If I Were an Insurance Company, I Would NEVER Pay For an Elective C-section

If I were an insurance company, I would not allow women to choose to have a C-section for no medical reason.  It would cost me twice as much money as a vaginal birth.  I would, however, be happy to pay for out-of-hospital births, as it costs me a fraction of the money a hospital birth does.

Oh wait, the only people I actually listen to, as an insurance company, is doctors and hospitals, who have a financial interests in these policies.  This is not about evidence-based care.  It's about putting the doctor on a pedestal and ignoring the midwife.  The doctors are thrilled to allow a woman to selfishly choose to have a C-section because it fits nicely into the doctor's schedule, and, oh yeah, cha-ching, it's twice as much money!  The doctors have done a great job of convincing me, the insurance company, how dangerous, reckless, and incompetent a midwife, especially a CPM or LM, is -- the smear campaign rages on against midwives.  

How can I, as an insurance company, in good judgement, take the advice of people who stand to gain financially by their recommendations?  The majority of doctors are trained to believe that birth is dangerous and needs to be managed.  The only place this can be done is in the hospital. They are convincing the insurance companies that homebirth is unsafe and women who choose to do this are placing their babies lives at risk.  (But let's go ahead and make abortion legal and accepted.)  Birth is safe for mothers and babies, as most midwives know and believe, because they see it and live it, day in and day out.

I have had a number of students who have wanted to have their baby at home or at a free-standing birthing center, only to be told that, no, they may only give birth in the hospital.  They have a choice of several doctors but only one or two midwives.  But if I am an insurance company, and I am in this for money, why am I ignoring a viable option -- homebirth?  Why, from a financial standpoint, am I covering a woman to have surgery to remove her baby because she is too scared to go through labor and give birth vaginally?  (I am not even going to address the moral and physical reasons why this woman is an idiot.)  I am paying thousands of dollars for a procedure that in 100% unnecessary.  The irony is so thick, it makes me sick.  And women who want to spend a fraction of what they would be allowed to spend if in the hospital are denied that option?  Unbelievable.  

When will the insurance companies begin to listen to midwives and to informed consumers who want to birth their babies at home?  We have to speak up to be heard.  Insist on options from your insurance companies.  They have to provide you with options.  I actually had my first homebirth reimbursed by our insurance company because they failed to give me all the information when I insisted that I needed options.  They could not make me give birth at that one hospital.  There was another hospital they were contracted with, but I was not given that information until the baby was 5 weeks old.  After 3 appeals, I had a hearing where we all sat around a big conference table listening to the recording of the phone conversation where I was told that I had no options.  Needless to say, we were fully reimbursed for our entire homebirth. But we didn't know that would happen at  the time we hired our midwife and we still made the choice to pay, out-of-pocket $2500, instead of our $100 co-pay at the hospital.  

I am not a fan of going into debt, but I do believe that sometimes we have to take our healthcare into our own hands and not leave it to the insurance to make all our choices for us. Fight for your right to birth your baby where you see fit.  Maybe, just maybe, we'll be heard. It's more important now than ever, as the AMA is on a campaign to make it impossible for homebirth midwives to practice.   If a woman wants a homebirth, she would have to illegally hire a midwife to attend her birth.  This is wrong.  Women deserve this choice in childbirth. They can legally kill their babies through abortion and choose to have them surgically removed from their bodies, but they can't lovingly and fearlessly birth their babies in their own homes and beds with midwives who believe in the natural process of birth.  

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The Needs of a Laboring Woman Are More Easily Achieved at Home

A woman is labor has specific needs. These include darkness, solitude, quiet, abdominal breathing, physical relaxation, the right to move around in different positions as she needs to, and support and encouragement from those around her. These are not in any particular order.

In "Orgasmic Birth", midwife Ina May Gaskin talked about how birth used to take place in a woman's bed, likely the same place the baby was conceived. When birth moved from the woman's bed to the hospital, everyone pretended that there was no sexual nature to birth. When a woman feels free to make laboring sounds, she sounds like she's having (great) sex. This makes people uncomfortable. The drugs used in childbirth take care of this "problem".

Some women are, what I call, silent birthers. Some are not. It really doesn't matter which category she falls into. What does matter is that women feel free to do whatever they need to during their labor and birth. Often, a woman who is vocal during labor is perceived as not handling labor well. This is not at all true. Deep, abdominal breathing and sounding it out as she exhales, is very beneficial for mom and baby. Baby is getting good oxygen and mom's vocal cords remain open and loose. It's very hard to tense up when she's breathing and sounding out her contractions in a low relaxed voice. I have a friend whose husband had kidney stones a few years ago. He found himself using some of the Bradley techniques they'd learned with the birth of one of their children. He said that he definitely learned that the low, controlled sounds were much more soothing and relaxing than the high-pitched sounds that created tension.

A woman no more wants to be watched in labor than she does when she's having sex. I'll return to a comment from Ina May (gotta love her!) that we have "shy sphincters". It's no wonder women are diagnosed with "failure to progress" so often. A woman really needs to be left alone to labor. It cannot be rushed. Adrenalin is the opposite hormone from what a woman needs to release in labor, which is oxytocin. If an animal is laboring, she will go off by herself, to her home where she feels safe and knows her surroundings well. If she suddenly feels threatened by a predator (in this case the doctor threatening a c-section), adrenalin kicks in and labor will stop. It will only resume once she feels safe again. In a hospital, this opportunity usually does not present itself again, as the baby was most likely surgically removed from its mother's body. Bottom line -- a woman needs to labor where she is comfortable and not rushed or watched.

Bright lights are not conducive to relaxation. Imagine if you dimmed the lights right now in your room. Wouldn't you automatically feel more relaxed and private? Bright hospital lights are often the first thing a new baby sees after its birth -- not very relaxing to the baby either.

A woman in labor is "in labor la-la land" when she doesn't have drugs in her body. She is listening to her body and focusing on controlled breathing, relaxing, imagining the baby coming down and her cervix opening up. When people are talking in the room, it is extremely distracting to most women. The fewer people in the room, often the better. But in the hospital, a woman has little or no control over who is in the room at her birth. At home, she has total control over this and will usually put a lot of thought into exactly who she would like to attend her birth. She is very comfortable with this group of people.

I have written quite a bit about EFM, or Electronic Fetal Monitoring, on this blog, but it must be mentioned here again. A woman must move around in labor. Not just for her labor to progress, but to help her baby out. When the uterus contracts, it tips forward. When a woman is laboring on her back in a hospital bed, it hurts. When you are chained to the bed by the EFM, you cannot move. This is bad for your labor and bad for your baby. This is not good medicine. It is a legal issue. End of story. When a woman labors and births at home, this is not a concern. Her midwife will monitor the baby at least once an hour, which evidence has proven to be adequate. A baby truly in distress will be picked up.

Birth is a natural process. When I say this, everyone agrees. But I think that there are very few people who believe in the natural process of birth and trust it. Women are missing out on this wonderful experience because they are afraid. They are not bonding with their babies as they should. They are not breastfeeding as often or as long as they should. What is wrong with us?

I hope this has been helpful to those who think that it is irresponsible to birth at home. When you understand the needs of a laboring woman, you can start to understand how the hospital is not set up to cater to these needs. If a woman wants to have a truly natural birth, free of interventions, the only place she can do that in America, is in her own home, in her own bed.

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ACOG vs. Homebirth

ACOG (American College of Obstetricians and Gynecologists) released a statement opposing the choice of homebirth for women earlier this year (specifically, after the release of "The Business of Being Born"), saying, "Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby." This is a ridiculous statement on their part. I chose to birth my babies at home because I believed it to be the best and safest place -- with no time constraints, augmentation of labor, or restricted laboring and birthing positions.

ACOG is the one failing, not midwives! The statistics coming out of the majority of American hospitals are disgraceful. We have the worst statistics and spend more per birth than any other country in the world. I am outraged by the suggestion that by birthing at home, I am putting my baby at risk. The statistics are on my side, not on theirs. I am a mother that loves my children -- how dare ACOG accuse me otherwise. I am an educated woman, with a Bachelor of Science -- my husband has a Master's Degree and is a CPA -- we are intelligent people who researched our options and made an educated decision about where to birth our babies.

ACOG is using the fear of childbirth to scare women into keeping birth in the hospital. I am so tired of scare tactics when it comes to childbirth. This is a normal, natural process! How on earth did we ever make it to this point in time? Doctors have been attending birth in a hospital for less than 100 years. Both my parents were born at home.

This is a woman's rights issue. It's not about health care. ACOG is trying to take away our choices. The insurance companies listen intently to what ACOG has to say already. I am always talking with women who want to have a homebirth, but their insurance will not cover it. A homebirth will cost anywhere between $2500-$5000. That is significantly less money, so it just seems absurd that the insurance won't cover a midwife. This is a perfect example of the influence ACOG has in taking away our rights and choices as birthing women. Instead of attacking the midwives and homebirth, ACOG needs to fix their own set of problems. And here's the kicker: Only 1% of women give birth at home. Why do the doctors care so much?

ACOG wants to interfere with the licensing of midwives. Really, OBs are almost in a different profession. That sounds crazy to the average reader, I bet. Doctors are trained to look for something to go wrong. I believe that they want something to go wrong so they can be the hero, save the baby, save the day. They talk about the goal of having a healthy baby, but they are all scheduling inductions and c-sections. Anyone who has done any research at all knows that these are not in the best interests of the baby!

I really take issue with ACOG dismissing women who value the birthing process, as if it doesn't matter. It is okay to want a good birth experience. How dare them make a woman feel bad about that, like she is being a bad mother for desiring that for herself and her baby. Birth matters! It is a doctor's way of dismissing women's valid requests for good health care and respectful, positive births. Recently, a report on NPR stated that the level of empathy a mother has for her child is directly related to whether she had a c-section. So obviously, the birth process does matter. As I've mentioned before, there is a link between postpartum depression and not feeling the birth, whether the birth is a c-section or with an epidural. The birth hormones are not released naturally when the process is tampered with. These hormones play a role in bonding and breastfeeding too.

Our maternal death rate and infant mortality rate in this country are outrageous, so don't tell me that it's about a healthy baby! Mothers and babies are dying in hospitals as often, or more, than at home. This is about pride. They need us to believe that we need them. Don't get me wrong, about 3 % of women actually do need a c-section for various reasons. We need doctors trained in this type of surgery. But when a woman wants a natural, unmedicated birth, she should go to a midwife, not a surgeon.

I can't help but laugh at the timing of ACOG's statement. If you have not seen "The Business of Being Born," you absolutely must. Link to it, watch the fantastic trailer, and just buy it. You'll want to watch it over and over and pass it on to your pregnant friends. If you don't want to fork over the $30, rent it on Netflix. These are the only two ways you can see this movie. If I were a doctor, I wouldn't want my "patients" to see it. I've picked up a number of students who saw this movie, fired their doctors, hired midwives, and have had wonderful, intervention-free birth center births and homebirths. Birth is great, but I believe it's better when you get it out of the hospital.

When we decided, at 33 weeks, to have a homebirth, I had people say to me, "That just seems so dangerous, so irresponsible." I have to tell you, for every single thing that happened -- whether it was the Group B Strep test at 36 weeks, or where to deliver the placenta (it was a water birth), whether to give the baby the eye drops or a Vitamin K shot after the birth -- I had to give the midwife an answer to all these questions. I had to be informed on what these things were. I was in total control. All the responsibility was placed squarely on our shoulders. When you birth in a hospital, it's so easy to just turn all the decision-making over to the doctor or nurses. You just follow along with procedure and protocol.

I absolutely believe that birth, in this day and age, is safer outside of a hospital with a capable midwife attending your birth. We must fight for our rights as birthing women, even if you are finished having children or don't even have children, to stand up to ACOG and demand that this right to birth at home not be taken away. ACOG should not be allowed to be in charge of licensing a midwife to practice. They really don't even know what a midwife does -- if they did, they would learn from them and adopt their practices!

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