Giving birth by C-section costs more than the MMM annual expenses

[Mrs WW]

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 live in Sweden and here a specialist doctor at a hospital makes around 10.000$ per month (about 35-40% of that will go to taxes though) base pay, but I know alot of docs that work extra to make more.

The thing is that here, the OB:s are not involved in pre-natal care or birth unless something is wrong. With my pregnancies I saw a doctor once for the first pregnancy (routine), the rest is all midwives in a clinic setting (government run or private on government subsidy) for the prenatal and hospital setting (government run) for the birth. Your prenatal midwife will not be the one delivering your child, but whoever is on staff. For a hospital delivery room with 12 rooms you will have one midwife per mother,  a few nurses and one or two ob gyn on staff and a couple of pediatricians (shared with the post-natal wards), several on call. Anastecia is shared with the whole hospital, and sometimes the wait is longer than the delivery. All in all a much lesser need for doctors period. AND we still manage to keep the best statistics in the field. This does not mean that its perfect though, with birthing wards being severly understaffed at times and no alternatives available really, home birth is extremely uncommon. Ceacarean births are rising here as well, especially the right to choose wether or not you will have a planned c-birth is heavily debated. As for malpractise I don't know enough to say, but my guess is close to unheard of...

For a normal pregnancy you see the doctor once if its your first child, otherwise nothing. With your first child your prenatal visits will be about every three weeks, 12 in total I think. If you want more visits because you have concerns/fears, you can have that. For a second pregnancy the visits are down to 8 for the whole pregnancy. Everyone gets one 17th week ultrasound, everyone over 35 (in my area, this varies regionally) gets an early screening if they want it. This might seem little to you, but the theme is low interference, and it seems to work.

All care pertaining pregnancy and birth is absolutely free, unless you choose to have extra (not needed) ultrasounds, screenings that are not called for by your doctor/midwife. If you want to do an amneo that is free. The only thing I had to pay anything for was the hospital stay for my husband to stay with us, but since he wasn't the one giving birth I guess that extra 20$ per night was fair, especially since it included five meals a day and coffee all day!

Long, I know, but a passionate subject :)

[oldtoyota]

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.

I'm glad to hear it! I live in the DC area. We had about three birthing centers. A few closed down. One was attached to a hospital. Other hospitals either did not not allow midwives in or a midwife could be present but not as an official medical provider.

[NumberJohnny5]

Our first baby, they did a C-Section because he looked to be pretty big in the ultrasound (10+ pounds I think), but once delivered...well he was a big baby but nowhere near "OMG cut her open now, there's no way he's coming out of there!" big.

Second baby...they wouldn't even entertain the idea of doing a VBAC (vaginal birth after caesarean). Against policy. Silly us, should have just found a different practice (though I wonder how hard it would be to find someone willing to do that?). They seemed to be competent in general...but then you have things happening like: doctor was going to be on vacation when the C-section needed to be scheduled, but would do it a couple weeks earlier...a bit too early without a medical reason (worked out in the end, wife went into labor before the scheduled date); doctor didn't believe my wife when she said her water broke (she ended up delivering over 24 hours later, which was another big no-no). I can't complain much, both kids are happy and healthy.

My wife is pro-midwife, though she may be just a tiny bit biased (she's a midwife here in Australia). From what I hear, sounds like a good setup. As far as the hospital part, imagine the hospital setting in the US. Now imagine that all the L&D nurses are actually midwives, they do all the same jobs except for the addition of being able to actually deliver the baby (well, L&D nurses in the US can deliver if there's no doctor available, my wife has done quite a few that way). If you need an OB, then you'll get one.

[GuitarStv]

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?

Average salary for a doctor in Canada is 307,000$ (Canadian, which is about on par with the US dollar these days).  It varies quite a bit depending on the specialization of the doctor though.  On average, psychiatrists make the least at about 232k a year (186k after taxes), and ophthalmologists make the most at about 676k a year (418 after taxes).  Physicians are among the highest paid people in Canada, below judges and above dentists and lawyers.

Malpractice lawsuits don't happen a lot in Canada, and even when they do happen they don't tend to go to completion.  From an estimated 100,000 errors that our doctors make each year with consequences that could potentially result in a lawsuit, on average only 4,524 suits are filed each year.  Of those filed only 521 go to trial, and of those that go to trial only 116 result in winning for the plaintiff.

(References: http://www.theglobeandmail.com/life/health-and-fitness/health-navigator/patients-odds-of-winning-medical-malpractice-suits-in-canada-arent-good-says-new-book/article10812604/, http://www.theglobeandmail.com/life/health-and-fitness/health/how-much-are-canadian-doctors-paid/article7750697/, http://www.theglobeandmail.com/life/health-and-fitness/health/mds-gross-income-307000-report-finds/article7640498/, http://www.workopolis.com/content/advice/article/how-much-money-are-we-earning-the-average-canadian-wages-right-now/)

[ace1224]

homebirths are "illegal" in my state.  in that a midwife cannot legally assist in a homebirth and insurance cannot and will not cover any part of it. 
the N.C. home birth bill has actually gained momentum http://www.newsobserver.com/2013/05/09/2882993/nc-home-birth-bill-gains-support.html

i hope it passes.  while i personally would never ever ever have a homebirth (Hello, epidural!) i think its utter bullshit that you don't have a choice.
obvs, people are going to homebirth anyways, but its crazy to me that its even against the law

[lisahi]

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.

Probably because children born of IVF or other fertility treatments are, around 50% of the time, born of mothers who have fertility issues. Some, although certainly not all, of these issues may cause other problems during pregnancy.

I would find it very odd if IVF itself "caused" premature births. There's no real difference between natural conception and IVF in the way a baby develops once the eggs are implanted. Other fertility treatments (like IUI) are even more akin to natural conception (the egg gets fertilized on its own in the woman).

[kikichewie]

The IVF correlation is due to other fertility/viability issues, higher frequency of advanced maternal age, and much higher frequency of multiples.  It's not the cause. 

[Jamesqf]

The IVF correlation is due to other fertility/viability issues, higher frequency of advanced maternal age, and much higher frequency of multiples.  It's not the cause.

The exact cause isn't really the point, though.  The correlation exists, which means that we (taxpayers and/or health insurance consumers) get to pay large amounts for the IVF treatments, then get to pay again for the higher rate of birth complications, so the average cost of having a kid goes up.

[brand new stash]

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.

Probably because children born of IVF or other fertility treatments are, around 50% of the time, born of mothers who have fertility issues. Some, although certainly not all, of these issues may cause other problems during pregnancy.

I would find it very odd if IVF itself "caused" premature births. There's no real difference between natural conception and IVF in the way a baby develops once the eggs are implanted. Other fertility treatments (like IUI) are even more akin to natural conception (the egg gets fertilized on its own in the woman).

60% of twins are born premature (before 37 weeks).   Fertility treatments increase the likelihood of twins and higher order multiples. 

[Rebecca Stapler]

The IVF correlation is due to other fertility/viability issues, higher frequency of advanced maternal age, and much higher frequency of multiples.  It's not the cause.

The exact cause isn't really the point, though.  The correlation exists, which means that we (taxpayers and/or health insurance consumers) get to pay large amounts for the IVF treatments, then get to pay again for the higher rate of birth complications, so the average cost of having a kid goes up.

Yeah, well, we're also subsidizing people who have to have expensive medical treatment because they made poor lifestyle choices. That's the whole point of insurance. Let's not vilify people who, I'm sure, would prefer not to have to resort to fertility treatments to get pregnant.

[MountainFlower]

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.

+1 for this.

I had two C-sections.  The first was emergency.  Thank god I was in a hospital or I wouldn't have my DD.    I could have done a VBAC for the second, but elected not to take the risks, which are small I know, associated with a VBAC.  I suffered no damage as a result of either.  I know plenty of women with permanent damage to their bodies from vaginal births.  That's just anecdotal, but still, makes me glad that my damage from childbirth was minimal.  I really don't understand the villification of C-sections...or why that term might be offensive. 

[Jamesqf]

Yeah, well, we're also subsidizing people who have to have expensive medical treatment because they made poor lifestyle choices. That's the whole point of insurance.

Not at all, or it shouldn't be.  I pay less for my car insurance because I don't have a history of tickets & DUIs.  I get discounts for not smoking, not being overweight, etc.

Let's not vilify people who, I'm sure, would prefer not to have to resort to fertility treatments to get pregnant.

Why not?  No one has to get pregnant.  Indeed, a good many of us have, at various times in our lives, probably devoted quite a bit of effort to avoiding pregnancy.  It's an option rather than a health condition.

[NumberJohnny5]

Why not?  No one has to get pregnant.  Indeed, a good many of us have, at various times in our lives, probably devoted quite a bit of effort to avoiding pregnancy.  It's an option rather than a health condition.

In the technical sense, no. But there is such a strong biological drive to reproduce (and I'm not just talking the physical act, I'm talking about having offspring), that it could nearly be considered an actual need for many. Perhaps you never had that particular need, but for many...yeah, it counts as an actual need.

So I guess you'd have to decide how to treat this need. Do you suppress it (as you would an alcoholic who "needs" a drink), or do you help the person to fulfill that need? I won't get into the philosophical debate about that, but it's probably important to answer that question before you decide how to treat the "problem".

[kikichewie]

In the US, most infertility treatment, including medications, is not covered by any insurance. I can tell you for a fact that our treatment did not cost taxpayers nor other insurance customers a dime. Hell, our cross-country travel provided taxes to other local economies.  And in cases where insurance (rarely) covers it, there are major limits/caps in place that make it more of a gesture than actual coverage.

Plus, if it WAS covered by insurance or even taxes, there would be less of an incentive to transfer multiple embryos, which would dramatically reduce the number of multiple births. Other countries have figured that part out already. By when you have to pay privately, you have the right to make those choices yourself, and many opt to transfer multiple embryos to increase the chances that just one will "stick."  Most don't want multiples because of the danger, but if they have $20k or more on the line, they want to improve their odds.  In our case we transferred two and one stuck. We were relieved.

But anyway, in the US it is asinine to talk of "subsidizing" infertility treatments because its just not remotely true. Would-be parents spend tens of thousands of dollars out of pocket for IVF, or tens of thousands for private adoption (a quote from an adoption coordinator: "just tell me what your budget is and I'll find you a baby you can afford.") or they can put themselves through the special hell of trying to adopt an unwanted child with special needs from the state.

Infertility is a truly complicated issue - one that we researched and agonized over for five years. It would take many, many hours of research (and probably some training in psychology) for anyone to have anything truly informed to say on the subject.  That includes peop,e who have been through it and those that have not.  If you haven't spent the time to really understand the issues involved, then STFU.

[EMP]

This thread reminds me why I:

love the internet
trust evidence based medicine
trust the scientific method

in no particular order

This. And can we please stop comparing the incredibly diverse population of the US to more homogeneous nations? 

[MrsPete]

Many thoughts, not necessarily in any order:

Why are people having babies if they aren't able to pay for the child's first day of life?  Probably because those very people who have no business having a baby are the ones who are less likely to use birth control.  Plenty of studies have shown that older, more educated women tend to have far fewer "birth control accidents" simply because they're more likely to use birth control correctly and to use it every time.  I suspect most of the families who have a baby and cannot pay didn't actually make a conscious choice. 

I didn't pay anything for the delivery of my two children.  Yes, it's true that insurance companies aren't in the business of losing money, and they charge enough to make sure they didn't lose money on me -- but I was going to have insurance anyway, so I didn't pay more than I would have paid anyway. 

My daughter, who considered midwifery for a while, tells me that OB/GYNs pay the highest levels of malpractice insurance.  Why?  Because they deal with twice as many patients -- the mother and the child; thus, twice as much room for individual error.  This wouldn't have occurred to me. 

As for pain medication being optional, yeah, it is optional -- and I have given birth twice without it, but I had pretty easy deliveries.  I don't think the big push is insurance companies saying, "Hey, we can get more money!"  Rather, it's expectant mothers demanding it.  My personal experience among my group of friends:  A good half of them have said very early on, "Of course I'm having pain medication!  Why on earth would I choose to do without it?"  Practically all the others say, "I'm going to try to do without it, but we'll see once the time comes", and almost all of them end up having the epidural. 

I have trouble believing that the C-section rates are really this high.  I have two friends and one family member who've had C-sections.  Literally every other mother I know has had a standard vaginal delivery.  I know that personal experience doesn't necessarily equate to averages, but this seems really far from my personal experience.

I do believe that Medicare pays for half of all births.  It's not politically correct to note it, but at school our poorest kids do tend to come from the largest families, whereas kids who come from financially stable homes with college educated parents -- on average -- tend to live in two-child households.   

I disagree with the idea that all a person needs to deliver is to be pregnant.  Yes, it's true that if you are pregnant, your body will eventually deliver the baby -- but think about generations past.  Something like 20% of all women died in childbirth.  That's too many lives to risk, and it's rather callous to say that birth isn't a procedure that needs some expert help.

As for pre-natal care, women need to take more responsibility for themselves in this arena.  Yes, OB/GYNs (or midwives) do give good advice to expectant mothers, but -- for a woman in a healthy pregnancy -- this same advice is widely available in books and on the internet.  By this, I mean information on diet, exercise, changes in the mother's body.  Obviously, any reasonable expectant mother needs to be monitored for "invisible" problems like Gestational Diabetes or Toxemia, but all mothers can find plenty of advice on good health during pregnancy in any number of sources -- yet we as a society have "decided" to turn to doctors as our primary source of information.

[lisahi]

Let's not vilify people who, I'm sure, would prefer not to have to resort to fertility treatments to get pregnant.

Why not?  No one has to get pregnant.  Indeed, a good many of us have, at various times in our lives, probably devoted quite a bit of effort to avoiding pregnancy.  It's an option rather than a health condition.

I'm a bit appalled by this statement. Basically, you're saying, "hey, your body makes it hard for you to reproduce so, too bad! Sucks to be you!" Or, "your husband's body has problems getting you pregnant, even though you have no problems getting pregnant in general. Oh well, sucks to be you!" Humans, in general, like every other animal on this planet, have a strong biological drive to reproduce. Not every human has this drive, but it's pretty obvious that most do. It's not something you can shut off. So telling people, "too bad, I don't want to have to pay for you to have a kid," is at both times cruel and a bit uninformed. It's cruel because it takes something that is truly a need* for most people, makes it sound like a mere luxury. Uninformed because most insurance companies don't pay out a single dime for fertility treatments. It's all out of pocket. I know for a fact my insurance only covers the cost of determining whether I have fertlity problems. If I do, then it's all up to me to alleviate that problem.

*Reproducing isn't a "need" like my neighbor "needs" a car to drive 3 miles to work. It isn't a "need" like my Dad "needs" to have a biggest cable subscription his cable company provides. It isn't a "need" like my sister needs to have a maid clean her house once a week. It's a biological need--something so ingrained in our species that it actually drives our actions to a certain extent.

[smalllife]

No one has to get pregnant.  Indeed, a good many of us have, at various times in our lives, probably devoted quite a bit of effort to avoiding pregnancy.  It's an option rather than a health condition.

I'm a bit appalled by this statement. Basically, you're saying, "hey, your body makes it hard for you to reproduce so, too bad! Sucks to be you!" Or, "your husband's body has problems getting you pregnant, even though you have no problems getting pregnant in general. Oh well, sucks to be you!" Humans, in general, like every other animal on this planet, have a strong biological drive to reproduce. Not every human has this drive, but it's pretty obvious that most do. It's not something you can shut off. So telling people, "too bad, I don't want to have to pay for you to have a kid," is at both times cruel and a bit uninformed. It's cruel because it takes something that is truly a need* for most people, makes it sound like a mere luxury. Uninformed because most insurance companies don't pay out a single dime for fertility treatments. It's all out of pocket. I know for a fact my insurance only covers the cost of determining whether I have fertlity problems. If I do, then it's all up to me to alleviate that problem.

*Reproducing isn't a "need" like my neighbor "needs" a car to drive 3 miles to work. It isn't a "need" like my Dad "needs" to have a biggest cable subscription his cable company provides. It isn't a "need" like my sister needs to have a maid clean her house once a week. It's a biological need--something so ingrained in our species that it actually drives our actions to a certain extent.

Reproducing is not a "need", it is a luxury in the modern world.  If you have a biological urge to raise a child, which is what I think you are referring to, use the tax credits and adopt someone already in this world.  Reproducing your DNA because you "need" a mini-me is not a right but a privilege.  If your body or your partner's body does not allow that naturally, there's probably a good biological reason why that is the case.  Trying to trump nature through IVF or any other artificial means is also a factor in why IVF babies have statistically more issues than planned, naturally conceived babies.  That isn't cruel, it's logic and science.

Also, I would argue that the deep seeded desire to parent is not in "almost all" humans but for most is a product of social and cultural conditioning that parenting is expected and glorious.  A select few have always desired pregnancy and parenthood, most are taught to desire it and therefore think they do, and some have that same deep seated feeling that children are not a part of their future.  The people in the middle are the 90% - easily manipulated by advertising, stuck due to lack of birth control, and unaware that there are other options.

[lisahi]

Reproducing is not a "need", it is a luxury in the modern world.  If you have a biological urge to raise a child, which is what I think you are referring to, use the tax credits and adopt someone already in this world.  Reproducing your DNA because you "need" a mini-me is not a right but a privilege.  If your body or your partner's body does not allow that naturally, there's probably a good biological reason why that is the case.  Trying to trump nature through IVF or any other artificial means is also a factor in why IVF babies have statistically more issues than planned, naturally conceived babies.  That isn't cruel, it's logic and science.

Also, I would argue that the deep seeded desire to parent is not in "almost all" humans but for most is a product of social and cultural conditioning that parenting is expected and glorious.  A select few have always desired pregnancy and parenthood, most are taught to desire it and therefore think they do, and some have that same deep seated feeling that children are not a part of their future.  The people in the middle are the 90% - easily manipulated by advertising, stuck due to lack of birth control, and unaware that there are other options.

So humans have completely evolved away from all other animals, and now we reproduce primarily because of "conditioning" or "advertising"? I don't think so. In fact, I think people who are pressured to have children because "it's the thing to do" represent the minority rather than the majority of those having children. I can only imagine you trying to give this theory to women and men who are members of support groups for infertility. "By the way, you don't really want to have kids. You're just enamored with all those commercials for baby stuff and envious of your friends slinging babies over their hip. You'll eventually get over it if you think logically about what you need versus what luxuries you want."

There is a reason people want to pass on their genes, and it's not because they're so full of themselves that they want a "mini-me" (as if that's what most people get). It's the same reason every animal on this planet wants to pass on their genes--it's the survival instinct. Just because we have the ability to comprehend that the instinct exists, and we can analyze it and disect it, doesn't mean that it has lost its ability, in part, to drive our actions.

It's not the same kind of need as eating or breathing--as is the case with every species, there are needs that keep a single individual alive, and needs that keep the species alive. Reproduction is the latter. As much as it logic can tell us that reproduction by any single human being is unnecessary for the survival of the human race, biologically that instinct is still inside us--individually to a varying degree, yes, but it's there. Considering that the vast majority of families who can afford birth control still have multiple children, I'm not sure that saying it's mostly conditioning explains these desires to reproduce.

[smalllife]

So humans have completely evolved away from all other animals, and now we reproduce primarily because of "conditioning" or "advertising"?

I think you are confusing sex and giving birth . . . . the instinct is to have sex, whose evolutionary purpose is to reproduce.  I would disagree that just because a human has a biological drive for sex that they automatically desire children.  Animals don't want to pass on their genes, most do not have the cognitive ability to recognize cause and effect.  Humans do, but only in the past 50 years have they had a viable alternative to pregnancy and childbirth as a result of sexual activity.

You are also implying that people who do not reproduce, for whatever reason (infertility, birth control, no desire) are not fully human. 

A quarter of women at age 40 have never reproduced and a great number of women are realizing that they don't have to be chained to motherhood and that it is not a requirement for adulthood.  Just think about that before you say that everyone wants children because they have a biological urge to have sex.

[Jamesqf]

I'm a bit appalled by this statement. Basically, you're saying, "hey, your body makes it hard for you to reproduce so, too bad! Sucks to be you!" Or, "your husband's body has problems getting you pregnant, even though you have no problems getting pregnant in general. Oh well, sucks to be you!"

OK, so why not extend this argument a bit.  As for instance I might really, really want to be a pro basketball player or an Olympic gymnast, but my body makes it really hard to do that.  Don't you all just say "sucks to be you"?

I think you are confusing sex and giving birth . . . . the instinct is to have sex, whose evolutionary purpose is to reproduce.

Wrong!  There's a whole literature on this, but to summarize: if the evolutionary purpose of sex was simply to reproduce, human females would, like most other mammals, come into heat a few times a year, and otherwise not even think about sex.

[smalllife]

I think you are confusing sex and giving birth . . . . the instinct is to have sex, whose evolutionary purpose is to reproduce.

Wrong!  There's a whole literature on this, but to summarize: if the evolutionary purpose of sex was simply to reproduce, human females would, like most other mammals, come into heat a few times a year, and otherwise not even think about sex.

I was oversimplifying for the sake of making a point, but there is a definite uptick in sexual hormones at the peak fertility time in a woman's cycle.   My point was simply that children are a product of sexual urges, not an end point unto themselves (otherwise no one would have sex unless they had confirmed they are fertile and then only for the sake of procreation).

[kdms]

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.

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.

I got lucky...I've managed to sign on with a midwifery in the Ottawa Valley at 20 weeks pregnant, which is extremely unusual...they usually start people at 10 weeks, and there's a waiting list, so you're not wrong about the availability.

On the topic of midwives vs ob/gyns and GPs:

I have to say that I love my GP, and the ob/gyn that delivered my son, while not exactly warm and fuzzy, was very competent, and respected my wishes for as little intervention as possible during an extremely long, exhausting, 22hr labour and birth.  (As the whole experience is still a little fuzzy, I still don't know how much my extremely protective paramedic husband had to do with that - I seem to recall him growling at people a couple of times to back off.)  At the end he had to use forceps (vacuum wasn't an option) and a ceaserean birth wasn't even considered - and even with that necessary intervention, he didn't do an episiotomy first, knowing that a natural tear would heal faster and cleaner than a cut.  My son was just too big for my small frame.  I wasn't kept on my back; they encouraged me to try different positions, and in the end, I needed help.  The hospital was the right place to be at that point in my life, and for a hospital, I thought it was about as non-interference as it possibly could be.  It didn't cost us a cent, even with a 5-day stay for me to get my strength back.  (DS could've gone home the next day - I was the white shaky one for days once the adrenaline wore off.)

This time around, though, we're choosing the midwife route for a couple of reasons, some of which people have already mentioned here. 

1.  As long as the delivery is non-complicated (ie emergency ceasarean) and neither I nor the baby require care only available in a hospital, I can go home almost immediately because I get released into the care of my official medical caregiver, and will have daily visits for the first week afterwards, and weekly visits up to 6 weeks postpartum.  While I could stay at the hospital to rest, by going home instead , we are no longer required to comply with the hospital post-natal protocols, and by being off-site, we're better able to control access to our child.  This is important to us, as we don't agree with all the standardized hospital protocols.  When you're asleep at 3am and the nurses take your child out of his bassinet to conduct their required testing and don't bother to wake you up, we have a problem with that.  I was absolutely furious to discover a little card on the bedside table informing me of the results of the test the next morning.

2.  It would have been nice to know the ob/gyn before the birth, but in a hospital you'll get whoever's on call.  It may be your doctor, it may not.  With the midwifery practice I'm with, I have a primary midwife, and a team of auxiliaries in the event she's not available when I go into labour, so at the very least, I'll have met the person who delivers this next baby at least a few times before.  My GP recommended a hospital delivery, just due to the sheer size my son was, and I'm definitely onboard with that, so we made sure that the practice we're with has privileges and a good working relationship with the staff at the hospital we're going to.

3.  It's virtually the only time I've ever completely given over 100% complete control and responsibility for decisions about my care to my husband, and I want him to have more support than he got the last time with someone professionally recognized by the hospital to be competent in making the necessary decisions.  I don't believe for one minute that the team of nurses and doctors I had the last time would push medically unnecessary procedures for the sake of clearing a room, but they would have definitely been stronger in their suggestions for speeding things up if my husband hadn't been there to insist that nature be allowed to do its thing, and it was really hard on him to keep them at bay - it's not like he enjoyed my discomfort either - until it truly did become necessary for help to be given.

I guess, in our case, we chose a midwife because we wanted a liaison officer between us and the hospital staff, and the extensive post-partum care available with a midwife.

We're in Ontario.  None of this is costing us a cent - and even if things do go wrong at the last minute, because I'm delivering in a hospital, we'll have the medical expertise available if required to fix it - and only when it's required.

It's a shame that the cooperative midwifery/ob-gyn model of care is not universally recognized as a legitimate standard of care in this supposedly enlightened age. 

I think it's completely bogus to charge a five-figure fee for giving birth.  Save the high cost operations for procedures that are completely unrelated to medically necessary procedures - like removing floating ribs to try and land a modelling job - and leave potentially life-saving procedures out of the profit-making business.

[Jamesqf]

My point was simply that children are a product of sexual urges, not an end point unto themselves (otherwise no one would have sex unless they had confirmed they are fertile and then only for the sake of procreation).

I don't think so.  Pregnancy is an accidental byproduct of human sexual urges, but few people have sex only for the sake of procreation.  Many of us do go to considerable lengths to avoid unwanted pregnancies.  And of course IVF doesn't involve sex at all.

[smalllife]

My point was simply that children are a product of sexual urges, not an end point unto themselves (otherwise no one would have sex unless they had confirmed they are fertile and then only for the sake of procreation).

I don't think so.  Pregnancy is an accidental byproduct of human sexual urges, but few people have sex only for the sake of procreation.  Many of us do go to considerable lengths to avoid unwanted pregnancies.  And of course IVF doesn't involve sex at all.

That's exactly my point .  . .

[Luck better Skill]

  Most stupid practices for child-birthing are from western medicine, male doctors being culprit most the time.  Policies are adopted based on what is easy and works well for Doctor, if it helps the woman or child that is nice too.  Even when the process increases danger to the baby or mother, doctor's needs take president. 
  Many factors add to medical cost, the USA limits the number of people who can become doctors.  Lower the supply will increases the pay.   

[DoubleDown]

The notion that human beings don't have a deep-seated and intuitive/biological desire to have children seems pretty silly to me. For most, there's a very powerful motivation to have children that goes beyond the immediate urge to have sex. And obviously it's necessary for the species to survive.

[smalllife]

The notion that human beings don't have a deep-seated and intuitive/biological desire to have children seems pretty silly to me. For most, there's a very powerful motivation to have children that goes beyond the immediate urge to have sex. And obviously it's necessary for the species to survive.

Well I guess that myself and all of the other childfree-by-choice (and mothers who regret having children) are just silly :-P

I would also decouple the desire to have children and the desire to be a parent when discussing this topic.  Many people want a cute cuddly baby without thinking about the loss of sleep and actual life impact for the next two decades, much less understanding how to raise a competent human being (aka parenting).

[lisahi]

So humans have completely evolved away from all other animals, and now we reproduce primarily because of "conditioning" or "advertising"?

I think you are confusing sex and giving birth . . . . the instinct is to have sex, whose evolutionary purpose is to reproduce.  I would disagree that just because a human has a biological drive for sex that they automatically desire children.  Animals don't want to pass on their genes, most do not have the cognitive ability to recognize cause and effect.  Humans do, but only in the past 50 years have they had a viable alternative to pregnancy and childbirth as a result of sexual activity.

You are also implying that people who do not reproduce, for whatever reason (infertility, birth control, no desire) are not fully human. 

A quarter of women at age 40 have never reproduced and a great number of women are realizing that they don't have to be chained to motherhood and that it is not a requirement for adulthood.  Just think about that before you say that everyone wants children because they have a biological urge to have sex.

Nope to all of that. I'm not confusing the urge for sex with the urge to reproduce, which is why I didn't mention sex at all. Most animals don't have the cognitive ability to understand why they do a lot of what they do, including reproduction--that's why it's instinct. They just do it. Why? Because if they don't the species will die off. The end. Human's ability to understand and analyze their own urges doesn't negate certain instincts that we still have.

Nor do I ever imply that those who do not want to reproduce or cannot reproduce are not "fully human." I was very careful to not speak in absolutes and only speak in generalities. I was discussing the human race as a whole, not specific individual members. Every species, especially one as complicated as human, has variances. But to say that, in general, our human urge to reproduce is nothing more than conditioning and advertising, is basically saying that all animals on this planet do exactly what humans do (reproduce), but humans do it for a different reason, which is an odd and unsupported supposition.

I'm a bit appalled by this statement. Basically, you're saying, "hey, your body makes it hard for you to reproduce so, too bad! Sucks to be you!" Or, "your husband's body has problems getting you pregnant, even though you have no problems getting pregnant in general. Oh well, sucks to be you!"

OK, so why not extend this argument a bit.  As for instance I might really, really want to be a pro basketball player or an Olympic gymnast, but my body makes it really hard to do that.  Don't you all just say "sucks to be you"?

When you discover that our evolutionary ancestors had the biological urge to become pro basketball players, then we can discuss how that is in any way an accurate comparison.

[kikichewie]

I equate infertility to being born without a limb or losing one. There are different levels of medical assistance in such cases, which have progressed from crutches, to wheelchairs to prosthetics. What level of support you get is a combination of factors, including personal preference and ability to pay.

Infertility in the US is a private matter because our society has chosen not to make it a priority over, say erectile dysfunction, weight loss, diabetes and hypertension. It is what it is. As long as that is the case, I don't see what business it is of anyone else's, nor what point there is to debating why some people want children and some don't.

And to correct some misinformation above, IVF (and other fertility treatments) can be much, much less expensive than adoption with far less risk.  If can be, as it was in our case, the far more "Mustachian" choice, even compared to lower cost adoption of an older child from the state with the accompanying tax credit.

Our fertility program:
- Under $10k, paid cash
- No unexpected fees (like most IVF programs)
- 3 tries in one year
- 90% cumulative success rate over 3 tries
- Money back guarantee of success
- 12 week gestation as definition of success (vs 6, which is still a high likelihood of miscarriage)
- Healthy donors with full background profiles and genetic screening
- complete control of gestational diet, etc.

Public adoption:
- waited more than six months to attend training
- Was superficially profiled and assigned two siblings in first class without any consideration given to our abilities, lifestyle, etc.
- Two siblings suffered from extreme neglect and were severely psychologically damaged both for the neglect in foster care, sexual abuse and the prenatal drug exposure. They were described as "animalistic," uncommunicative and "feces smearers." We were two working adults with no siblings, no special needs training and not a huge support system like a church.
- One sibling was less than 70 IQ and could never be self sufficient as an adult
- We were trained on the high likelihood of false molestation and abuse accusations, which would be considered guilty until prove innocent
- We were instructed not to ever allow a child of the opposite sex to take a shower, swim or change clothes without someone of the same sex home as a witness
- in the case of an accusation, my husband would immediately lose his job and professional licenses until the court system was though with him.  They told us of two married teachers who lost their jobs and house because of a false accusation from a troubled teen. Resolution would take upwards of a year.
- There is no actual support for therapy once the adoption is final
- Half of all adoptions from the state fail, which requires the adoptive parent to plead guilty to a criminal charge of neglect to give the child back to the state.
- We really, really wanted to adopt an older child or children from the state, but we backed out when we saw how completely the system in our state has failed these children. Aside from the many criminals that adopt to make money on special needs allowances, the ones that do it from a pure heart are absolute angels here on earth.  We could not do what they do. We still may consider it after we have more parenting experience, when we have less to lose.

[MrsPete]

Human being aren't animals.  We're able to think, we're able to anticipate future consequences of our actions, and we have souls.  Sure, we have a biological desire for sex -- but we also have a desire to raise children, which is entirely separate from sexual desire. 

I'll second what Kikichewie says about adoption:  It is an extremely complicated and expensive process.  A good friend of mine has adopted twice through the Catholic church, and each child "cost her" about 20K.  Each situation was a heart-wrenching, touch-and-go process in which she was several times "offered" a child, only to be disappointed when the birthmother changed her mind at the last minute (very common) or the birthmother chose another couple.  With each of her children, she had something like three days notice that they were officially to be hers.  Several years later when she got her daughter, she had a big complication because the child was part Indian, and the adoption agency was required to offer the child to "her" Indian tribe (who knew nothing of either of the birth parents and couldn't have cared less, but still they had the legal right to block the adoption) before giving her over to a person in the outside world.  And although she's a wonderful mother, her kids have gone through some "my real mother didn't want me" that natural-born children never have to face.  I have another friend who adopted a child who was born in a prison.  She says that's the perfect situation:  If the mother is a convict, you know that she is eating three times a day, and her access to drugs /alcohol is greatly diminished.  Adoption is a wonderful thing, and I have nothing but respect for the people on both sides of the table, but I'm very grateful that I was able to bear my own children -- it's so much easier.   

[kikichewie]

When we pursued private adoption, it was very clear that it was a process of buying a baby.  All the coordinator cared about was how much we wanted to spend.  The friend who referred us had adopted three boys from three different mothers, and had been taken advantage of twice. Then the mother of the third boy got pregnant again, and held them hostage for a huge sum of money if they wanted to adopt their son's birth sibling.  She was a real pro.  Unfortunately, I don't think they were able to raise enough money in time.  And had the birth mother cared at all, she could have given the baby to them for adoption with little to no money changing hands. (And her birth would have still been covered by Medicaid.)

[Jamesqf]

When you discover that our evolutionary ancestors had the biological urge to become pro basketball players, then we can discuss how that is in any way an accurate comparison.

OK, if you want to get all paleolithic, just change that to becoming a superior warrior or hunter.  For instance, I'd need 20/20 distance vision to be a great hunter, so obviously insurance should pay for Lasik, no?

[kikichewie]

You're comparing becoming an elite athlete or "superior" to a basic biological function?  One of the very few biological functions (including eating, breathing and sleeping) that is required for the perpetuation of the human species (if not by everyone, than by at least some critical number)?

And by using LASIK as an example, you are picking only one means of treatment vs. the many that are available and largely covered by most insurance plans or available at discounted out of pocket rates?

Oh, I get it.  You're just a troll.  My bad.

[Jamesqf]

You're comparing becoming an elite athlete or "superior" to a basic biological function?  One of the very few biological functions (including eating, breathing and sleeping) that is required for the perpetuation of the human species (if not by everyone, than by at least some critical number)?

So if I am a paleolithic human, my survival depends on being able to eat, no?  (That's WAY more basic than reproduction.)  That in turn depends on having good eyesight.

As you point out, survival of the species does not depend on everyone being able to reproduce, so using this as an argument in favor of me paying for other people's fertility treatments seems to lack a certain logic.  I want things, other people want things, including perhaps having kids.  I don't see why my wants should take a back seat to theirs, do you?

[lisahi]

As you point out, survival of the species does not depend on everyone being able to reproduce, so using this as an argument in favor of me paying for other people's fertility treatments seems to lack a certain logic.  I want things, other people want things, including perhaps having kids.  I don't see why my wants should take a back seat to theirs, do you?

Putting aside all the other stuff about the "want" or "need" to have children, you're not paying for others to have fertility treatments. The vast, vast, vast majority of insurance plans don't cover fertility treatments. The ones that do have very limited coverage. I don't recall anybody arguing that you had to pay for somebody with fertility issues to conceive a baby. Especially since 99% of them are paying everything out of pocket for their own treatment.

[GuitarStv]

And can we please stop comparing the incredibly diverse population of the US to more homogeneous nations?

Which more homogenous nations are we comparing to the US?


If you're talking about Canada, we have a 19.8% immigrant population compared to the US 11.7%.  Canada has more people per capita who speak a non-official language that the US does.  (http://canadianstudies.isp.msu.edu/docs/Cherry%20McGee%20Banks.pdf)  Based on the evidence, I'm going to argue that the US is more homogenous . . .

[EMP]

And can we please stop comparing the incredibly diverse population of the US to more homogeneous nations?

Which more homogenous nations are we comparing to the US?


If you're talking about Canada, we have a 19.8% immigrant population compared to the US 11.7%.  Canada has more people per capita who speak a non-official language that the US does.  (http://canadianstudies.isp.msu.edu/docs/Cherry%20McGee%20Banks.pdf)  Based on the evidence, I'm going to argue that the US is more homogenous . . .

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

But the specific examples above were Japan and Sweden.


Edited for spelling

[DoubleDown]

The notion that human beings don't have a deep-seated and intuitive/biological desire to have children seems pretty silly to me. For most, there's a very powerful motivation to have children that goes beyond the immediate urge to have sex. And obviously it's necessary for the species to survive.

Well I guess that myself and all of the other childfree-by-choice (and mothers who regret having children) are just silly :-P

I would also decouple the desire to have children and the desire to be a parent when discussing this topic.  Many people want a cute cuddly baby without thinking about the loss of sleep and actual life impact for the next two decades, much less understanding how to raise a competent human being (aka parenting).

To be fair, and clear, I did not say you or other childfree-by-choice people are silly, I said the notion that humans, in general, don't have an innate drive to sire children is silly. As already pointed out by others, it's a very basic function in our species and other mammals. If we were getting into statistics, I'm certain that we'd find the number of people that have or want to have children far outweigh the number who don't, probably on the order of 80-90% to 10%, or perhaps even higher (I pulled those figures out of my ass based on what I see around me).

[GuitarStv]

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

Is a language other than English used in US legislation, regulations, executive orders, treaties, or federal court rulings?  :P  It is interesting that there is no specified official language though.

[EMP]

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

Is a language other than English used in US legislation, regulations, executive orders, treaties, or federal court rulings?  :P  It is interesting that there is no specified official language though.

Nation of imigrants FTW!  That's the argument I pull out when people start telling me, "all these illegals need to learn to talk 'Murican!"

I was trying (not terribly diligently) to find some more accurate stats to compare Canada and the US.  From what I could see, they collect data relating to ethnicity so differently that it's difficult to compare. 

It makes me wonder where the differences between the Canadian and American view of things like gun control and gov't subsidized maternity leave come from. 

[GuitarStv]

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

Is a language other than English used in US legislation, regulations, executive orders, treaties, or federal court rulings?  :P  It is interesting that there is no specified official language though.

Nation of imigrants FTW!  That's the argument I pull out when people start telling me, "all these illegals need to learn to talk 'Murican!"

I was trying (not terribly diligently) to find some more accurate stats to compare Canada and the US.  From what I could see, they collect data relating to ethnicity so differently that it's difficult to compare. 

It makes me wonder where the differences between the Canadian and American view of things like gun control and gov't subsidized maternity leave come from.

Oh, that's an easy one to point to.  The Vietnam war.  All the hippie, liberal draft dodgers came up here to Canada . . . which swung our demographics more political left, while simultaneously making the US demographics more political right.

[Mrs WW]

And can we please stop comparing the incredibly diverse population of the US to more homogeneous nations?

Which more homogenous nations are we comparing to the US?


If you're talking about Canada, we have a 19.8% immigrant population compared to the US 11.7%.  Canada has more people per capita who speak a non-official language that the US does.  (http://canadianstudies.isp.msu.edu/docs/Cherry%20McGee%20Banks.pdf)  Based on the evidence, I'm going to argue that the US is more homogenous . . .

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

But the specific examples above were Japan and Sweden.
Edited for spelling

Would you plase care to explain what a homogenous country is? While its easy to imagine Sweden to be homogenous because its small and the image in media is of the blond, tall nation, today 15% of the population is born abroad. Abroad not being limited to other scandinavian nations but mainly from Syriah, Afghnistan, Irak, Somalia and Poland and yearly about 170 different nations come as refugees or immigrants.

If you meant to say small and highly taxed, yes, homogenous, no.

[EMP]

And can we please stop comparing the incredibly diverse population of the US to more homogeneous nations?

Which more homogenous nations are we comparing to the US?


If you're talking about Canada, we have a 19.8% immigrant population compared to the US 11.7%.  Canada has more people per capita who speak a non-official language that the US does.  (http://canadianstudies.isp.msu.edu/docs/Cherry%20McGee%20Banks.pdf)  Based on the evidence, I'm going to argue that the US is more homogenous . . .

Since the US doesn't have an offical language, I'm not sure how to interpret that point. ;)

But the specific examples above were Japan and Sweden.
Edited for spelling

Would you plase care to explain what a homogenous country is? While its easy to imagine Sweden to be homogenous because its small and the image in media is of the blond, tall nation, today 15% of the population is born abroad. Abroad not being limited to other scandinavian nations but mainly from Syriah, Afghnistan, Irak, Somalia and Poland and yearly about 170 different nations come as refugees or immigrants.

If you meant to say small and highly taxed, yes, homogenous, no.

I said more homogenous than the US, not completely homogenous. Although a quick Google tells me that of that foreign born statistic, the group that makes up the largest percentage? The culturally similar Finnish.  Also Sweden counts native born citizens with foreign born parents in that group. Whereas the US doesn't include any native citizens in their stats to get almost 13% foreign born.
So homogenous? No. More homogenous than the US? Absolutely.