Author Topic: Giving birth by C-section costs more than the MMM annual expenses  (Read 28922 times)

ch12

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giving birth in the U.S. is more expensive than any other country in the world. Total costs average $18,329 for a vaginal delivery and $27,866 for a C-section, with the bulk of the bill going to insurers. However, families with insurance still have to pay about $3400 out of pocket.

I don't have kids yet, but I'm horrified by those figures. The cost for a vaginal delivery is quite high...and it's worse if you have some complications and you need to have a C-section. This was part of the discussion that always crops up on MMM, that health care costs a lot and you need insurance, etc.

I know that Jr. Mustache's birth cost more than anticipated due to unforeseen circumstances. Fortunately, the Mustache household was well able to cope with the financial burden.

However, there are a lot of families in America who can't afford it. If half of Americans would struggle to scrape together $2000 in 30 days http://business.time.com/2011/06/01/nearly-half-of-americans-would-struggle-to-come-up-with-2k-in-30-days/, then why do so many people in America choose to have children when they can't even afford giving birth? This is incredible to me. I read about this stuff and I vow to have children when I'm financially stable. And then I read stuff like Meg Jay's The Defining Decade, where she says to have kids before age 30 and definitely before 35 and I know that the window of financial stability (as I define it, not as society does) and the "right" time to have children is pretty slim.

This isn't a thread about the need for birth control; it's more about the way that our healthcare system penalizes people for having children. There was an incredibly stupid article in the WSJ http://online.wsj.com/article/SB10001424127887323375204578270053387770718.html?mod=WSJ_hp_mostpop_read that said that the remedy for our declining fertility rate was to cut Social Security tax, control college costs, and help people in lower-cost areas. Those are way too far out - when people can't afford just the first day of life, you should probably look into that.

One reason why the Mustachian lifestyle appeals so much is that I know that if I save a lot of money, I might be able to afford to enjoy my child's babyhood with some peace of mind and enough money to do what I want to.

http://www.cnn.com/2013/07/09/opinion/declercq-childbirth-costs/index.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+rss%2Fcnn_topstories+%28RSS%3A+Top+Stories%29

Joet

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #1 on: July 09, 2013, 06:39:02 PM »
there's never a 'right' time to have kids. Health care is expensive here (and the sky is blue!) :)

gooki

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #2 on: July 09, 2013, 08:17:01 PM »
And compare that to a country that has state provided health care, and the tax payer cost is $4,000 per child birth, one has to wonder why Americans are against universal health care.

Leaving it to private companies has obviously ramped the costs up astronomically, with no measurable increase in quality. Going by the figures provided, health care in the USA is 4x to 5x more expensive than it should be.

"But my Health Insurance pays for it." No they don't. Health insurance companies aren't in the business of losing money. So you're all still paying for this, just not with taxes to government, but with higher insurance premiums to private companies.

ch12

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #3 on: July 09, 2013, 08:23:03 PM »
@Joet The sky is indeed blue ;). If anything, I'd say that the "right" time for me to have kids is while I'm stilled employed at my employer, which charges me a $50.10 a month pre tax for a really incredible insurance package that covers 100% of whatever I do (minus emergency room visits - I do have copays for those). I know that colleagues have had kids and not paid a penny. That's probably the best perk of working at my company.

@gooki Yes. It is way more expensive than it should be and the hard facts of that have been presented to the American public and yet people are still complaining about the mild reforms of Obamacare, which were made to make healthcare organizations more accountable and to drive down the cost of care, among a lot of other things, such as providing my job :).

oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #4 on: July 09, 2013, 08:46:32 PM »
Let us not forget that the US has more C-section births than most places.

Why is that?

Well, someone needs to pay for that expensive anesthesiologist salary. Might as well be the pregnant woman's insurance.

Sometimes, a doctor just wants to get home to see a football game (true story).


cdub

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #5 on: July 09, 2013, 08:47:59 PM »
The copay for us at Kaiser is around $360 total for birth - vaginal or otherwise.

kkbmustang

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #6 on: July 09, 2013, 09:00:23 PM »
Here's an example of epic irony for you. Health insurance won't cover a doula, the sole purpose of which is to help the birthing mother avoid epidurals and other pain relief for those wanting a natural childbirth ($400) but they will cover an epidural ($4,000ish). I had two natural child births on purpose and paid more out of pocket than those mothers who got epidurals. Makes zero sense.

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #7 on: July 09, 2013, 09:37:02 PM »
This is a pet topic of mine (I am thinking of becoming a midwife actually...), but just as an FYI for those on high deductible insurance, you can have a safe, natural birth with a midwife, at home or in a birth center, for around $3000 all in (varies geographically, just a ballpark).  Many insurance plans cover this now too. Obviously there's still a small possibility of transfer to a hospital at the 11th hour for a serious complication, but you might be shocked how many "complications" are caused by the way birth is generally done at hospitals- woman lying on the back (stupidest position because it narrows the pelvis and makes it hard to use abdominal muscles), and pumped full of drugs (first the epidural, which slows labor, followed by pitosin to speed it up if its not progressing fast enough for the doctor to get home for dinner, followed by the baby freaking out from the super strong contractions due to the pitosin, then followed by the c-section to rescue the now distressed baby).  You really don't need, or need to pay, a trained surgeon just to late nature take it's course for the vast majority of births.

Not to mention that other civilized countries where midwives attend to the majority of births, costs are much lower AND statistics show lower death rates for babies and mothers.

SO STUPID.

marty998

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #8 on: July 10, 2013, 02:28:09 AM »
This is a pet topic of mine (I am thinking of becoming a midwife actually...), but just as an FYI for those on high deductible insurance, you can have a safe, natural birth with a midwife, at home or in a birth center, for around $3000 all in (varies geographically, just a ballpark).  Many insurance plans cover this now too. Obviously there's still a small possibility of transfer to a hospital at the 11th hour for a serious complication, but you might be shocked how many "complications" are caused by the way birth is generally done at hospitals- woman lying on the back (stupidest position because it narrows the pelvis and makes it hard to use abdominal muscles), and pumped full of drugs (first the epidural, which slows labor, followed by pitosin to speed it up if its not progressing fast enough for the doctor to get home for dinner, followed by the baby freaking out from the super strong contractions due to the pitosin, then followed by the c-section to rescue the now distressed baby).  You really don't need, or need to pay, a trained surgeon just to late nature take it's course for the vast majority of births.

Not to mention that other civilized countries where midwives attend to the majority of births, costs are much lower AND statistics show lower death rates for babies and mothers.

SO STUPID.

Maybe it's just me being the idiot man that I am but why is there a cost at all? I mean come on folks, the only pre-requisite to give birth is to be pregnant. Everything else is an optional add on.

Ok that's insensitive of me, I do recognise not all births are complication free. But for the ones that are, why have hospital involvement at all?

I agree with the sentiments above...
Story in the paper today of a young mum who went through labour so quickly the baby popped out in the living room before she could even pack her bags for the trip to the hospital. The SIL was talked through the delivery by a 000 (your 911) operator over the phone until paramedics arrived, who were also not needed anyway.

MichaelR

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #9 on: July 10, 2013, 03:34:58 AM »
Yes we could go all natural and have maternal mortality rates of 5/1000 births and infant mortality rates of 70/1000 births like Africa - admittedly the worse statistics in the world, but they also have the highest at home births and lowest caesarian rates.

In 2009 there were around 4,000,000 live births in the USA. So that year we could go for 20,000 dead mums and 280,000 dead babies if you would like to take modern medicine out of the equation.

Of course as for pain relief you could also have your appendix out with no anesthetic but strangely there do not seem to be a lot of people lining up for that option.

brand new stash

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #10 on: July 10, 2013, 06:59:48 AM »
That $3,400 is average...so it includes people who have no maternity coverage for their insurance.

I have had two csections, and both cost $20 copay for the entire pregnancy care and $200 for the hospital delivery....for a total each time of $220.  One of those pregnancies was extremely high risk with three hospitalizations, 18 ultrasounds, MFM specialists in addition to the OB, csection twin birth attended by neonatologists....then thankfully two healthy babies., which I attribute largely to the care leading up to their birth... all that care cost me only $220 out of pocket.   

If you think you may have kids in the near future, research your insurance with maternity in mind.

kikichewie

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #11 on: July 10, 2013, 07:17:18 AM »
We have a planned c section coming up in. Few months, and our planned out of pocket is $0 plus anesthesiology.  As long as that part is within our plan, it should be fully covered as well.  All company's have been "free" except for the perinatoligist visits every 4-6 weeks to monitor my condition.  However, I've been warned that if any non-plan doctor orders any tests or does any consultation in the hospital (say ordering and EKG in the middle of the night for the baby), then they will bill separately out of pocket.  I can just see how easy it would be for doctors to pad their earnings with these consultations and tests.  We are going to ask for a note on our/her chart to have in-network doctor consults only.  Just because the hospital is in network, doesn't mean the doctors are.

Recently I had to explain to my mom about "out of network" billing for the PPO she was considering.  If a doctor isn't in your network, let's say they send you a bill for $900.  The insurance should cover. 20% in most cases, right? No. The insurance company say "we pay $20 for that service in our network, so you are entitled to $4."  Then only $16 goes toward your deductible.  And you owe the doctor $896.  True story (mine).

oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #12 on: July 10, 2013, 07:22:19 AM »
Yes we could go all natural and have maternal mortality rates of 5/1000 births and infant mortality rates of 70/1000 births like Africa - admittedly the worse statistics in the world, but they also have the highest at home births and lowest caesarian rates.

In 2009 there were around 4,000,000 live births in the USA. So that year we could go for 20,000 dead mums and 280,000 dead babies if you would like to take modern medicine out of the equation.

Of course as for pain relief you could also have your appendix out with no anesthetic but strangely there do not seem to be a lot of people lining up for that option.

The above is one of most misleading posts I've ever read here.

Your post includes nothing about additional reasons for infant mortality in Africa. How about not washing hands? How about poor prenatal care? How about whether mothers take folic acid throughout the pregnancy or not? How about whether doctors know how to deliver a breech baby (a lost art)?

On this board, we're not that stupid to believe we'd have the number of dead babies and mothers just because they did not have a C-section.

32% of births in the US are done by C-section. C-sections are a cash cow for hospitals, and the majority of women do not need them.

The United States has a 3x higher rate than the UK for C-sections. The UK encourages natural birthing without pain medication. Pain meds really foul up the process.

http://gma.yahoo.com/blogs/abc-blogs/royal-baby-american-british-birthing-practices-differ-115918234.html

If you want some numbers that are not three years old, here you go:

United States:
      Number of vaginal deliveries: 2,680,947
    Number of Cesarean deliveries: 1,309,182
    Percent of all deliveries by Cesarean: 32.8%

http://www.cdc.gov/nchs/fastats/delivery.htm


oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #13 on: July 10, 2013, 07:24:39 AM »
This is a pet topic of mine (I am thinking of becoming a midwife actually...), but just as an FYI for those on high deductible insurance, you can have a safe, natural birth with a midwife, at home or in a birth center, for around $3000 all in (varies geographically, just a ballpark).  Many insurance plans cover this now too. Obviously there's still a small possibility of transfer to a hospital at the 11th hour for a serious complication, but you might be shocked how many "complications" are caused by the way birth is generally done at hospitals- woman lying on the back (stupidest position because it narrows the pelvis and makes it hard to use abdominal muscles), and pumped full of drugs (first the epidural, which slows labor, followed by pitosin to speed it up if its not progressing fast enough for the doctor to get home for dinner, followed by the baby freaking out from the super strong contractions due to the pitosin, then followed by the c-section to rescue the now distressed baby).  You really don't need, or need to pay, a trained surgeon just to late nature take it's course for the vast majority of births.

Not to mention that other civilized countries where midwives attend to the majority of births, costs are much lower AND statistics show lower death rates for babies and mothers.

SO STUPID.

YES. YES. YES.

Having a woman lie on her back to have a baby is beyond dumb. There's this thing called gravity...Last time I checked, babies are not born through the back.


GuitarStv

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #14 on: July 10, 2013, 07:29:28 AM »
Here's an example of epic irony for you. Health insurance won't cover a doula, the sole purpose of which is to help the birthing mother avoid epidurals and other pain relief for those wanting a natural childbirth ($400) but they will cover an epidural ($4,000ish). I had two natural child births on purpose and paid more out of pocket than those mothers who got epidurals. Makes zero sense.

Here in Ontario, Canada our health care system allows you to get a midwife rather than a doctor for your pregnancy (covered by the province of course).  Apparently a few years back someone ran the numbers and figured out that midwives statistically do as good a job at most of the baby stuff as doctors, but cost less and don't require the whole hospital support staff.  Of course, if complications arise then you are transferred from a midwife to a doctor (covered by the province of course).  Added benefit of going with a midwife is that they come to your home for a few weeks after birth, so you don't have to drag the tired mom and baby to a germ infested hospital on a regular basis.

We hear many of these stories about US health care and wonder why you Americans love your wasteful private health care so much, and fight any change to it.

oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #15 on: July 10, 2013, 07:42:42 AM »
Here's an example of epic irony for you. Health insurance won't cover a doula, the sole purpose of which is to help the birthing mother avoid epidurals and other pain relief for those wanting a natural childbirth ($400) but they will cover an epidural ($4,000ish). I had two natural child births on purpose and paid more out of pocket than those mothers who got epidurals. Makes zero sense.

Here in Ontario, Canada our health care system allows you to get a midwife rather than a doctor for your pregnancy (covered by the province of course).  Apparently a few years back someone ran the numbers and figured out that midwives statistically do as good a job at most of the baby stuff as doctors, but cost less and don't require the whole hospital support staff.  Of course, if complications arise then you are transferred from a midwife to a doctor (covered by the province of course).  Added benefit of going with a midwife is that they come to your home for a few weeks after birth, so you don't have to drag the tired mom and baby to a germ infested hospital on a regular basis.

We hear many of these stories about US health care and wonder why you Americans love your wasteful private health care so much, and fight any change to it.

I don't think we do. However, people who control the media do not want national insurance and they fight it while misleading Americans. Somehow, many Americans vote against their best interests.


TrulyStashin

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #16 on: July 10, 2013, 07:54:26 AM »
This is a pet topic of mine (I am thinking of becoming a midwife actually...), but just as an FYI for those on high deductible insurance, you can have a safe, natural birth with a midwife, at home or in a birth center, for around $3000 all in (varies geographically, just a ballpark).  Many insurance plans cover this now too. Obviously there's still a small possibility of transfer to a hospital at the 11th hour for a serious complication, but you might be shocked how many "complications" are caused by the way birth is generally done at hospitals- woman lying on the back (stupidest position because it narrows the pelvis and makes it hard to use abdominal muscles), and pumped full of drugs (first the epidural, which slows labor, followed by pitosin to speed it up if its not progressing fast enough for the doctor to get home for dinner, followed by the baby freaking out from the super strong contractions due to the pitosin, then followed by the c-section to rescue the now distressed baby).  You really don't need, or need to pay, a trained surgeon just to late nature take it's course for the vast majority of births.

Not to mention that other civilized countries where midwives attend to the majority of births, costs are much lower AND statistics show lower death rates for babies and mothers.

SO STUPID.

YES. YES. YES.

Having a woman lie on her back to have a baby is beyond dumb. There's this thing called gravity...Last time I checked, babies are not born through the back.

I gave birth to my daughter (Florida, 1990) in a restored Victorian house that Certified Nurse Midwife, Mary Beth, had converted to a birthing center.  We were the only people there that day and it was very much like a home birth.  I had a long labor (18 hours) and Mary Beth stayed with me the whole time.  I walked in the garden with my husband and patted a cat.  I sat in the front porch rocker.  When it was time to push, I used an old fashioned birthing chair that supported me in a semi-upright position.  It cost less than $2000 and insurance covered all but $50.   A week before, I had made and frozen a lasagne.  We ate that after Annie was born.

My son (Virginia, 1997) was born at home with CNM Marsha and her assistant Cindy.  Again a hard labor, almost 19 hours, and if I'd been in a hospital it most certainly would have ended in a C-section because my labor kept stalling.  We kept it going with natural methods and I was standing up when he was born -- supported by my husband.  Marsha was on her belly on the floor, ready to catch and our daughter, Annie held the flashlight.  Total cost, less than $3,000.  We had Kentucky Fried Chicken that time.   During my labor, my grandmother kept Annie (6 1/2) busy in the kitchen making cookies.

For a healthy pregnancy with appropriate prenatal care, home births or birthing center-births are safer than hospital births for a wide variety of reasons, but primarily because there are fewer interventions, which tend to snowball, and there is a lower risk of infection because our bodies are accustomed to the germs we live with every day.

Add to that:   I experienced something primal, painful, and really hard and not only did I survive but I kicked ass.  Knowing that, deep in my bones, is priceless.

TrulyStashin

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #17 on: July 10, 2013, 07:57:33 AM »
Oh, forgot to say that insurance covered our son's home birth too.  We paid just a regular office co-pay -- $10.  I think.

chatsc

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #18 on: July 10, 2013, 07:58:56 AM »

Here in Ontario, Canada our health care system allows you to get a midwife rather than a doctor for your pregnancy (covered by the province of course).  Apparently a few years back someone ran the numbers and figured out that midwives statistically do as good a job at most of the baby stuff as doctors, but cost less and don't require the whole hospital support staff.  Of course, if complications arise then you are transferred from a midwife to a doctor (covered by the province of course).  Added benefit of going with a midwife is that they come to your home for a few weeks after birth, so you don't have to drag the tired mom and baby to a germ infested hospital on a regular basis.

[/quote]

I agree with this sentiment.  I had much better service and care with a midwife than i did with a doctor.  but it is not easy to get in with a midwife in ontario nowadays.  you pretty much need to contact them the minute you find out you are preg.  hopefully that will change in the future.

prodarwin

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #19 on: July 10, 2013, 08:02:36 AM »
Forgive me, but isn't the ~$3K out of pocket made up very quickly with the tax-deduction one gets for having kids?


Rebecca Stapler

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #20 on: July 10, 2013, 08:06:30 AM »

Maybe it's just me being the idiot man that I am but why is there a cost at all? I mean come on folks, the only pre-requisite to give birth is to be pregnant. Everything else is an optional add on.

Ok that's insensitive of me, I do recognise not all births are complication free. But for the ones that are, why have hospital involvement at all?


Are you actually asking this? It's because you don't know if you'll have a complication until it occurs, and if you're not trained to recognize a complication, you won't know until it's too late.

A friend of mine experienced complications during a home birth and her child will suffer the serious effects of it for the rest of his life because he didn't get the care he needed right away. Conversely, another friend's baby was born in a hospital, just after her umbilical cord ruptured unexpectedly. It was a miracle that she lived, and she probably wouldn't have if it hadn't happened in the hospital.

And secondly, there is one thing all mothers experience during childbirth: Pain. Yes, it's very insensitive to assume that even complication-free births shouldn't be accompanied by pain medication if the mother wants it. 

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #21 on: July 10, 2013, 08:06:49 AM »
This is a pet topic of mine (I am thinking of becoming a midwife actually...), but just as an FYI for those on high deductible insurance, you can have a safe, natural birth with a midwife, at home or in a birth center, for around $3000 all in (varies geographically, just a ballpark).  Many insurance plans cover this now too. Obviously there's still a small possibility of transfer to a hospital at the 11th hour for a serious complication, but you might be shocked how many "complications" are caused by the way birth is generally done at hospitals- woman lying on the back (stupidest position because it narrows the pelvis and makes it hard to use abdominal muscles), and pumped full of drugs (first the epidural, which slows labor, followed by pitosin to speed it up if its not progressing fast enough for the doctor to get home for dinner, followed by the baby freaking out from the super strong contractions due to the pitosin, then followed by the c-section to rescue the now distressed baby).  You really don't need, or need to pay, a trained surgeon just to late nature take it's course for the vast majority of births.

Not to mention that other civilized countries where midwives attend to the majority of births, costs are much lower AND statistics show lower death rates for babies and mothers.

SO STUPID.

Maybe it's just me being the idiot man that I am but why is there a cost at all? I mean come on folks, the only pre-requisite to give birth is to be pregnant. Everything else is an optional add on.

Ok that's insensitive of me, I do recognise not all births are complication free. But for the ones that are, why have hospital involvement at all?

I agree with the sentiments above...
Story in the paper today of a young mum who went through labour so quickly the baby popped out in the living room before she could even pack her bags for the trip to the hospital. The SIL was talked through the delivery by a 000 (your 911) operator over the phone until paramedics arrived, who were also not needed anyway.

Well it costs something to have a baby because you do generally want  a trained professional there to ensure safety of mom and baby.  You pay a price for consulting with the professional who is going to make sure your pregnancy is progressing normally, and you pay that trained professional to be on call for your birth, and you pay that trained professional for their time and expertise with post natal care as well.  Your fee to them ensures that they can afford the proper safety equipment, etc.  Sure, you could give birth somewhere in a barn for free, but birth is one time when you want someone around who knows what there's doing for the safety of mother and baby!!!  You don't need to pay a trained surgeon (that's what an OB really is...), but you'll need to pay someone SOMETHING.

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #22 on: July 10, 2013, 08:18:08 AM »
Yes we could go all natural and have maternal mortality rates of 5/1000 births and infant mortality rates of 70/1000 births like Africa - admittedly the worse statistics in the world, but they also have the highest at home births and lowest caesarian rates.

In 2009 there were around 4,000,000 live births in the USA. So that year we could go for 20,000 dead mums and 280,000 dead babies if you would like to take modern medicine out of the equation.

Of course as for pain relief you could also have your appendix out with no anesthetic but strangely there do not seem to be a lot of people lining up for that option.

What you said is patently false.  Other civilized countries (think European countries, Japan, etc) where midwives and home births are far more common actually have lower infant and mother mortality rates than the United States.  The United States actually is among the worst statistically among civilized countries.  You can view past WHO reports for more specific information.  If you are concerned with the safety of home birth, don't have one.  However, at least familiarize yourself with the facts surrounding modern home birth before spewing off on a topic you clearly no nothing about.

The cesarean rate in the United States is out of control.  In some places it is around 50%.  It's easy to forget that cesearean is actually major surgery and there can be very serious complications associated with it.  The risk of complication increases with each cesarean as well.

NumberCruncher

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #23 on: July 10, 2013, 08:21:19 AM »

For a healthy pregnancy with appropriate prenatal care, home births or birthing center-births are safer than hospital births for a wide variety of reasons, but primarily because there are fewer interventions, which tend to snowball, and there is a lower risk of infection because our bodies are accustomed to the germs we live with every day.

Add to that:   I experienced something primal, painful, and really hard and not only did I survive but I kicked ass.  Knowing that, deep in my bones, is priceless.

Thanks for sharing your story, and I'm really glad you had a good experience and outcomes!

On a purely statistical level, however, hospital births have lower risks associated with them (looking at perinatal mortality and life of the mother). There are multiple studies from the CDC and others that show once accounting for risk levels (higher risk pregnancies are basically all in the hospital group), hospital births are safer. I think this is mostly due to the fact that IF something goes wrong (low likelihood in either case), the hospital has the facilities to very quickly respond. When talking about these rare circumstances that can't be detected early-on, the 10 minutes it would take to drive to a hospital can make a big difference.

The studies often talked about in other countries vs US usually talk about infant mortality (birth to 1 year), which isn't really the best measure of care in this case.

This does make me wonder why there aren't more birthing centers staffed primarily with midwives attached to hospitals or some other such arrangement so there can be instant surgical or advanced medical intervention when deemed necessary, while still maintaining some of the benefits of homebirth.

lisahi

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #24 on: July 10, 2013, 09:36:46 AM »
Health care costs are high in America in part because of high malpractice insurance and unnecessary tests doctors perform to cover their asses due to the cost of getting sued for malpractice. Not only do we need health care insurance reform in America, we need tort reform as well. Capping the amount of damages on malpractice claims would go a long way to getting hospitals to reduce their bills to something resembling the actual cost of service. Setting up an administrative procedure (like the EEOC) prior to allowing judicial litigation to discourage frivolous claims and pay off smaller claims with less expense, may also accomplish something similar.

Hospitals also overcharge for services knowing that the insurance company won't pay for it all (secretly hoping the insurance company will, though). They eventually write off huge chunks as a loss, and send the remainder to the patient as out-of-pocket expenses. It's a strategy game. And yes, that is part of our broken private healthcare system in America.

Joet

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #25 on: July 10, 2013, 09:44:44 AM »
This thread reminds me why I:

love the internet
trust evidence based medicine
trust the scientific method

in no particular order

GuitarStv

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #26 on: July 10, 2013, 09:59:48 AM »
On a purely statistical level, however, hospital births have lower risks associated with them (looking at perinatal mortality and life of the mother). There are multiple studies from the CDC and others that show once accounting for risk levels (higher risk pregnancies are basically all in the hospital group), hospital births are safer. I think this is mostly due to the fact that IF something goes wrong (low likelihood in either case), the hospital has the facilities to very quickly respond. When talking about these rare circumstances that can't be detected early-on, the 10 minutes it would take to drive to a hospital can make a big difference.

The studies often talked about in other countries vs US usually talk about infant mortality (birth to 1 year), which isn't really the best measure of care in this case.

This does make me wonder why there aren't more birthing centers staffed primarily with midwives attached to hospitals or some other such arrangement so there can be instant surgical or advanced medical intervention when deemed necessary, while still maintaining some of the benefits of homebirth.

That's how our midwife group operates . . . basically the midwife meets the woman in the hospital and handles the whole birthing procedure.  In case of emergency they can call a hospital doctor.  Mom and baby go home 24 hours later, and the midwife does the next several bunch of checkups.

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #27 on: July 10, 2013, 10:20:21 AM »


This does make me wonder why there aren't more birthing centers staffed primarily with midwives attached to hospitals or some other such arrangement so there can be instant surgical or advanced medical intervention when deemed necessary, while still maintaining some of the benefits of homebirth.

These do exist, but the reason why they aren't more widespread is somewhat complicated.

When hospital births started becoming more common, the was a huge increase in the numbers of obgyns coming out of medical school.  When these doctors graduated, they needed jobs.  Midwives were competition, and doctored lobbies essentially drove midwives out of practice through smear campaigns painting them as basically a group of uneducated grannies.  So midwives never moved into the hospitals.  The practice of midwifery more or less died out.

In the 70s when there was a resurgence of interest in natural birth and midwifery, the number of midwives began to grow, but without established courses of education or any widely accepted credentials, midwifery was still viewed as fringe.

Now today, CNM (certified nurse midwife), and to a lesser degree CPM or CM (certified professional midwife), is a recognized medical credential and midwives are gaining recognition as real professionals.  However, the medical establishment is not really comfortable with the idea of home birth, and the obgyn is quite entrenched into the hospital way of doing birth.  The doctors lobbies don't want the midwives coming in and taking the doctors jobs, and the hospitals don't want to lose all that money from the expensive births that are typical in hospitals, so it's an uphill battle to move these safe, women-wellness centered births into the hospitals where they would be the safest.  There has even been evidence of midwives being fired from their jobs at hospitals when their practice grows to too large a percentage of their department

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #28 on: July 10, 2013, 11:21:21 AM »
These do exist, but the reason why they aren't more widespread is somewhat complicated.

When hospital births started becoming more common, the was a huge increase in the numbers of obgyns coming out of medical school.  When these doctors graduated, they needed jobs.  Midwives were competition, and doctored lobbies essentially drove midwives out of practice through smear campaigns painting them as basically a group of uneducated grannies.  So midwives never moved into the hospitals.  The practice of midwifery more or less died out.
In Ontario we had all but obliterated midwives until the 1990s. Then something funny happened, the obgyns went on strike demanding higher pay. In response the government legalized midwives in the province. Makes me very happy! We are even getting some birthing centers which make a ton of sense. Why would you take a baby to a place where sick people go (aka hospital)?

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #29 on: July 10, 2013, 11:31:18 AM »
Forgive me, but isn't the ~$3K out of pocket made up very quickly with the tax-deduction one gets for having kids?

No, not even close.  There are other expenses associated with children.  The deduction is a drop in the bucket.

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #30 on: July 10, 2013, 11:43:08 AM »
I was hoping to see a claim that deciding to have and pay for a c-section was deserving of ridicule as an extremely anti-mustachian expense (not a position I share, I just wanted to see THAT set of fireworks).

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #31 on: July 10, 2013, 11:44:08 AM »
I have had two csections, and both cost $20 copay for the entire pregnancy care and $200 for the hospital delivery....for a total each time of $220. 

Sorry, but that is not what they cost, that is the fraction of the cost that you paid.  The rest was paid by insurance.  You probably got (or could get) paperwork showing the actual cost.

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #32 on: July 10, 2013, 12:00:27 PM »
YES. YES. YES.

Having a woman lie on her back to have a baby is beyond dumb. There's this thing called gravity...Last time I checked, babies are not born through the back.

Giving birth flat on your back also pulls the vaginal tissue in such a way that tearing is more likely.  So of course the doctor just does that part for you and gives you an episiotomy.  The stupidity is truly mind boggling. :P

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #33 on: July 10, 2013, 02:31:47 PM »
Yes we could go all natural and have maternal mortality rates of 5/1000 births and infant mortality rates of 70/1000 births like Africa - admittedly the worse statistics in the world, but they also have the highest at home births and lowest caesarian rates.

In 2009 there were around 4,000,000 live births in the USA. So that year we could go for 20,000 dead mums and 280,000 dead babies if you would like to take modern medicine out of the equation.

Of course as for pain relief you could also have your appendix out with no anesthetic but strangely there do not seem to be a lot of people lining up for that option.

What you said is patently false.  Other civilized countries (think European countries, Japan, etc) where midwives and home births are far more common actually have lower infant and mother mortality rates than the United States.  The United States actually is among the worst statistically among civilized countries.  You can view past WHO reports for more specific information.  If you are concerned with the safety of home birth, don't have one.  However, at least familiarize yourself with the facts surrounding modern home birth before spewing off on a topic you clearly no nothing about.

The cesarean rate in the United States is out of control.  In some places it is around 50%.  It's easy to forget that cesearean is actually major surgery and there can be very serious complications associated with it.  The risk of complication increases with each cesarean as well.

I won't disagree about C-section prevalence or the rank of the aggregate IMR's among developed countries.  However, IMR's among developed countries are so incredibly low that the U.S.'s "terrible" IMR is still damn good compared to the historical US (even mid-20th century) or the developing countries today often times by an order of magnitude.  I studied mortality/fertility stats pretty extensively in grad school* so my figures are 3-4 years old but at the time Japan/Sweden of course led the way with an IMR of near 3-4 IIRC while the US was near 8 per 1000.  Sure, it's twice as high but I don't think simply being pregnant in the US leads to double the risk of infant death.  In other words, nothing is in the water here and going to Sweden to deliver your baby shouldn't matter significantly as far as survival outcomes of the first year. 

IMO, it is mainly socioeconomic/healthcare access reasons for the higher than "normal" ultra-developed rate found in the US.  The #1 indicator of infant survival is birthweight.  An absurd # of infant deaths occur in the infant population born under 1000 grams (1 kg or 2.2 pounds).  Birthweight is of course correlated with prematurity.  Prematurity is negatively correlated with maternal health.  This isn't to say healthy mother CANNOT have low-weight children, it's just less probable.  Maternal health is correlated with poverty (negatively) and education (those uneducated tend to fear establishments/institutions more and would be more likely to have little or no professional medical help for myriad reasons).  The US has one of the highest Gini coefficients in the world meaning wealth is nowhere near evenly distributed (not saying this is bad or good, just stating).  This could mean that the poorest in the US aren't afforded the same opportunities that the poorest in other developed countries are.  I'd be willing to bet that countries with lower IMR's have one or both of the following a) higher % of babies born >1000g b) higher % of mothers with healthcare access, especially at the poorer quantiles.  This doesn't solve the "problem" of the US's IMR but all I'm saying is it's not necessarily an issue of Country A's IMR where they have too many C-sections vs. Country B's IMR where they have an acceptable # of C-sections.  C-sections and midwives may very well play a part in IMR (and why the US IMR is lower than other ultra developed countries) but I also think they tend to be too much a center of focus in relation to IMR and that there are other more salient factors at play.  Yep, educate yourself about pregnancy options and medical checkups while being fairly healthy and the odds are ever in your favor (yeah, I saw Hunger Games with my wife, got a problem? haha).

MichaelR-taking modern medicine out of the equation altogether is irrelevant (and misleading!) to the point you were trying to make.
Evakatharina-I don't disagree with anything you said, really.  I just wanted to toss in my two cents about IMR variance.

*I'm no expert.  Just stating an excuse to use data which are not the most current.

DoubleDown

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #34 on: July 10, 2013, 02:42:09 PM »
Our first daughter (unexpected fast delivery) would not have survived any kind of non-hospital birth without physicians and life-saving equipment on hand. Having an at-home or midwife birth is probably great for the 999 that go easily, but for the 1 out of 1000 with complications (or whatever the real stats are) that's literally a life-and-death gamble.

And health care costs/politics in the U.S., and unnecessary C-sections scheduled out of "convenience" are all a cluster f*ck.

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #35 on: July 10, 2013, 03:51:29 PM »
The #1 indicator of infant survival is birthweight.  An absurd # of infant deaths occur in the infant population born under 1000 grams (1 kg or 2.2 pounds).  Birthweight is of course correlated with prematurity.

There is also reported to be a correlation between IVF and other fertility treatments, and premature births/low birth weight.

hybrid

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #36 on: July 10, 2013, 07:21:42 PM »

Maybe it's just me being the idiot man that I am but why is there a cost at all? I mean come on folks, the only pre-requisite to give birth is to be pregnant. Everything else is an optional add on.

Ok that's insensitive of me, I do recognise not all births are complication free. But for the ones that are, why have hospital involvement at all?


Are you actually asking this? It's because you don't know if you'll have a complication until it occurs, and if you're not trained to recognize a complication, you won't know until it's too late.

A friend of mine experienced complications during a home birth and her child will suffer the serious effects of it for the rest of his life because he didn't get the care he needed right away. Conversely, another friend's baby was born in a hospital, just after her umbilical cord ruptured unexpectedly. It was a miracle that she lived, and she probably wouldn't have if it hadn't happened in the hospital.

I'm with Stan here.  We would have lost our daughter and quite possibly my wife as well because of a ruptured placenta during labor had we delivered at home with a midwife.  A very rare defect to be sure, but one that involved very rapid bleeding out.  Had we not been in a hospital.....

I can get on board with a midwife, but only in the proper setting.

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #37 on: July 11, 2013, 12:07:27 AM »
Having given birth less than 4 weeks ago, I'm finding this discussion both compelling and... complicated.

Yes, I agree that costs in America are crazy.  But really that's not isolated to the cost of maternity care, that's healthcare across the board.  I am curious in country's with socialized medicine, are doctors still highly compensated? What's the malpractice situation like there?  I guess what I'm mentally trying to get at is--is american healthcare so expensive just because of the profit motive of private insurance companies or are there other factors that add in to our high costs?

I'm also curious, from an economic point of view, how being the "richest country in the world" factors into the economics of our healthcare.  Presumably there's a lot more money in the US available to be spent and healthcare is something you can pretty easily convince people to pay for, so is that a major reason for our cost being high? Anyone with more econ background than me want to weigh in?

As to the midwife/obgyn/anesthesia/hospital/birthcenter/death/etc/etc/etc discussion, my own experience is so recent it clouds my view. What I know is that I would have died had I not been in a hospital environment. What I don't know is how being in a hospital environment may have caused the very complications they were then able to save me from.  Whatever the case may be, I would never not do that in a hospital--to me, it's too big of a risk, no matter how frugal I am.  And, for all the obgyn hating, my dr. was very, very patient with my labor and avoided a c-section even though she had multiple opportunities to call for one.

FWIW, my out of pocket costs for labor and delivery were $1056. That doesn't include pre-natal care which was a shtshow because I switched insurance companies three times in the course of the pregnancy (why oh why is our healthcare tied to our employment situation?).  Total paid by insurance: $6,175.  Total actually billed by those providers: $26,900.  It's interesting that the hospital only got 17% of the total it billed paid whereas the obgyn got 97% and the anesthesiologist fell in between at around 63%.  After the insurance adjustments I would say what they got paid, relative to one another and how much work goes into each, was about right.

NumberCruncher

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #38 on: July 11, 2013, 07:09:01 AM »
Yes, I agree that costs in America are crazy.  But really that's not isolated to the cost of maternity care, that's healthcare across the board.  I am curious in country's with socialized medicine, are doctors still highly compensated? What's the malpractice situation like there?  I guess what I'm mentally trying to get at is--is american healthcare so expensive just because of the profit motive of private insurance companies or are there other factors that add in to our high costs?

I'm also curious, from an economic point of view, how being the "richest country in the world" factors into the economics of our healthcare.  Presumably there's a lot more money in the US available to be spent and healthcare is something you can pretty easily convince people to pay for, so is that a major reason for our cost being high? Anyone with more econ background than me want to weigh in?

Read this a while back: http://www.time.com/time/magazine/article/0,9171,2136864,00.html

"The Bitter Pill" - long article, but pretty compelling. There's lots of reasons people give for the high costs in the US -> most discussed to some degree in the article (though it would be great to hear from anyone with more knowledge in the area). The biggest shock is looking at the "charge master" price of care vs. the much lower insurance adjusted price vs. the much lower medicare billing price. Hospital administrators will tell you that they take a loss on the medicare billing price, pharmaceutical industry says they need all their monies to do the cutting edge research, and everyone hates insurance companies, but they're losing their negotiating power to large networks of care providers. 

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #39 on: July 11, 2013, 07:20:58 AM »
Evakatharina-I don't disagree with anything you said, really.  I just wanted to toss in my two cents about IMR variance.

*I'm no expert.  Just stating an excuse to use data which are not the most current.

Well I'm not about to pretend to be a statistician!  Your criticisms of using IMR to measure safety of birth practices are more than fair!!

FYI- you are totally correct in your guess that poorer regions of the United States have abysmally poor health care for pregnant women, and that it likely drags down the numbers for the entire United States even though birth in wealthy regions of the US is statistically very safe.  And it's in some of those wealthy regions that the c-section rate is the highest (for example, in and around NYC the c-section rate astronomical due to the popularity of scheduled sections favored by wealthy women).  So I'm definitely not saying that c-section = dangerous. 

My real point is that the United States doesn't keep women really any safer than places like Scandinavia or Japan where home birth and midwives are wide spread, and that the system in place actively does harm to women by making birth extremely expensive, systemically limiting their safe options, and having a system that is more focused on doctor convenience (20 min c-sections vs 12 hour labors, birthing on the back, over use of medication) than it is on providing really good care for mother & baby.  We would do better financially and in terms of women's overall wellness to focus on making safe midwife care available for the vast majority of normal births in this country, and then let the trained surgeons (the ob's) do what they are good and and likely what excited them in the first place- they handle the difficult cases involving surgery and complications all day every day.  There's room for both and IMO both are very important and valid professions.  I don't mean to denigrate obgyns in any way- all I'm saying is that it's overkill and there is a potential for a greater number of women to have positive birth experiences with midwives who provide consistent, nurturing care throughout the pregnancy and who allow women the opportunity to choose the type of birth they want without forcing unwanted interventions.  If other countries can do birth just as safely as the US and without all the crap that our system forces so many women to go through, then we should be doing that too.  It would be a win for everyone.

The reason I feel so passionate about this topic is that I know many women are deprived of having the kind of birth experience they want, and it leaves them feeling traumatized.  Conversely, the women I've spoken to who have been lucky enough to have full knowledge of their birth choices and have made their best choice based on all the information (whether they choose a scheduled c-section or a home water birth or anywhere in between) have the opposite experience of feeling empowered and capable to do what they feel is best for themselves and for their babies.  Lack of information about (and access to) options and mis-information about the perceived safety of the options is damaging.

Something that hasn't been talked about in this thread is that an unwanted/unneeded c-section deprives the mother and baby of many things, and women might not even be aware of what they are missing out on because the information is not given to women when they are making their decisions about what kind of birth they want.  Some advantages women might not even be aware that they and their baby are not getting:
- natural childbirth causes the release of an incredibly powerful and complex combination of chemicals that forms an instant, euphoric love connection between the two and triggers the mothers protective instincts.
- there is no cascade of interventions to create conditions where a csection becomes necessary to "save" a baby that is distressed due to circumstances caused by the drugs.  And then everyone saying OMG thank god we were at the hospital or we would have been in trouble!! Pitosin drips cause very strong contractions, and these strong contractions can restrict oxygen flow resulting in neurological damage.
- breast feeding is easier after a natural childbirth- when the mother gets an epidural, those drugs are passed to the baby, and research shows that these babies are less able to use their natural suckling abilities than unmediated babies.
- women who give birth at home or at a birthing center are more supported to move around, eat, drink, etc to feel comfortable and manage their pain which allows birth to proceed more normal resulting in less need to begin medical interventions

footenote

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #40 on: July 11, 2013, 07:29:25 AM »
And babies born through C-section miss out on the benefit of ingesting mom's beneficial gut biota:
http://www.scienceandsensibility.org/?p=4995

"In vaginally-born babies, the bacteria destined for the gut microbiota originate primarily in the maternal birth canal and rectum. Once these bacteria are swallowed by the newborn, they travel through the stomach and colonize the upper and lower intestine, a complicated process that evolves rapidly.

"Infants born by cesarean section—particularly cesareans performed before labor begins—don’t encounter the bacteria of the birth canal and maternal rectum. Instead, bacteria from the skin and hospital environment quickly populate the bowel. As a result, the bacteria inhabiting the lower intestine following a cesarean birth can differ significantly from those found in the vaginally-born baby."

oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #41 on: July 11, 2013, 09:06:21 AM »

Maybe it's just me being the idiot man that I am but why is there a cost at all? I mean come on folks, the only pre-requisite to give birth is to be pregnant. Everything else is an optional add on.

Ok that's insensitive of me, I do recognise not all births are complication free. But for the ones that are, why have hospital involvement at all?


Are you actually asking this? It's because you don't know if you'll have a complication until it occurs, and if you're not trained to recognize a complication, you won't know until it's too late.

A friend of mine experienced complications during a home birth and her child will suffer the serious effects of it for the rest of his life because he didn't get the care he needed right away. Conversely, another friend's baby was born in a hospital, just after her umbilical cord ruptured unexpectedly. It was a miracle that she lived, and she probably wouldn't have if it hadn't happened in the hospital.

I'm with Stan here.  We would have lost our daughter and quite possibly my wife as well because of a ruptured placenta during labor had we delivered at home with a midwife.  A very rare defect to be sure, but one that involved very rapid bleeding out.  Had we not been in a hospital.....

I can get on board with a midwife, but only in the proper setting.

That's why I think people should be able to give birth with a midwife in a hospital. Unfortunately, that is rarely possible in the US. If midwives *are* allowed in a hospital, the hospital may not be on board with allowing labor to run its course. Then, they might start to medicate, which often leads to unnecessary surgery for the woman and greater profits for the hospital.

The ideal situation would be like the UK. Allow people to have a real natural childbirth in a hospital if they so choose.


oldtoyota

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #42 on: July 11, 2013, 09:13:01 AM »
I have never really liked the word "C-section" and prefer "Caesarean birth" on behalf of the women who have them.

That said, I think either phrase sugar coats the fact that we're talking about abdominal surgery. That surgery can have long-lasting negative consequences for women. My friend no longer has feeling in certain areas of her abdomen after her abdominal surgery/c-section/birth.


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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #43 on: July 11, 2013, 09:25:32 AM »
That's why I think people should be able to give birth with a midwife in a hospital. Unfortunately, that is rarely possible in the US. If midwives *are* allowed in a hospital, the hospital may not be on board with allowing labor to run its course. Then, they might start to medicate, which often leads to unnecessary surgery for the woman and greater profits for the hospital.

The ideal situation would be like the UK. Allow people to have a real natural childbirth in a hospital if they so choose.

Just anecdotal about how hospital birth with midwife can get f'ed up-

When my MIL was in labor giving birth to the person who would one day be my husband, she was at an in-hospital, midwife-run birth center.  The labor was in progress, and my MIL had reached a point where she was resting between contractions.  A doctor stops in to check on her, and decides that its's time to push.  She starts pushing (against her natural inclination), and things begin going wrong very quickly.  Baby goes into distress, emergency c-section is performed, and baby is rushed to a larger hospital an hour away for still-undiagnosed respiratory issues.  It turns out that the doctor had her start pushing when there was swelling in her cervix- swelling that very well may had gone down if she had rested like her body was telling her to.  It's one of those nebulous situations- did the hospital save the baby, or was the rescue only necessary because the hospital did not allow her body to run its natural course?  Who's to say.

Situations like that are also why many midwives don't want to work in hospitals - especially midwives who are most passionate about their work and the conviction that labor should progress in almost every case according to what the mothers body (an instrument that is BRILLIANTLY designed for giving birth...) is telling her to do.

The hospital is unhappy because labors are taking too long and they're making less money per labor, and midwives are unhappy because they aren't always able to do their work they way they feel it should be done.  Mothers suffer because they don't have adequate access to information or options.  A sad situation all around.

EK

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #44 on: July 11, 2013, 09:27:10 AM »
I have never really liked the word "C-section" and prefer "Caesarean birth" on behalf of the women who have them.


(Emphasis mine) I really like that.  I'm going to start using that.

NumberCruncher

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #45 on: July 11, 2013, 09:47:00 AM »
The hospital is unhappy because labors are taking too long and they're making less money per labor, and midwives are unhappy because they aren't always able to do their work they way they feel it should be done.  Mothers suffer because they don't have adequate access to information or options.  A sad situation all around.

I understand where you're coming from and the emotions involved, but you keep making it sound like the hospitals and obgyns have no human compassion whatsoever. Is it true that sometimes interventions may cascade and involve otherwise unnecessary surgeries? Probably. Is it also true that complications can occur in "natural births" that midwives cannot handle that can cascade and involve otherwise unnecessary mortality? Definitely. As stated by multiple people, these cases are rare, but they do happen.

I have the opinion that most obgyns, in the end, are looking to minimize pain and increase the chances of survival for the child and mother. Every person involved in the birth of the child is concerned with the outcome - these doctors aren't robot golfers.  Placental function can decline throughout labor, potentially causing fetal distress. Having a long labor increases the risks...how do you quantify these risks? Who's to say? Not me because I have like absolutely no medical training whatsoever. Even if I did, I wouldn't know whether surgery was necessary for any given birth probably ever - there are so many grey areas. And if something goes wrong? You can fairly confidently bet there will be a big drawn out malpractice suit, regardless of the birth plan involved. (http://www.equotemd.com/blog/obgyn-medical-malpractice-insurance/ holy crap is that expensive)

Hamster

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #46 on: July 11, 2013, 10:36:54 AM »
As a pediatrician, I take care of many patients who have had home births or midwife births in our local midwife-run birthing center. Most do great. I also attend in the hospital (which also has midwives on staff, btw). There are certainly cases where there is escalation of interventions, but the OBs I work with are amazingly compassionate people and the caricature of them as trying to increase c-section rates to get home for dinner is patently dishonest. Everyone involved truly does have the mom and baby's health as top priority. I will say, though, that in our community hospital, the worst outcomes I have seen in babies disproportionately fall on the out of hospital births where mom's either labor too long with ruptured membranes (leading to infection) or maternal hemorrhage, or babies o aren't breathing effectively after a routine birth, aren't able to get adequate resuscitation at birth and end up with permanent brain injury. I think the hospital does mean a higher risk of unnecessary intervention, but also a better opportunity to prevent the worst outcomes, many of which happen following routine, uncomplicated pregnancies.

Christiana

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #47 on: July 11, 2013, 11:42:28 AM »

However, there are a lot of families in America who can't afford it. If half of Americans would struggle to scrape together $2000 in 30 days http://business.time.com/2011/06/01/nearly-half-of-americans-would-struggle-to-come-up-with-2k-in-30-days/, then why do so many people in America choose to have children when they can't even afford giving birth? This is incredible to me. I read about this stuff and I vow to have children when I'm financially stable. And then I read stuff like Meg Jay's The Defining Decade, where she says to have kids before age 30 and definitely before 35 and I know that the window of financial stability (as I define it, not as society does) and the "right" time to have children is pretty slim.

Somewhere I read that Medicaid pays for almost half of the births in the U.S.

CanuckExpat

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #48 on: July 11, 2013, 12:28:54 PM »
Somewhere I read that Medicaid pays for almost half of the births in the U.S.

This might be right. "Poor" Americans have a higher rate of fertility than "rich" americans, and presumably the former would have their birthing costs covered. See here: http://www.slate.com/articles/double_x/doublex/2011/09/knocked_up_and_knocked_down.html

"the rates of unplanned pregnancies and births among poor women now dwarf the fertility rates of wealthier women, and finds that the gap between the two groups has widened significantly over the past five years"

Rebecca Stapler

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Re: Giving birth by C-section costs more than the MMM annual expenses
« Reply #49 on: July 11, 2013, 01:21:55 PM »

That's why I think people should be able to give birth with a midwife in a hospital. Unfortunately, that is rarely possible in the US. If midwives *are* allowed in a hospital, the hospital may not be on board with allowing labor to run its course. Then, they might start to medicate, which often leads to unnecessary surgery for the woman and greater profits for the hospital.

The ideal situation would be like the UK. Allow people to have a real natural childbirth in a hospital if they so choose.

I don't think having a midwife in a hospital is rare at all. My son was born in a region of the country that isn't exactly progressive, in a major hospital, and there were midwives on staff. We brought in our own doula, who was amazing, but I have friends who gave birth in birthing centers that had doulas and midwives on staff -- and either a level 1 NICU on site or a hospital across the street.