Another Article About the Cost of Birth in the U.S

Image from CNN.com

This is the third article this month that talks about the high cost of giving birth in the United States. As I've said before, there are many reasons that women birth in hospitals; familiarity, a sense of safety and more. It should also be noted that, and I'm quoting Ina May Gaskin and a number of birth advocates, birth is not a medical procedure. Sure a c-section is medical, but the natural process of giving birth is quite natural and happens just fine when left alone.

I'm a woman with multiple fibroids in my uterus. Did I mention I'm want to start trying to get pregnant in the fall? I'm well aware that because of my fibroids some midwives and birthing centers will automatically make my pregnancy and me "high risk" which basically means that I might not find a midwife willing to let me give birth at home and the only freestanding birthing center in NYC may not accept me...which means that I may be a woman who births in a hospital.

It happens to even the most determined woman.

But you know what:? It's okay. When we, as women, are knowledgeable about our rights, knowledgeable about hospital norms and express those wants and desires through our partners, doulas, and doctors that listen it's still possible to have a natural birth in the hospital.

Of course, hospitals work on schedules and the odds are stacked against you: You may be hooked up to an IV and unable to move around; You may have to labor and give birth on your back (gravity doesn't work that way!); You may only be able to labor for a set amount of time before they try to induce which may lead to a c-section; They may automatically give you a dose of pitocin (that IV is handy, eh?) to help birth the placenta (the placenta usually will birth itself if the baby is sucking at the breast-oxytocin!); They may cut the cord before it's done pulsing; They may wash the baby; They may not put him directly on you...the list goes on and on. But if you know your rights and the hospital's practice (none of these things are necessary and you can decline all of them) you have just as easy a shot (and a cheaper bill) than if you aren't aware.

My point? Educate yourself. Your doctor isn't smarter or more in tune to your body, because it's your body.

"Newer equals improvement" and "More is better than less" have long been effective marketing themes in American culture. But the problem is that in the case of medical technology, the results don't consistently bear that out.

While other countries have set up elaborate systems to assess new medical interventions for their cost effectiveness compared to existing practices before approving them, until recently that has not been a priority in U.S. medical care. The result is that public infatuation with newer technologies merges smoothly with the medical industry's desire to profit from providing more services.
A prime example of this problem is the failure to take advantage of midwife-led birthing centers. These have been found in the U.S. and overseas to be a safe andcost effective alternative to universal reliance on large hospitals. Freestanding birthing centers (as opposed to hospitals which refer to their maternity ward as a "birthing center") are usually directed by midwives and are affiliated with hospitals that serve as a referral site for transfers. The cost savings stem from less reliance on expensive medications and technologies, a shorter stay (mothers typically return home within 24 hours) and lower personnel costs.
While the numbers of birthing centers have increased in the last decade, less than 1 in 300 U.S. births occur in a center. How come?.... The U.S. needs to seriously rethink how we approach maternity care. The first question that needs to be addressed is: Do more tests and reliance on the biggest, most expensive hospital settings actually improve the health of mothers and babies? When they do, great. But when they don't, we need to overcome the financial, institutional and cultural barriers to use reasonable options like birthing centers.Medical technology has done wonders for our lives, especially in select, high-risk cases. But rising maternity care costs reflects the downside of our societal obsession with newer, bigger and shinier technology.

Read the full article here.

How Being a Midwife Made Me a Better Doctor-{Cross Post}

I think that sometimes, it's like birth workers are on one side or another: medical hospital birth with an OB vs. unmedicated birthing center or home birth with a midwife. Unfortunately, the lines are quite clear and when you "pick a side" you don't often get to switch-especially if you're in labor.

Of course, a mother who is at a home birth can transfer to a hospital, but I've not heard of a mother laboring in the hospital transferring to a home birth. There are, of course, some hospitals that think well of laboring mothers and have a good understanding of the birthing process. In these hospitals women are able to eat food, move around and birth in a way that is comfortable and natural. More often than not, though, women who birth in hospitals are offered (and sometimes not) interventions like pitocin or an epidural that can sometimes slow the natural rhythms of birth.

I don't believe that these doctors are purposefully trying to interfere with the natural process of birth (which does take some time!), I think there are a lot of factors contributing to the rise of interventions and subsequent unscheduled c-sections and they're not to do with the mother, in my opinion.

Doctors and hospitals are over booked and L&D rooms are a hot commodity. When you've got a large city with a lot of women in labor, there simply isn't time to let a mother labor for 24, 36 or 48 hours. Another factor is that some doctors have never experienced an un-medicated natural birth. This is something that Ina May Gaskin talks about in her books and lectures a lot and was a snip-it in the documentary The Business of Being Born.

In my opinion medical schools and the training are the culprit. Imagine of all medical students did what Dr.Aviv Romm did? What if all OBs trained as midwives? Can you imagine how differently birth would look in our country?

I have many professional titles and roles: physician, midwife, herbalist, author, teacher. Of these, being a midwife most informs and enhances all of what I do and who I am.

Midwife literally means “with woman.” But it also means, “to bring forth.” Midwives listen, coach, cheerlead, care, reassure, support, and speak truth. At my best, I am a midwife in all contexts – not just to the women I serve, but to my partner, my children, my friends, my patients. At my best I bring forth their best – their strength, confidence, and belief that they can do it. And as a midwife I am able to be patient about whether this happens quietly or with loud screaming! At my best I am deeply present and listen closely to what the people in my life are telling me. And I listen to the unsaid, as well.

When I graduated from medical school at Yale I was given an award as the most promising primary care physician in my state for that year. This was not a result of what I learned during my medical education. Being a midwife for 20 plus years prior to medical training imbued in me the art of caring that should accompany doctoring but too often doesn’t. As a physician I care for my patients with the compassion, deep presence, and heart of a midwife, whether they are giving birth or being treated for pneumonia, whether they are trying to nurse their newborn for the first time, or have suffered a stroke, leukemia, or are in their last days of their life. And because the demonstration of presence and compassion is more rare than common amongst physicians, it was noticed.

It is my understanding and internalization of the midwifery model of care, which places a partnership model and a patient-centered model first and which treats the body as wise and self-healing rather than as a machine that requires repair that makes me the physician I am. It is being a midwife that informs the care in the health care I provide to all of my patients. And it is this true caring that inspires me to do what it best for my patients, and to truly know who they are as people, not diseases.

I not only midwife my patients, but their families at their hospital bedsides and in clinic rooms. I care just as I would for an anxious expectant father or other children at a birth. I bring the whole family in.

Keep Reading Here

Getting Insurance to Pay for Midwives

Cheryl Senter for The New York Times

Earlier this week the NYT posted an article siting America as the costliest place to give birth. Several people, myself included, cross-posted the piece and the comments section has hundreds of replies. Many people blame the insurance companies for the price of birth, while others blame doctors and hospital's often unnecessary and costly interventions. What was missing was other birthing options; at home or in a birthing center with a Midwife.

NYC has only one free standing birthing center, Brooklyn Birthing Center. This is where I hope, Gd-willing/Inshallah/Bezrat Hashem, to give birth when my partner and I get pregnant. The fact of the matter is, birthing with a midwife is substantially cheaper not because you receive inferior service, but because most midwife births are women-centered. A midwife and doula team supports a mother and her partner fully and holistically, relying not on the use of pitocin and monitoring to get the baby out, but on the body's own ability to birth a child.

Here's a quote from the article:

In the United States, the use of midwives varies hugely by state and region; they can deliver babies at a birthing center, in hospitals or in homes. They generally need physician back-up in case a pregnancy has complications they cannot handle. There are few midwife births in the South and Texas, while the rate is above 15 percent in Oregon and New Mexico. In Britain and Denmark, more than two-thirds of all births are attended by a midwife.

Read the entire article on the NYT here.

NYT Cross-Post: Birthing in America is Costly!

Josh Haner/The New York Times

As a doula, my job is to sort of come outside of myself, my wishes, my thoughts and my needs to focus solely on a mother as she labors. This means that I support a mother who wants to give birth in a hospital with an epidural as equally and fully as a mother who wants to give birth squatting in her living room. As a woman who's TTC I find this article by the New York Times shocking!

I've been considering a home birth when we, Gd willing, get pregnant. Birthing at home or at a Birthing Center with a midwife and doula insures woman-focused, mother-lead birthing with a caregiver you've had a continuous relationship with, but it's also, quite shockingly, cheaper!

In nearly every other developed country in the world, midwives, not OBs attend births. Why? Because birth isn't a medical "problem" and OBs are trained surgeons. Of course, and I know this because I have fibroids which may put me in the "high risk" area of moms, some births have medical complications where having an OB is necessary. But for women who are healthy, birthing is and should be a natural process. Our bodies were made and are perfectly capable of birthing babies.

It wasn't until the 1950s that birth came to hospitals, before then the majority of American births were done at home. It's also interesting to note that while our births have moved into the hospital and away from the home, we've lost more mothers and babies. In fact, the U.S has one of the worst mother and baby mortality rates.

What are your thoughts on this article? 

From the New York Times: American Way of Birth; Costliest in the World

 LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Keep Reading at the NY Times