her for three hours after birth. I was not going to go through this again. Again, I had the support of my doctor and my doula who helped me through the worst part of my second child’s labor. I had to push through the old scary memories of the first birthing process and move through the second, natural one. To have everyone in that birthing room to be in agreement with me and to be on the right track, was part of my success. It all came down to that moment when I pushed her out and heard her cry. To be able to be there for the whole process was surreal and beautiful. I encourage anyone who is thinking about VBAC to go for it, but please make sure everyone supports your decision. Now, if I can only encourage my husband to go for a third, but this story I will keep for another day.

Why Cesarean Sections Should Not Be Elective Before 39 Weeks

In the year 2009 we are seeing an increasing rise in elective cesarean section births, and a concerning trend that is going along with these deliveries.
Late Pre Term Births.
The March of Dimes says

"With any cesarean, it's important that the surgery be done at 39 completed weeks of pregnancy or later, unless there's a medical reason for delivering earlier. C-sections may contribute to the growing number of babies who are born “late preterm,” between 34 and 36 weeks gestation. While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term"

Problems that can go along with a late, pre term birth can be respiratory distress, problems eating, issues maintaining body temperature, and jaundice. Some can be minor, but others can result in a NICU stay for your baby that can become longer than your recovery in the hospital. Not too many mothers take this into consideration, or even want to leave the hospital without their baby.
The problem in many cases is the inaccuracy in due dates. Ovulation can vary in women, cycles can be different, ultrasounds cannot accurately measure a fetus to the date of conception in any woman, which can result in turn, in a pre term birth with elective cesarean section.
"I am due on December 8th, but I am going in for my Cesarean on November 24th" but what if your due date was truly December 21st? Or December 18th? That could mean a drastic difference in your baby's development.

Also if you are planning on having more than one of two children, a cesarean by request for no medical reason should not be considered. With each pregnancy, the risk of placenta previa, placenta accreta, hysterectomy, blood transfusion, uterine rupture during pregnancy, and adhesion's to other major organs such as the bladder or bowel occur.

Think twice, research, and become fully educated before you make the decision for an elective cesarean section. It can mean your health, as well as the health and life long well being of your child.

After a Cesarean

Thank you to ICAN for making this amazing brochure to help women all across the world. For those who are unable or have not seen the brochure at this point, I took the time to type out most of the information on it.

Make an informed choice about the risks of repeat cesareans Vs. VBAC.

Cesarean sections are major abdominal surgery, and like all surgery, carry the risks of complications. These can include dense adhesion's, excessive scar tissue growth that connects the uterus to surrounding tissues and organs. Adhesion's can increase the risk of longer operation times and injury to adjacent organs. The risk of hysterectomy, or the surgical removal of the uterus, also rises. Undergoing repeated cesareans make it more likely a woman will experience placenta accreta, in which the placenta grows into the middle layer of the uterus, possibly causing hemorrhage and requiring a hysterectomy.

A woman who has repeat cesareans can also be more likely to experience thromboebolisms (blood clots that break lose and block vessels), or experience blood loss. And while uterine rupture (a rare but potentially catastrophic event during pregnancy or childbirth in which the uterine wall splits open) remains a concern after one or more cesareans, the risk of uterine rupture is small, and it decreases further with each additional VBAC.

Lets Look at the numbers....

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion's : 21.6% (1 in 5)

2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion's : 32.2% (1 in 3)

3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in 8)
Risk of Dense Adhesion's : 42.2% (2 in 5)

Note : "Major complications" include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

Call for Action

ICAN Mother Provides Testimony on Capitol Hill Discriminatory Insurance Practices Investigated by Senate HELP Committee

REDONDO BEACH, CA, October 15, 2009 – Gretchen Humphries, Advocacy Director for the International Cesarean Awareness Network accompanied Peggy Robertson of Centennial, Colorado to a Senate hearing in the Health, Education, Labor and Pensions (HELP) Committee. Ms. Robertson testified about her experiences with discriminatory insurance practices based on her history of cesarean.

Ms. Robertson was featured in a New York Times article in July 2008 after she was declined insurance due to her previous cesarean. She was informed by the insurance company that her application would be accepted if she agreed to be sterilized.

As of 2007, 31.8% of childbearing women in the United States had a cesarean delivery and the rate continues to increase each year. These increases are due, in part, to the growing number of women who are denied the opportunity to have a vaginal birth after cesarean (VBAC) through similarly discriminatory VBAC bans. “The prospect of rendering a third of women uninsurable is frightening and unconscionable,” said Desirre Andrews, President of ICAN. “Many of these women are being pressured or bullied into first-time and repeat cesareans, and to doubly inflict them by leaving them without health insurance is offensive.” Clearly this type of practice potentially affects a very large number of women now and in the future as the cesarean rate continues to climb and the vaginal birth after cesarean rate continues to decline.

The practice of denying a woman health insurance because of a prior cesarean also indicts the medical community. Many of the cesareans performed today are unnecessary or the by-product of an over-interventive labor management process that is rooted in defensive medicine practices. “It is absolutely wrong to deny coverage to women either because of past cesareans or the risk of future cesareans, but it is also wrong to prop up a system where physicians can overuse surgery that both harms the health of women and babies, and forces insurance companies to take on excessive costs.” said Gretchen Humphries, ICAN’s Advocacy Director.

Cesarean section is associated with double to triple the cost of a normal vaginal birth. Cesarean also imposes the risks of medical complications in the short-term and long-term, which often carry high costs. “Insurance companies, in their actuarial pragmatism, are doing the math and recognizing that moms with a history of cesarean are high-cost beneficiaries and working to weed them out of the pool of people they cover. It’s discriminatory and lawmakers need to address this issue and determine a way to protect mothers, both from the practices of the insurance industry and the non-evidence based care from obstetricians,” said Humphries.

Maternity care is the number one most expensive line-item in the U.S. healthcare bill. From 1996 to 2006, the national cesarean rate rose by 50 percent, setting a new record each year from 2000 onward. The proportion of medically induced labors rose by 135 percent from 1990 to 2005, with strong suggestions that these official induction rates identify only roughly 50 percent of actual inductions. The burden on the health care system is staggering for maternity care as it is today. In 2005, the combined hospital charges for birthing women and newborns totaled $79,277,733,843 and exceeded charges for any other condition. Private insurers paid for 51 percent and Medicaid paid for 42 percent of these stays. “Pregnancy and delivery” was the most expensive condition, followed by “newborn infants” for both payers. Six of the ten most common procedures billed to Medicaid and to private insurers in 2005 were maternity related. Cesarean section was the most common operating room procedure for Medicaid, private payers and all payers combined.

As policymakers focus on healthcare reform and finding ways to improve outcomes while lowering costs, ICAN calls on policymakers to address the needs of pregnant women and make low-cost, optimal-outcome birth easier to access.

Currently: ·

Few women are given the information they need to navigate the pitfalls of the defensive medicine model of care that is rampant ·

Women are routinely coerced or pressured into expensive care that does nothing to improve outcomes, especially through the increasing practice of banning vaginal birth after cesarean (VBAC) ·

Access to low-intervention midwife-attended births are hampered by reimbursement issues, or onerous collaborative agreement requirements for practicing midwives

“The unique beauty of maternity care is that we can simultaneously improve quality and reduce costs,” said Andrews. “But we need to start by treating women fairly and equitably, and intelligently reserve medical technology and interventions for when they are appropriate.”

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 117 ICAN Chapters across North America, Canada , and various international locations which hold educational and support meetings for people interested in cesarean prevention and recovery.

Citation: C. Sakala & M. Corry. Evidence-Based Maternity Care: What It Is and What It Can Achieve. 2008.

If you or someone you know has been denied insurance coverage because of a previous cesarean section, please contact ICAN at Advocacy@ican-online.org

Acupuncture May Help Prevent Cesarean Births

Taken from Exam Health...
http://www.emaxhealth.com/1275/84/34080/acupuncture-may-help-prevent-cesarean-births.html

Submitted by Deborah Mitchell on Oct 11th, 2009

Women who receive acupuncture during pregnancy are less likely to have a cesarean birth, according to several studies. A review of the research on the use of acupuncture during pregnancy and its impact on the rate of cesarean births, the need for epidurals, the number of inductions, and other factors are being presented at a workshop in Vancouver, Canada, on October 13 and 14.

In 1965, the rate of cesarean births in the United States was 4.5 percent. Yet in December 2007, the National Center for Health Statistics reported that the cesarean delivery rate in the United States for 2006 was 31.1 percent. This rate exceeds the rate in Canada, which reports that nearly 28 percent of the infants born in that country in 2007 and 2008 were by cesarean.

According to the Society of Obstetricians and Gynaecologists of Canada (SOGC), 20 percent fewer cesarean births would occur if doctors and hospitals followed guidelines designed to reduce unnecessary surgeries and if women had support during labor. Several studies show that acupuncture performed during pregnancy may help with this effort.

For example, in a randomized, controlled trial of acupuncture in first-time mothers, researchers evaluated 56 women who were randomly assigned to either a control group (no acupuncture) or three outpatient acupuncture treatments during pregnancy. Compared with the control group, women in the acupuncture group were more likely to labor spontaneously (70% vs 50%) and less likely to have a cesarean birth (39% vs 17%).

Cesarean births are associated with considerable morbidity in both women and their infants, as well as significant costs to the health care system. The most common complications after cesarean birth for women are infection, heavy blood loss, blood clots, nausea, vomiting, and severe headache. Maternal death, though rare, is three times more likely after cesarean births (18 per 100,000) than vaginal deliveries (6 per 100,000). Recovery time after cesarean delivery is 4 to 6 weeks compared with 1 to 2 weeks for vaginal delivery.)

Risks for infants after cesarean birth include injury during delivery, immature lung function (if the infant is delivered before 39 weeks of gestation, and need for special care in the neonatal intensive care unit. There is also some evidence that children born by cesarean section and whose parents have allergies are about twice as likely to develop allergies.

According to Debra Betts, an international expert on acupuncture and author of Essential Acupuncture for Pregnancy and Childbirth, acupuncture delivered during pregnancy can reduce nausea, high blood pressure, and back pain, and can naturally induce labor, thus reducing cesarean births. Betts is presenting the workshop on acupuncture and cesarean births and related information in Vancouver.

SOURCES:
Cunningham FG et al. “Cesarean delivery and peripartum hysterectomy. In Williams, Obstetrics 22nd ed. 2005
Harper TC et al. Journal of Maternal Fetal Neonatal Medicine 2006 Aug; 19(8): 465-70
Kolas T et al. American Journal of Obstetrics and Gynecology 2006; 195(6): 1538-43.
News-Medical.net October 9, 2009
Taffel SM et al. American Journal of Public Health 1987; 77:955-59