Recent Articles on Cesarean Delivery
1. Another birthing option
(a letter to The Gainesville Sun, April 18th, 2008)
I found The Sun's April 8 online article titled "Birthing options" disappointing. The option to have a vaginal birth after Cesarean (or VBAC) was downplayed, and the old saying "once a Cesarean, always a Cesarean" was promoted based on the fact that it is difficult to find a physician to attend a VBAC. Only a few local home birth midwives attend VBACs and few care providers promote them openly to clients, because of the fear of lawsuits, malpractice insurance regulations and inconvenience. However, VBAC should be promoted as the healthiest option, given that a second (or third or fourth) Cesarean is much riskier for babies and women than a normal birth. If women refuse elective repeat Cesarean surgery and demand care providers to attend VBACs, more and more providers will begin to attend them.
For mothers like Liz Schenck, who found her Cesarean "really disappointing," you are not alone. Florida has a 36.6 percent Cesarean rate, meaning that more than one out of three births is a surgical extraction. This trend is disturbing for the health of mothers and children.
April, Cesarean Awareness Month, acknowledges the impact of Cesareans of mothers, babies and families worldwide. The International Cesarean Awareness Network (ICAN), a nonprofit organization, has a local chapter in Gainesville. It meets once a month and provides support to women in Cesarean recovery and information on Cesarean prevention and VBAC. Please visit www.gainesville.ican-online.org for information.
Irene Halmari-Meneses,
Gainesville
2. After Caesareans, Some See Higher Insurance Cost
By DENISE GRADY (Published: June 1, 2008 New York Times)
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified. “It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.” She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage. With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person’s medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson’s situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans. “Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery. “You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.
Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition. “Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles. “In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,” Ms. Pisano said. Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company’s age requirements. “If you don’t work for someone who has insurance, and you have to get insurance on your own, this is terrifying,” Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.